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Risk factors and outcomes for recurrent paediatric in-hospital cardiac arrest: Retrospective multicenter cohort study
Maria E Frazier1, Stephanie R Brown2, Amanda O'Halloran3
1Riley Hospital for Children, Indianapolis, IN, USA.
Insights
Pediatric recurrent in-hospital cardiac arrest (IHCA) occurs in 15.5% of cases. Shorter cardiopulmonary resuscitation (CPR) times and more pre-existing conditions increase risk, leading to significantly worse survival outcomes.
Area of Science:
- Pediatric critical care medicine
- Cardiovascular research
- Hospital quality improvement
Background:
- Recurrent in-hospital cardiac arrest (IHCA) in adults is linked to increased morbidity and mortality.
- Understanding risk factors and outcomes for pediatric recurrent IHCA is crucial for improving patient care.
Purpose of the Study:
- To describe the risk factors associated with pediatric recurrent IHCA.
- To evaluate the outcomes of pediatric patients experiencing recurrent IHCA.
Main Methods:
- A retrospective cohort study was conducted on patients 18 years or younger with single or recurrent IHCA.
- Recurrent IHCA was defined as two or more events within the same hospitalization.
- Outcomes were analyzed using unadjusted and propensity-matched analyses.
Main Results:
- 15.5% of patients experienced recurrent IHCA between July 2015 and January 2021.
- Recurrent IHCA patients were more likely to have trauma and less likely to be surgical cardiac patients.
- Patients with recurrent IHCA had significantly shorter cardiopulmonary resuscitation (CPR) durations and worse survival rates to ICU and hospital discharge compared to single IHCA patients.
Conclusions:
- Pre-existing conditions and shorter CPR durations are associated with an increased risk of recurrent IHCA in children.
- Recurrent IHCA is independently associated with significantly worse survival outcomes, even after propensity matching.
Aim Of Study:
Recurrent in-hospital cardiac arrest (IHCA) is associated with morbidity and mortality in adults. We aimed to describe the risk factors and outcomes for paediatric recurrent IHCA.
Methods:
Retrospective cohort study of patients ≤18 years old with single or recurrent IHCA. Recurrent IHCA was defined as ≥2 IHCA within the same hospitalization. Categorical variables expressed as percentages and compared via Chi square test. Continuous variables expressed as medians with interquartile ranges and compared via rank sum test. Outcomes assessed in a propensity match cohort.
Results:
From July 1, 2015 to January 26, 2021, 139/894 (15.5%) patients experienced recurrent IHCA. Compared to patients with a single IHCA, recurrent IHCA patients were more likely to be trauma and less likely to be surgical cardiac patients. Median duration of cardiopulmonary resuscitation (CPR) was shorter in the recurrent IHCA (5 vs. 11 min; p < 0.001) with no difference in IHCA location or immediate cause of CPR. Patients with recurrent IHCA had worse survival to intensive care unit (ICU) discharge (31% vs. 52%; p < 0.001), and worse survival to hospital discharge (30% vs. 48%; p < 0.001) in unadjusted analyses and after propensity matching, patients with recurrent IHCA still had worse survival to ICU (34% vs. 67%; p < 0.001) and hospital (31% vs. 64%; p < 0.001) discharge.
Conclusion:
When examining those with a single vs. a recurrent IHCA, event and patient factors including more pre-existing conditions and shorter duration of CPR were associated with risk for recurrent IHCA. Recurrent IHCA is associated with worse survival outcomes following propensity matching.
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