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CPR in children
A Zaritsky1, V Nadkarni, P Getson
1Department of Anesthesiology, Children's Hospital National Medical Center, Washington, DC.
Insights
Pediatric cardiac arrest (CA) has a high mortality rate, with no specific lab or demographic factors predicting outcomes. However, the number of epinephrine doses in CA and bicarbonate in respiratory arrest (RA) correlated with survival in children.
Area of Science:
- Pediatric critical care medicine
- Cardiopulmonary resuscitation (CPR) outcomes
- Pediatric emergency medicine
Background:
- Limited research exists on pediatric cardiopulmonary resuscitation (CPR).
- Factors predicting survival in pediatric arrest are not well understood.
- Prevalence of ionized hypocalcemia in pediatric arrest requires further study.
Purpose of the Study:
- To longitudinally determine demographic and laboratory data of pediatric arrest victims.
- To identify factors predictive of outcome in pediatric arrest.
- To determine the prevalence of ionized hypocalcemia in pediatric arrest victims.
Main Methods:
- A one-year observational study in a tertiary care children's hospital.
- Patients classified into respiratory arrest (RA) and cardiac arrest (CA) groups.
- Step-wise discriminant analysis used to identify predictive factors for outcome.
Main Results:
- 113 arrests in 93 children; 53 CA (90.6% mortality) and 40 RA (32.5% mortality).
- No demographic or laboratory values significantly predicted outcome.
- Epinephrine doses in CA and bicarbonate in RA correlated with outcome; no CA patients receiving >2 epinephrine doses survived.
Conclusions:
- Pediatric cardiac arrest carries a high mortality rate.
- The number of resuscitation medication doses may be associated with outcomes.
- Low ionized calcium was observed in 10 patients, often with septic shock or renal failure.
Abstract:
CPR has not been well studied in children and little is known about factors predictive of outcome. We conducted a study with three goals: longitudinal determination of demographic and laboratory data characterizing pediatric arrest victims; identification of factor(s) predictive of outcome; and determination of the prevalence of ionized hypocalcemia in pediatric arrest victims. All resuscitation efforts were documented during a one-year period in a 240-bed tertiary care children's hospital. Patients were classified into two groups--respiratory arrest (RA, requiring only assisted ventilation), and cardiac arrest (CA, absence of palpable cardiac activity requiring closed-chest CPR). Collected data and laboratory tests were analyzed using a step-wise discriminant analysis to determine which factors were predictive of outcome. There were 113 arrests in 93 children; 53 were CA victims and 40 were RA victims. CA had a high in-hospital mortality (90.6%) compared to RA (32.5%). The population was young (55% less than 1 year old) and 87% had at least one chronic underlying disease. No laboratory or demographic value was significantly associated with eventual outcome. The number of doses of epinephrine in CA victims, or bicarbonate in RA victims, was associated with eventual outcome. None of 31 CA victims receiving more than two doses of epinephrine survived to discharge. Low ionized calcium concentrations (less than 3.5 mg/dL) were identified in ten patients; septic shock was present in seven, and chronic renal failure in two.(ABSTRACT TRUNCATED AT 250 WORDS)