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Factors influencing outcome of cardiopulmonary resuscitation in children
Insights
Pediatric cardiopulmonary arrest outcomes show 57% of children were resuscitated. Favorable survival is linked to in-hospital arrest and shorter resuscitation times, with long-term survivors showing no neurological deficits.
Area of Science:
- Pediatric critical care medicine
- Emergency medicine
- Cardiology
Background:
- Cardiopulmonary arrest (CPA) in children presents significant survival and neurological challenges.
- Understanding factors influencing outcomes is crucial for improving pediatric resuscitation efforts.
Purpose of the Study:
- To evaluate outcomes in pediatric patients following CPA and advanced life support.
- To identify factors associated with favorable long-term survival after pediatric CPA.
Main Methods:
- Retrospective evaluation of 47 pediatric patients from the onset of advanced life support until hospital discharge or death.
- Categorization into three groups: long-term survivors, short-term survivors, and nonsurvivors.
- Analysis of clinical factors, including presenting arrhythmia, resuscitation method, duration of cardiopulmonary resuscitation (CPR), and neurological status at discharge.
Main Results:
- Overall resuscitation success rate was 57% (27/47 patients).
- Eighteen patients (38%) were long-term survivors, and nine (19%) were short-term survivors.
- Favorable outcomes were associated with in-hospital arrest, extreme bradycardia, resuscitation with ventilation/oxygen/chest compressions, and CPR duration < 15 minutes.
Conclusions:
- Pediatric CPA survival is achievable, with long-term survivors demonstrating good neurological function.
- Specific factors like in-hospital arrest and brief CPR duration predict better outcomes.
- Patient demographics and initial neurological responses did not correlate with long-term survival.
Abstract:
We evaluated 47 pediatric patients after cardiopulmonary arrest. Patients entered the study with the onset of advanced life support. We followed them until death, or discharge from the hospital, occurred. We identified three groups of patients: long-term survivors, who survived to discharge, short-term survivors, who survived longer than 24 hours after CPR but not until discharge, and nonsurvivors, who died within 24 hours of their arrest. All of the long-term surviving patients were discharged from the hospital without gross neurologic deficit attributable to the arrest or resuscitation effort. Twenty-seven (57%) children were successfully resuscitated. Eighteen (38%) were long term-survivors, while nine (19%) were short-term survivors. Favorable outcome is associated with the following factors: inhospital arrest, extreme bradycardia as the presenting arrhythmia, successful resuscitation with only ventilation, oxygen and closed chest massage, and a duration of CPR of less than 15 minutes. Age, sex, and race, as well as pupillary reaction and motor response at the onset of advanced life support, did not correlate with long-term survival.