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Long-term functional outcome of inpatient pediatric cardiopulmonary resuscitation
A Torres1, C B Pickert, J Firestone
1Department of Pediatrics, Arkansas Children's Hospital-University of Arkansas for Medical Sciences, Little Rock, USA.
Insights
Survival rates for pediatric inpatient cardiopulmonary resuscitation (CPR) are low. Most survivors of advanced CPR maintained their pre-arrest functional status, but those with sepsis or prolonged CPR had extremely poor outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Resuscitation Science
- Pediatric Cardiology
Background:
- Limited data exists on the long-term outcomes for pediatric patients who survive inpatient cardiopulmonary resuscitation (CPR).
- Understanding functional status post-CPR is crucial for patient management and family counseling.
Purpose of the Study:
- To document the long-term functional outcome (>= 1 year) of pediatric survivors of inpatient CPR.
- To identify factors influencing survival and functional status after pediatric CPR.
Main Methods:
- Retrospective review of medical records for children (<18 years) undergoing advanced CPR in a tertiary children's hospital.
- Prospective telephone follow-up conducted at least one year post-arrest.
- Assessment of functional status using the Pediatric Cerebral Performance Category (PCPC) scale.
Main Results:
- Overall survival to one year was 10% (9/92).
- No patients with sepsis syndrome (0/44) or prolonged CPR (>30 min) (0/24) survived one year.
- Among survivors, 5/9 had moderate to severe disabilities, but 8/9 showed little to no change in PCPC score compared to pre-arrest baseline.
Conclusions:
- Survival following inpatient pediatric CPR is low.
- Pediatric patients surviving advanced CPR often maintain their pre-arrest functional level.
- Survival is extremely poor for children with sepsis requiring CPR or those receiving prolonged CPR (>30 min).
Objective:
There is limited information published regarding the long-term outcome of pediatric survivors of inpatient cardiopulmonary resuscitation (CPR). The purpose of this study was to document the long-term (i.e., > or = 1 year after the arrest) functional outcome of children surviving inpatient CPR.
Methods:
We reviewed the medical records of children (i.e., less than 18 years of age) receiving advanced CPR (i.e., chest compressions, assisted ventilation, and resuscitation medications) as inpatients in a tertiary care children's hospital. Prospective telephone follow-up of the survivors a minimum of one year after the arrest was performed. A change in the survivors' Pediatric Cerebral Performance Category (PCPC) scale was determined.
Results:
Approximately half of the 92 subjects were diagnosed with sepsis syndrome. None (0/44) of the patients with sepsis syndrome survived at one year. None (0/24) of the patients who experienced a single episode of advanced CPR > or = 30 min in duration survived one year. Although 36% (33/92) of the patients resuscitated were alive 24 h after their arrest, the proportion surviving fell steadily to 10% (9/92) at one year. Although five of the nine survivors were moderately to severely disabled at one year, the majority (8/9) had little or no change in their PCPC score at one year compared to their prearrest level of function.
Conclusion:
Survival of inpatient pediatric CPR is small. Children surviving inpatient advanced CPR may have little or no change from prearrest function. The survival of hospitalized children with sepsis syndrome requiring CPR or receiving greater than > 30 min of advanced CPR is extremely low.