(1) Describe the clinical characteristics, hospital courses and outcomes of a cohort of children cared for within the Pediatric Emergency Care Applied Research Network (PECARN) who experienced in-hospital cardiac arrest with sustained return of circulation between July 1, 2003 and December 31, 2004, and (2) identify factors associated with hospital mortality in this population. These data are required to prepare a randomized trial of therapeutic hypothermia on neurobehavioral outcomes in children after in-hospital cardiac arrest.
Retrospective cohort study.
Fifteen children’s hospitals associated with PECARN.
Patients between one day and 18 years of age who had cardiopulmonary resuscitation (CPR) and received chest compressions for >1 minute, and had a return of circulation for >20 minutes.
Measurements and Main Results
A total of 353 patients met entry criteria; 172 (48.7%) survived to hospital discharge. Among survivors, 132 (76.7%) had good neurological outcome documented by Pediatric Cerebral Performance Category scores. After adjustment for age, gender and first documented cardiac arrest rhythm, variables available prior to and during the arrest that were independently associated with increased mortality included pre-existing hematologic, oncologic, or immunologic disorders, genetic or metabolic disorders, presence of an endotracheal tube prior to the arrest, and the use of sodium bicarbonate during the arrest. Variables associated with decreased mortality included post-operative CPR. Extending the time frame to include variables available prior to, during, and within 12 hours following arrest, variables independently associated with increased mortality included the use of calcium during the arrest. Variables associated with decreased mortality included higher minimum blood pH and pupillary responsiveness.
Many factors are associated with hospital mortality among children after in-hospital cardiac arrest and return of circulation. Such factors must be considered when designing a trial of therapeutic hypothermia after cardiac arrest in pediatric patients.
Keywords: cardiac arrest, return of circulation, children, pediatric, cohort study, mortality, outcome, therapeutic hypothermia