Outcomes of in-hospital pediatric cardiac arrest in the emergency department of a tertiary referral hospital in Tanzania: a retrospective cohort study

Abstract

Abstract Background: Cardiopulmonary resuscitation (CPR) is an emergency procedure performed to bring back the heart function following cardiac arrest. Despite the establishment of emergency department and training on Pediatric Advanced Life Support (PALS) at Muhimbili National Hospital (MNH) the outcomes of in-hospital pediatric cardiac arrest have not been documented. We ought to determine the outcomes and factors associated with survival at 24 hours after in-hospital pediatric cardiac arrests at MNH in Tanzania. Methods: We conducted a retrospective study of all patients aged 1 month to 18 years who had in-hospital cardiac arrests (IHCA) prompting CPR in the Emergency Medicine Department (EMD) at MNH, Tanzania from January 2016 to December 2019. Data was collected from electronic medical record (Wellsoft) system using standardized and pretested data collection form that recorded clinical baseline, pre-arrest, arrest, and post-arrest parameters. Bivariate and multivariable logistic regression analyses were performed to assess the influence of each factor on survival at 24 hours. Results: A total of 11,951 patients requiring resuscitation were screened, and 257 (2.1%) had cardiac arrest at EMD. Among 136 patients enrolled, the median age was 1.5 years (interquartile range: 0.5-3 years) years, and the majority 108 (79.4%) aged ≤ 5 years, and 101 (74.3%) had been referred from peripheral hospitals. Overall stained return of spontaneous circulation was achieved in 70 (51.5%) patients, survival at 24 hours was attained in 43 (31.3%) of patients, and only 7 patients (5.2%) survived to hospital discharge. Factors independently associated with survival at 24 hours were CPR event during the day/evening (p=0.035), duration of CPR ≤ 20 minutes (p=0.017), epinephrine ≤2 doses (p=0.049), reversible causes of cardiac arrest being identified (p=0.001), and having assisted/mechanical ventilation after CPR (p=0.001). Conclusion: In our cohort of children with cardiac arrest, survival to hospital discharge was only 5%. Factors associated with 24-hours survival were CPR event during daytime, short duration of CPR, recognition of reversible causes of cardiac arrest and receiving mechanic ventilation. Future studies should explore detection of decompensation, the quality of CPR, and post cardiac arrest care on the outcomes of IHCA.