Survival With Favorable Neurologic Outcome and Quality of Cardiopulmonary Resuscitation Following In-Hospital Cardiac Arrest in Children With Cardiac Disease Compared With Noncardiac Disease*

Author:

Federman Myke1,Sutton Robert M.2,Reeder Ron W.3,Ahmed Tageldin4,Bell Michael J.5,Berg Robert A.2,Bishop Robert67,Bochkoris Matthew8,Burns Candice9,Carcillo Joseph A.8,Carpenter Todd C.67,Dean J. Michael3,Diddle J. Wesley5,Fernandez Richard10,Fink Ericka L.8,Franzon Deborah11,Frazier Aisha H.1213,Friess Stuart H.14,Graham Kathryn2,Hall Mark10,Hehir David A.2,Horvat Christopher M.8,Huard Leanna L.1,Kirkpatrick Theresa1,Maa Tensing10,Maitoza Laura A.1,Manga Arushi14,McQuillen Patrick S.11,Meert Kathleen L.4,Morgan Ryan W.2,Mourani Peter M.14,Nadkarni Vinay M.2,Notterman Daniel15,Palmer Chella A.3,Pollack Murray M.5,Sapru Anil1,Schneiter Carleen67,Sharron Matthew P.5,Srivastava Neeraj1,Tilford Bradley4,Viteri Shirley16,Wessel David5,Wolfe Heather A.2,Yates Andrew R.10,Zuppa Athena F.2,Naim Maryam Y.2

Affiliation:

1. Department of Pediatrics, Mattel Children’s Hospital, University of California Los Angeles, Los Angeles, CA.

2. Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA.

3. Department of Pediatrics, University of Utah, Salt Lake City, UT.

4. Department of Pediatrics, Children’s Hospital of Michigan, Central Michigan University, Detroit, MI.

5. Department of Pediatrics, Children’s National Hospital, George Washington University School of Medicine, Washington, DC.

6. Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.

7. Department of Pediatrics, Children’s Hospital Colorado, Aurora, CO.

8. Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA.

9. Department of Pediatrics and Human Development, Michigan State University, Grand Rapids, MI.

10. Department of Pediatrics, Nationwide Children’s Hospital, The Ohio State University, Columbus, OH.

11. Department of Pediatrics, Benioff Children’s s, University of California, San Francisco, San Francisco, CA.

12. Nemours Cardiac Center, Nemours Children’s Hospital, Delaware, Wilmington, DE.

13. Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA.

14. Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.

15. Department of Molecular Biology, Princeton University, Princeton, NJ.

16. Department of Pediatrics, Nemours Children’s Hospital, Delaware and Thomas Jefferson University, Wilmington, DE.

Abstract

OBJECTIVES: To assess associations between outcome and cardiopulmonary resuscitation (CPR) quality for in-hospital cardiac arrest (IHCA) in children with medical cardiac, surgical cardiac, or noncardiac disease. DESIGN: Secondary analysis of a multicenter cluster randomized trial, the ICU-RESUScitation Project (NCT02837497, 2016–2021). SETTING: Eighteen PICUs. PATIENTS: Children less than or equal to 18 years old and greater than or equal to 37 weeks postconceptual age receiving chest compressions (CC) of any duration during the study. INTERVENTIONS: None MEASUREMENTS AND MAIN RESULTS: Of 1,100 children with IHCA, there were 273 medical cardiac (25%), 383 surgical cardiac (35%), and 444 noncardiac (40%) cases. Favorable neurologic outcome was defined as no more than moderate disability or no worsening from baseline Pediatric Cerebral Performance Category at discharge. The medical cardiac group had lower odds of survival with favorable neurologic outcomes compared with the noncardiac group (48% vs 55%; adjusted odds ratio [aOR] [95% CI], aOR 0.59 [95% CI, 0.39–0.87], p = 0.008) and surgical cardiac group (48% vs 58%; aOR 0.64 [95% CI, 0.45–0.9], p = 0.01). We failed to identify a difference in favorable outcomes between surgical cardiac and noncardiac groups. We also failed to identify differences in CC rate, CC fraction, ventilation rate, intra-arrest average target diastolic or systolic blood pressure between medical cardiac versus noncardiac, and surgical cardiac versus noncardiac groups. The surgical cardiac group had lower odds of achieving target CC depth compared to the noncardiac group (OR 0.15 [95% CI, 0.02–0.52], p = 0.001). We failed to identify a difference in the percentage of patients achieving target CC depth when comparing medical cardiac versus noncardiac groups. CONCLUSIONS: In pediatric IHCA, medical cardiac patients had lower odds of survival with favorable neurologic outcomes compared with noncardiac and surgical cardiac patients. We failed to find differences in CPR quality between medical cardiac and noncardiac patients, but there were lower odds of achieving target CC depth in surgical cardiac compared to noncardiac patients.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Critical Care and Intensive Care Medicine,Pediatrics, Perinatology and Child Health

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