Factors associated with mortality in pediatric in-hospital cardiac arrest: a prospective multicenter multinational observational study

Purpose To analyze prognostic factors associated with in-hospital cardiac arrest (CA) in children. Methods A prospective, multicenter, multinational, observational study was performed on pediatric in-hospital CA in 12 countries and included 502 children between 1 month and 18 years. The primary endp...

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Bibliographic Details
Published in:Intensive care medicine 2013-02, Vol.39 (2), p.309-318
Main Authors: López-Herce, Jesús, del Castillo, Jimena, Matamoros, Martha, Cañadas, Sonia, Rodriguez-Calvo, Ana, Cecchetti, Corrado, Rodriguez-Núñez, Antonio, Álvarez, Angel Carrillo
Format: Article
Language:English
Subjects:
Adolescent
Analysis
Anesthesiology
Cardiac arrest
Child
Child, Preschool
Children
Critical Care Medicine
Drugs
Emergency Medicine
Female
Health aspects
Heart Arrest - mortality
Hospital Mortality
Hospitals
Humans
Infant
Intensive
Intensive care units
Male
Medicine
Medicine & Public Health
Mortality
Nervous system diseases
Original
Pain Medicine
Pediatrics
Pneumology/Respiratory System
Prognosis
Prospective Studies
Risk Factors
Spain
Survival
Survival Rate
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Summary:Purpose To analyze prognostic factors associated with in-hospital cardiac arrest (CA) in children. Methods A prospective, multicenter, multinational, observational study was performed on pediatric in-hospital CA in 12 countries and included 502 children between 1 month and 18 years. The primary endpoint was survival at hospital discharge. Univariate and multivariate logistic regression analyses were performed to assess the influence of each factor on mortality. Results Return of spontaneous circulation was achieved in 69.5 % of patients; 39.2 % survived to hospital discharge and 88.9 % of survivors had good neurological outcome. The pre-arrest factors related to mortality were lower Human Development Index [odds ratio (OR) 2.32, 95 % confidence interval (CI) 1.28–4.21], oncohematologic disease (OR 3.33, 95 % CI 1.60–6.98), and treatment with inotropic drugs at the time of CA (OR 2.35, 95 % CI 1.55–3.56). CA and resuscitation factors related to mortality were CA due to neurological disease (OR 5.19, 95 % CI 1.49–18.73) and duration of cardiopulmonary resuscitation greater than 10 min (OR 4.00, 95 % CI 1.49–18.73). Factors related to survival were CA occurring in the pediatric intensive care unit (PICU) (OR 0.38, 95 % CI 0.16–0.86) and shockable rhythm (OR 0.26, 95 % CI 0.09–0.73). Conclusions In-hospital CA in children has a low survival but most of the survivors have a good neurological outcome. Some prognostic risk factors cannot be modified, making it important to focus efforts on improving hospital organization to care for children at risk of CA in the PICU and, in particular, in other hospital areas.
ISSN:0342-4642
1432-1238
DOI:10.1007/s00134-012-2709-7