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Outcomes of Pediatric In-Hospital Cardiac Arrests
Quick Takes
- The odds of survival to discharge were lower for patients at hospitals with the shortest and longest median CPR durations among events without return of spontaneous circulation.
- On multivariable analysis, Black or Asian children did not receive a different CPR duration compared with White children. However, in the hospital-level analysis, race was associated with hospital median CPR duration.
- Patient sex was not associated with CPR duration.
Study Questions:
Does hospital median cardiopulmonary resuscitation (CPR) duration in patients without return of circulation (ROC) predict survival among hospitalized children?
Methods:
A retrospective cohort study was performed for patients undergoing pediatric in-hospital CPR between January 1, 2000 and December 31, 2021, using data from the Get With the Guidelines–Resuscitation registry. Patient-level analysis was used to describe characteristics associated with CPR duration. Children receiving chest compressions for ≥2 minutes and/or defibrillation were included in the patient-level analysis. Outcomes included patient and event factors including race and ethnicity and event location. Hospital-level analysis was used to determine whether hospital median CPR duration in patients without ROC is associated with survival. The main outcome for the hospital-level analysis was survival to discharge.
Results:
Of 13,899 CPR events, 3,859 patients did not have ROC (median age, 7 months [interquartile range, 0 months to 7 years]; 56% males. Shorter median CPR duration was associated with neonates compared with older children and members of racial or ethnic minority groups compared with White patients. Among all CPR events, the adjusted odds of survival to discharge differed based on hospital quartile of median CPR duration among events without ROC; compared with quartile 1 (15-25.9 minutes), the adjusted odds ratio for quartile 2 (26-29.4 minutes) was 1.22 (95% confidence interval [CI], 1.09-1.36; p < 0.01); for quartile 3 (29.5-32.9 minutes) was 1.23 (95% CI, 1.08-1.39; p = 0.002); and for quartile 4 (33-53 minutes) was 1.04 (95% CI, 0.91-1.19; p = 0.58).
Conclusions:
The authors conclude that the odds of survival are lower for patients at hospitals with the shortest and longest median CPR durations among events without ROC. Further studies are needed to determine the optimal duration of CPR and to provide training guidelines for resuscitation teams to eliminate disparities in resuscitation care.
Perspective:
In adult studies of in-hospital cardiac arrest, CPR duration in events without return of spontaneous circulation is used as a proxy for resuscitation intensity, with longer CPR duration associated with survival. This study assessed CPR outcomes in children. This is a complex issue, with many patient and hospital factors contributing to outcomes. An important contributor is likely a center’s approach to mechanical circulatory support, with centers with a high utilization of mechanical support likely having longer resuscitation time. This study showed lower survival in centers with the shortest resuscitation duration, suggesting that some patients may benefit from longer resuscitation efforts. On the other hand, centers with longer resuscitation efforts also trended towards lower survival. The authors postulate that these centers may have been more likely to perform prolonged resuscitation in moribund patients unlikely to survive. The study did show that in the hospital-level analysis, race was associated with hospital median CPR duration. Further investigation is required to understand hospital resuscitation practices and patient racial composition.
Clinical Topics: Arrhythmias and Clinical EP, Implantable Devices, SCD/Ventricular Arrhythmias
Keywords: Cardiopulmonary Resuscitation, Heart Arrest, Pediatrics
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