In-hospital versus out-of-hospital pediatric cardiac arrest: A multicenter cohort study

Frank W. Moler, Kathleen Meert, Amy E. Donaldson, Vinay Nadkarni, Richard J. Brilli, Heidi J. Dalton, Robert S B Clark, Donald H. Shaffner, Charles L. Schleien, Kimberly Statler, Kelly S. Tieves, Richard Hackbarth, Robert Pretzlaff, Elise W. Van Der Jagt, Fiona Levy, Lynn Hernan, Faye S. Silverstein, J. Michael Dean

Research output: Contribution to journalArticle

129 Citations (Scopus)

Abstract

Objectives: To describe a large multicenter cohort of pediatric cardiac arrest (CA) with return of circulation (ROC) from either the in-hospital (IH) or the out-of-hospital (OH) setting and to determine whether significant differences related to pre-event, arrest event, early postarrest event characteristics, and outcomes exist that would be critical in planning a clinical trial of therapeutic hypothermia (TH). Design: Retrospective cohort study. Setting: Fifteen Pediatric Emergency Care Applied Research Network sites. Patients: Patients aged 24 hours to 18 years with either IH or OH CA who had a history of at least 1 minute of chest compressions and ROC for at least 20 minutes were eligible. Interventions: None. Measurements and Main Results: A total of 491 patients met study entry criteria with 353 IH cases and 138 OH cases. Major differences between the IH and OH cohorts were observed for patient prearrest characteristics, arrest event initial rhythm described, and arrest medication use. Several postarrest interventions were used differently, however, the use of TH was similar (<5%) in both cohorts. During the 0-12-hour interval following ROC, OH cases had lower minimum temperature and pH, and higher maximum serum glucose recorded. Mortality was greater in the OH cohort (62% vs. 51%, p = 0.04) with the cause attributed to a neurologic indication much more frequent in the OH than in the IH cohort (69% vs. 20%; p < 0.01). Conclusions: For pediatric CA with ROC, several major differences exist between IH and OH cohorts. The finding that the etiology of death was attributed to neurologic indications much more frequently in OH arrests has important implications for future research. Investigators planning to evaluate the efficacy of new interventions, such as TH, should be aware that the IH and OH populations differ greatly and require independent clinical trials.

Original languageEnglish (US)
Pages (from-to)2259-2267
Number of pages9
JournalCritical Care Medicine
Volume37
Issue number7
DOIs
StatePublished - Jul 2009

Fingerprint

Out-of-Hospital Cardiac Arrest
Multicenter Studies
Cohort Studies
Induced Hypothermia
Pediatrics
Heart Arrest
Nervous System
Clinical Trials
Emergency Medical Services

Keywords

  • Cardiac Arrest
  • Children
  • Cohort study
  • In hospital
  • Mortality
  • Out of hospital
  • Outcome
  • Pediatric
  • Randomized controlled trial
  • Return of spontaneous circulation
  • Therapeutic hypothermia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Moler, F. W., Meert, K., Donaldson, A. E., Nadkarni, V., Brilli, R. J., Dalton, H. J., ... Dean, J. M. (2009). In-hospital versus out-of-hospital pediatric cardiac arrest: A multicenter cohort study. Critical Care Medicine, 37(7), 2259-2267. https://doi.org/10.1097/CCM.0b013e3181a00a6a

In-hospital versus out-of-hospital pediatric cardiac arrest : A multicenter cohort study. / Moler, Frank W.; Meert, Kathleen; Donaldson, Amy E.; Nadkarni, Vinay; Brilli, Richard J.; Dalton, Heidi J.; Clark, Robert S B; Shaffner, Donald H.; Schleien, Charles L.; Statler, Kimberly; Tieves, Kelly S.; Hackbarth, Richard; Pretzlaff, Robert; Van Der Jagt, Elise W.; Levy, Fiona; Hernan, Lynn; Silverstein, Faye S.; Dean, J. Michael.

In: Critical Care Medicine, Vol. 37, No. 7, 07.2009, p. 2259-2267.

Research output: Contribution to journalArticle

Moler, FW, Meert, K, Donaldson, AE, Nadkarni, V, Brilli, RJ, Dalton, HJ, Clark, RSB, Shaffner, DH, Schleien, CL, Statler, K, Tieves, KS, Hackbarth, R, Pretzlaff, R, Van Der Jagt, EW, Levy, F, Hernan, L, Silverstein, FS & Dean, JM 2009, 'In-hospital versus out-of-hospital pediatric cardiac arrest: A multicenter cohort study', Critical Care Medicine, vol. 37, no. 7, pp. 2259-2267. https://doi.org/10.1097/CCM.0b013e3181a00a6a
Moler FW, Meert K, Donaldson AE, Nadkarni V, Brilli RJ, Dalton HJ et al. In-hospital versus out-of-hospital pediatric cardiac arrest: A multicenter cohort study. Critical Care Medicine. 2009 Jul;37(7):2259-2267. https://doi.org/10.1097/CCM.0b013e3181a00a6a
Moler, Frank W. ; Meert, Kathleen ; Donaldson, Amy E. ; Nadkarni, Vinay ; Brilli, Richard J. ; Dalton, Heidi J. ; Clark, Robert S B ; Shaffner, Donald H. ; Schleien, Charles L. ; Statler, Kimberly ; Tieves, Kelly S. ; Hackbarth, Richard ; Pretzlaff, Robert ; Van Der Jagt, Elise W. ; Levy, Fiona ; Hernan, Lynn ; Silverstein, Faye S. ; Dean, J. Michael. / In-hospital versus out-of-hospital pediatric cardiac arrest : A multicenter cohort study. In: Critical Care Medicine. 2009 ; Vol. 37, No. 7. pp. 2259-2267.
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AU - Moler, Frank W.

AU - Meert, Kathleen

AU - Donaldson, Amy E.

AU - Nadkarni, Vinay

AU - Brilli, Richard J.

AU - Dalton, Heidi J.

AU - Clark, Robert S B

AU - Shaffner, Donald H.

AU - Schleien, Charles L.

AU - Statler, Kimberly

AU - Tieves, Kelly S.

AU - Hackbarth, Richard

AU - Pretzlaff, Robert

AU - Van Der Jagt, Elise W.

AU - Levy, Fiona

AU - Hernan, Lynn

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