Multicenter cohort study of in-hospital pediatric cardiac arrest

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

Research output: Contribution to journalArticle

160 Citations (Scopus)

Abstract

OBJECTIVES: 1) To describe clinical characteristics, hospital courses, and outcomes of a cohort of children cared for within the Pediatric Emergency Care Applied Research Network who experienced in-hospital cardiac arrest with sustained return of circulation between July 1, 2003 and December 31, 2004, and 2) to identify factors associated with hospital mortality in this population. These data are required to prepare a randomized trial of therapeutic hypothermia on neurobehavioral outcomes in children after in-hospital cardiac arrest. DESIGN: Retrospective cohort study. SETTING: Fifteen children's hospitals associated with Pediatric Emergency Care Applied Research Network. PATIENTS: Patients between 1 day and 18 years of age who had cardiopulmonary resuscitation and received chest compressions for >1 min, and had a return of circulation for >20 mins. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 353 patients met entry criteria; 172 (48.7%) survived to hospital discharge. Among survivors, 132 (76.7%) had good neurologic outcome documented by Pediatric Cerebral Performance Category scores. After adjustment for age, gender, and first documented cardiac arrest rhythm, variables available before and during the arrest that were independently associated with increased mortality included pre-existing hematologic, oncologic, or immunologic disorders, genetic or metabolic disorders, presence of an endotracheal tube before the arrest, and use of sodium bicarbonate during the arrest. Variables associated with decreased mortality included postoperative cardiopulmonary resuscitation. Extending the time frame to include variables available before, during, and within 12 hours following arrest, variables independently associated with increased mortality included the use of calcium during the arrest. Variables associated with decreased mortality included higher minimum blood pH and pupillary responsiveness. CONCLUSIONS: Many factors are associated with hospital mortality among children after in-hospital cardiac arrest and return of circulation. Such factors must be considered when designing a trial of therapeutic hypothermia after cardiac arrest in pediatric patients.

Original languageEnglish (US)
JournalPediatric Critical Care Medicine
Volume10
Issue number5
DOIs
StatePublished - Sep 2009

Fingerprint

Pediatric Hospitals
Heart Arrest
Multicenter Studies
Cohort Studies
Pediatrics
Induced Hypothermia
Mortality
Cardiopulmonary Resuscitation
Emergency Medical Services
Hospital Mortality
Inborn Genetic Diseases
Sodium Bicarbonate
Research
Nervous System
Survivors
Thorax
Retrospective Studies
Calcium
Population

Keywords

  • Cardiac arrest
  • Children
  • Cohort study
  • Mortality
  • Outcome
  • Pediatric
  • Return of circulation
  • Therapeutic hypothermia

ASJC Scopus subject areas

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

Cite this

Meert, K. L., Donaldson, A., Nadkarni, V., Tieves, K. S., Schleien, C. L., Brilli, R. J., ... Moler, F. W. (2009). Multicenter cohort study of in-hospital pediatric cardiac arrest. Pediatric Critical Care Medicine, 10(5). https://doi.org/10.1097/PCC.0b013e3181a7045c

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

In: Pediatric Critical Care Medicine, Vol. 10, No. 5, 09.2009.

Research output: Contribution to journalArticle

Meert, KL, Donaldson, A, Nadkarni, V, Tieves, KS, Schleien, CL, Brilli, RJ, Clark, RSB, Shaffner, DH, Levy, F, Statler, K, Dalton, HJ, Van Der Jagt, EW, Hackbarth, R, Pretzlaff, R, Hernan, L, Dean, JM & Moler, FW 2009, 'Multicenter cohort study of in-hospital pediatric cardiac arrest', Pediatric Critical Care Medicine, vol. 10, no. 5. https://doi.org/10.1097/PCC.0b013e3181a7045c
Meert KL, Donaldson A, Nadkarni V, Tieves KS, Schleien CL, Brilli RJ et al. Multicenter cohort study of in-hospital pediatric cardiac arrest. Pediatric Critical Care Medicine. 2009 Sep;10(5). https://doi.org/10.1097/PCC.0b013e3181a7045c
Meert, Kathleen L. ; Donaldson, Amy ; Nadkarni, Vinay ; Tieves, Kelly S. ; Schleien, Charles L. ; Brilli, Richard J. ; Clark, Robert S B ; Shaffner, Donald H. ; Levy, Fiona ; Statler, Kimberly ; Dalton, Heidi J. ; Van Der Jagt, Elise W. ; Hackbarth, Richard ; Pretzlaff, Robert ; Hernan, Lynn ; Dean, J. Michael ; Moler, Frank W. / Multicenter cohort study of in-hospital pediatric cardiac arrest. In: Pediatric Critical Care Medicine. 2009 ; Vol. 10, No. 5.
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AU - Donaldson, Amy

AU - Nadkarni, Vinay

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AU - Schleien, Charles L.

AU - Brilli, Richard J.

AU - Clark, Robert S B

AU - Shaffner, Donald H.

AU - Levy, Fiona

AU - Statler, Kimberly

AU - Dalton, Heidi J.

AU - Van Der Jagt, Elise W.

AU - Hackbarth, Richard

AU - Pretzlaff, Robert

AU - Hernan, Lynn

AU - Dean, J. Michael

AU - Moler, Frank W.

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N2 - OBJECTIVES: 1) To describe clinical characteristics, hospital courses, and outcomes of a cohort of children cared for within the Pediatric Emergency Care Applied Research Network who experienced in-hospital cardiac arrest with sustained return of circulation between July 1, 2003 and December 31, 2004, and 2) to identify factors associated with hospital mortality in this population. These data are required to prepare a randomized trial of therapeutic hypothermia on neurobehavioral outcomes in children after in-hospital cardiac arrest. DESIGN: Retrospective cohort study. SETTING: Fifteen children's hospitals associated with Pediatric Emergency Care Applied Research Network. PATIENTS: Patients between 1 day and 18 years of age who had cardiopulmonary resuscitation and received chest compressions for >1 min, and had a return of circulation for >20 mins. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 353 patients met entry criteria; 172 (48.7%) survived to hospital discharge. Among survivors, 132 (76.7%) had good neurologic outcome documented by Pediatric Cerebral Performance Category scores. After adjustment for age, gender, and first documented cardiac arrest rhythm, variables available before and during the arrest that were independently associated with increased mortality included pre-existing hematologic, oncologic, or immunologic disorders, genetic or metabolic disorders, presence of an endotracheal tube before the arrest, and use of sodium bicarbonate during the arrest. Variables associated with decreased mortality included postoperative cardiopulmonary resuscitation. Extending the time frame to include variables available before, during, and within 12 hours following arrest, variables independently associated with increased mortality included the use of calcium during the arrest. Variables associated with decreased mortality included higher minimum blood pH and pupillary responsiveness. CONCLUSIONS: Many factors are associated with hospital mortality among children after in-hospital cardiac arrest and return of circulation. Such factors must be considered when designing a trial of therapeutic hypothermia after cardiac arrest in pediatric patients.

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KW - Cardiac arrest

KW - Children

KW - Cohort study

KW - Mortality

KW - Outcome

KW - Pediatric

KW - Return of circulation

KW - Therapeutic hypothermia

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