Multicenter cohort study of out-of-hospital pediatric cardiac arrest

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

Research output: Contribution to journalArticle

128 Citations (Scopus)

Abstract

Objectives: To describe a large cohort of children with out-of-hospital cardiac arrest with return of circulation and to identify factors in the early postarrest period associated with survival. These objectives were for planning an interventional trial of therapeutic hypothermia after pediatric cardiac arrest. Methods: A retrospective cohort study was conducted at 15 Pediatric Emergency Care Applied Research Network clinical sites over an 18-month study period. All children from 1 day (24 hrs) to 18 yrs of age with out-of-hospital cardiac arrest and a history of at least 1 min of chest compressions with return of circulation for at least 20 mins were eligible. Measurements and main results: One hundred thirty-eight cases met study entry criteria; the overall mortality was 62% (85 of 138 cases). The event characteristics associated with increased survival were as follows: weekend arrests, cardiopulmonary resuscitation not ongoing at hospital arrival, arrest rhythm not asystole, no atropine or NaHCO3, fewer epinephrine doses, shorter duration of cardiopulmonary resuscitation, and drowning or asphyxial arrest event. For the 0- to 12-hr postarrest return-of-circulation period, absence of any vasopressor or inotropic agent (dopamine, epinephrine) use, higher lowest temperature recorded, greater lowest pH, lower lactate, lower maximum glucose, and normal pupillary responses were all associated with survival. A multivariate logistic model of variables available at the time of arrest, which controlled for gender, age, race, and asystole or ventricular fibrillation/ventricular tachycardia anytime during the arrest, found the administration of atropine and epinephrine to be associated with mortality. A second model using additional information available up to 12 hrs after return of circulation found 1) preexisting lung or airway disease; 2) an etiology of arrest drowning or asphyxia; 3) higher pH, and 4) bilateral reactive pupils to be associated with lower mortality. Receiving more than three doses of epinephrine was associated with poor outcome in 96% (44 of 46) of cases. Conclusions: Multiple factors were identified as associated with survival after out-of-hospital pediatric cardiac arrest with the return of circulation. Additional information available within a few hours after the return of circulation may diminish outcome associations of factors available at earlier times in regression models. These factors should be considered in the design of future interventional trials aimed to improve outcome after pediatric cardiac arrest.

Original languageEnglish (US)
Pages (from-to)141-149
Number of pages9
JournalCritical Care Medicine
Volume39
Issue number1
DOIs
StatePublished - Jan 2011
Externally publishedYes

Fingerprint

Out-of-Hospital Cardiac Arrest
Heart Arrest
Epinephrine
Multicenter Studies
Cohort Studies
Cardiopulmonary Resuscitation
Pediatrics
Atropine
Mortality
Induced Hypothermia
Dopamine Agents
Asphyxia
Emergency Medical Services
Ventricular Fibrillation
Ventricular Tachycardia
Pupil
Lactic Acid
Thorax
Retrospective Studies
Logistic Models

Keywords

  • cardiac arrest
  • children
  • cohort study
  • mortality
  • out of hospital
  • outcome
  • pediatric
  • randomized controlled trial
  • return of circulation
  • therapeutic hypothermia

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Moler, F. W., Donaldson, A. E., Meert, K., Brilli, R. J., Nadkarni, V., Shaffner, D. H., ... Dean, J. M. (2011). Multicenter cohort study of out-of-hospital pediatric cardiac arrest. Critical Care Medicine, 39(1), 141-149. https://doi.org/10.1097/CCM.0b013e3181fa3c17

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

In: Critical Care Medicine, Vol. 39, No. 1, 01.2011, p. 141-149.

Research output: Contribution to journalArticle

Moler, FW, Donaldson, AE, Meert, K, Brilli, RJ, Nadkarni, V, Shaffner, DH, Schleien, CL, Clark, RSB, Dalton, HJ, Statler, K, Tieves, KS, Hackbarth, R, Pretzlaff, R, Van Der Jagt, EW, Pineda, J, Hernan, L & Dean, JM 2011, 'Multicenter cohort study of out-of-hospital pediatric cardiac arrest', Critical Care Medicine, vol. 39, no. 1, pp. 141-149. https://doi.org/10.1097/CCM.0b013e3181fa3c17
Moler FW, Donaldson AE, Meert K, Brilli RJ, Nadkarni V, Shaffner DH et al. Multicenter cohort study of out-of-hospital pediatric cardiac arrest. Critical Care Medicine. 2011 Jan;39(1):141-149. https://doi.org/10.1097/CCM.0b013e3181fa3c17
Moler, Frank W. ; Donaldson, Amy E. ; Meert, Kathleen ; Brilli, Richard J. ; Nadkarni, Vinay ; Shaffner, Donald H. ; Schleien, Charles L. ; Clark, Robert S B ; Dalton, Heidi J. ; Statler, Kimberly ; Tieves, Kelly S. ; Hackbarth, Richard ; Pretzlaff, Robert ; Van Der Jagt, Elise W. ; Pineda, Jose ; Hernan, Lynn ; Dean, J. Michael. / Multicenter cohort study of out-of-hospital pediatric cardiac arrest. In: Critical Care Medicine. 2011 ; Vol. 39, No. 1. pp. 141-149.
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AU - Moler, Frank W.

AU - Donaldson, Amy E.

AU - Meert, Kathleen

AU - Brilli, Richard J.

AU - Nadkarni, Vinay

AU - Shaffner, Donald H.

AU - Schleien, Charles L.

AU - Clark, Robert S B

AU - Dalton, Heidi J.

AU - Statler, Kimberly

AU - Tieves, Kelly S.

AU - Hackbarth, Richard

AU - Pretzlaff, Robert

AU - Van Der Jagt, Elise W.

AU - Pineda, Jose

AU - Hernan, Lynn

AU - Dean, J. Michael

PY - 2011/1

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N2 - Objectives: To describe a large cohort of children with out-of-hospital cardiac arrest with return of circulation and to identify factors in the early postarrest period associated with survival. These objectives were for planning an interventional trial of therapeutic hypothermia after pediatric cardiac arrest. Methods: A retrospective cohort study was conducted at 15 Pediatric Emergency Care Applied Research Network clinical sites over an 18-month study period. All children from 1 day (24 hrs) to 18 yrs of age with out-of-hospital cardiac arrest and a history of at least 1 min of chest compressions with return of circulation for at least 20 mins were eligible. Measurements and main results: One hundred thirty-eight cases met study entry criteria; the overall mortality was 62% (85 of 138 cases). The event characteristics associated with increased survival were as follows: weekend arrests, cardiopulmonary resuscitation not ongoing at hospital arrival, arrest rhythm not asystole, no atropine or NaHCO3, fewer epinephrine doses, shorter duration of cardiopulmonary resuscitation, and drowning or asphyxial arrest event. For the 0- to 12-hr postarrest return-of-circulation period, absence of any vasopressor or inotropic agent (dopamine, epinephrine) use, higher lowest temperature recorded, greater lowest pH, lower lactate, lower maximum glucose, and normal pupillary responses were all associated with survival. A multivariate logistic model of variables available at the time of arrest, which controlled for gender, age, race, and asystole or ventricular fibrillation/ventricular tachycardia anytime during the arrest, found the administration of atropine and epinephrine to be associated with mortality. A second model using additional information available up to 12 hrs after return of circulation found 1) preexisting lung or airway disease; 2) an etiology of arrest drowning or asphyxia; 3) higher pH, and 4) bilateral reactive pupils to be associated with lower mortality. Receiving more than three doses of epinephrine was associated with poor outcome in 96% (44 of 46) of cases. Conclusions: Multiple factors were identified as associated with survival after out-of-hospital pediatric cardiac arrest with the return of circulation. Additional information available within a few hours after the return of circulation may diminish outcome associations of factors available at earlier times in regression models. These factors should be considered in the design of future interventional trials aimed to improve outcome after pediatric cardiac arrest.

AB - Objectives: To describe a large cohort of children with out-of-hospital cardiac arrest with return of circulation and to identify factors in the early postarrest period associated with survival. These objectives were for planning an interventional trial of therapeutic hypothermia after pediatric cardiac arrest. Methods: A retrospective cohort study was conducted at 15 Pediatric Emergency Care Applied Research Network clinical sites over an 18-month study period. All children from 1 day (24 hrs) to 18 yrs of age with out-of-hospital cardiac arrest and a history of at least 1 min of chest compressions with return of circulation for at least 20 mins were eligible. Measurements and main results: One hundred thirty-eight cases met study entry criteria; the overall mortality was 62% (85 of 138 cases). The event characteristics associated with increased survival were as follows: weekend arrests, cardiopulmonary resuscitation not ongoing at hospital arrival, arrest rhythm not asystole, no atropine or NaHCO3, fewer epinephrine doses, shorter duration of cardiopulmonary resuscitation, and drowning or asphyxial arrest event. For the 0- to 12-hr postarrest return-of-circulation period, absence of any vasopressor or inotropic agent (dopamine, epinephrine) use, higher lowest temperature recorded, greater lowest pH, lower lactate, lower maximum glucose, and normal pupillary responses were all associated with survival. A multivariate logistic model of variables available at the time of arrest, which controlled for gender, age, race, and asystole or ventricular fibrillation/ventricular tachycardia anytime during the arrest, found the administration of atropine and epinephrine to be associated with mortality. A second model using additional information available up to 12 hrs after return of circulation found 1) preexisting lung or airway disease; 2) an etiology of arrest drowning or asphyxia; 3) higher pH, and 4) bilateral reactive pupils to be associated with lower mortality. Receiving more than three doses of epinephrine was associated with poor outcome in 96% (44 of 46) of cases. Conclusions: Multiple factors were identified as associated with survival after out-of-hospital pediatric cardiac arrest with the return of circulation. Additional information available within a few hours after the return of circulation may diminish outcome associations of factors available at earlier times in regression models. These factors should be considered in the design of future interventional trials aimed to improve outcome after pediatric cardiac arrest.

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KW - children

KW - cohort study

KW - mortality

KW - out of hospital

KW - outcome

KW - pediatric

KW - randomized controlled trial

KW - return of circulation

KW - therapeutic hypothermia

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