title: Cardiopulmonary resuscitation in pediatric intensive care units.
abstract: OBJECTIVE
  To determine the effectiveness of cardiopulmonary resuscitation (CPR) in the pediatric intensive care unit (ICU).
  
  
  METHODS
  A nonconcurrent cohort study of consecutive admissions.
  
  
  METHODS
  Thirty-two pediatric ICUs.
  
  
  METHODS
  Consecutive admissions to 32 pediatric ICUs.
  
  
  METHODS
  None.
  
  
  RESULTS
  Pediatric ICU patients were followed for the occurrence of a cardiopulmonary arrest (external cardiac massage for at least 2 mins). Patients who were in a state of continuous cardiopulmonary arrest on admission, or who never achieved stable vital signs, were excluded from the study. A total of 205 patients, from a sample of 11,165 (1.8%) pediatric admissions, experienced a cardiopulmonary arrest. Overall, 28 (13.7%) patients survived to hospital discharge. Neither mean ages nor age distribution affected survival. Only two diagnostic categories, traumatic illness, and other etiologies, were associated with survival. None of the patients fitting this category survived (p = .0028). The durations of CPR for survivors and nonsurvivors were 22.5 +/- 10.1 and 24.8 +/- 1.9 mins, respectively (p = .015). For CPR durations of <15 mins, 15 to 30 mins, and >30 mins, the survival rates were 18.6%, 12.2%, and 5.6%, respectively (linear trend p = .022). Thirty-five (17.1%) patients had a cardiopulmonary arrest before pediatric ICU admission and another arrest in the pediatric ICU. Only two (5.7%) of these 35 patients survived to discharge. Pediatric ICU survival decreased as the number of pediatric ICU arrests increased. Patients with one arrest (n = 155), two arrests (n = 29), and more than three arrests (n = 21) experienced survival rates of 14%, 14%, and 9.5%, respectively. Severity of illness, as measured by the Pediatric Risk of Mortality III score, was a significant predictor of survival (p < .001).
  
  
  CONCLUSIONS
  Pediatric ICU cardiac arrest is an uncommon event. When it does occur, prehospital CPR, duration of resuscitation, traumatic etiology, and severity of illness are important factors associated with survival.
authors.affiliation: Critical Care Medicine Department, Warren G. Magnuson Clinical Center, National Institutes of Health, USA.
authors.forename: A D
authors.initials: AD
authors.lastname: Slonim
authors.forename: K M
authors.initials: KM
authors.lastname: Patel
authors.forename: U E
authors.initials: UE
authors.lastname: Ruttimann
authors.forename: M M
authors.initials: MM
authors.lastname: Pollack
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D017063:Outcome Assessment, Health Care; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate