Effectiveness and long-term outcome of cardiopulmonary resuscitation in paediatric intensive care units in Spain.
OBJECTIVE
To analyse the immediate effectiveness of resuscitation and long-term outcome of children who suffered a cardiorespiratory arrest when admitted to paediatric intensive care units (PICU).


METHODS
Secondary analysis of data from an 18-month prospective, multicentre study analysing cardiorespiratory arrest in children in 16 paediatric intensive care units in Spain.


METHODS
We studied 116 children between 7 days and 17 years of age. Data were recorded according to the Utstein style. Analysed outcome variables were sustained return of spontaneous circulation (ROSC), survival to hospital discharge and survival at 1 year. Neurological and general performance outcome was assessed by means of the Paediatric Cerebral Performance Category (PCPC) and the Paediatric Overall Performance Category (POPC) scales.


METHODS
None.


RESULTS
In 80 patients (69%) ROSC was achieved and it was sustained > 20 min in 69 (59.5%). At one-year follow-up, 40 children (34.5%) were alive. Survival was not associated with sex, age or weight of patients. Mortality from cardiac arrest was higher than respiratory arrest (69.8% versus 40%, p = 0.01). Patients with sepsis had a higher mortality than other diagnostic groups. Mechanically ventilated children and those treated with vasoactive drugs had a higher mortality. Initial mortality was slightly higher in patients with slow ECG rhythms (35.7%) compared to those with ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) (27.2%). Duration of resuscitation effort was correlated with mortality (p < 0.0001). Patients who required one or more doses of adrenaline had also a higher mortality (77.8% versus 20.7%, p < 0.0001) and survivors needed less doses of adrenaline (0.85 +/- 1.14 versus 4.4+/-2.9, p < 0.0001). At hospital discharge 86.8 and 84.6% of patients had scores 1 or 2 (normal or near-normal) in the PCPC and POPC scales. At 1-year follow-up these figures were 90.8 and 86.3%, respectively.


CONCLUSIONS
One-third of children who suffer a cardiac or respiratory arrest when admitted to PICU survive, and most of them had a good long-term neurological and functional outcome. The duration of cardiopulmonary resuscitation attempts is the best indicator of mortality.
Rodríguez-Núñez
Antonio
A
Paediatric Emergency and Critical Care Division, Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain. Antonio.Rodriguez.Nunez@sergas.es
López-Herce
Jesús
J
García
Cristina
C
Carrillo
Angel
A
Domínguez
Pedro
P
Calvo
Custodio
C
Delgado
Miguel Angel
MA
D000293:Adolescent; D001775:Blood Circulation; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006323:Heart Arrest / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D009420:Nervous System / Q000503:physiopathology; D011446:Prospective Studies; D020127:Recovery of Function; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome