Vasopressin for in-hospital pediatric cardiac arrest: results from the American Heart Association National Registry of Cardiopulmonary Resuscitation.
OBJECTIVE
To describe the landscape of vasopressin uses reported to the American Heart Association National Registry of cardiopulmonary resuscitation (CPR) and test the hypothesis that vasopressin use will be associated with improved return of a sustained circulation (ROSC) following in-hospital pediatric cardiac arrest.


METHODS
Multicentered, national registry of in-hospital CPR.


METHODS
One hundred seventy-six North American Hospitals reporting to registry from October 1999 to November 2004.


METHODS
Totally, 1293 consecutive pediatric patients with pulseless cardiac arrest meeting criteria for analysis identified from a registry of all patients resuscitated for cardiac arrest. Inclusion criteria were age <18 years, chest compressions and/or defibrillation, in-hospital location, and documented resuscitation record.


METHODS
None.


METHODS
Prearrest, event, cardiopulmonary resuscitation, and postresuscitation variables were collected. Primary outcome variable was ROSC >20 minutes. Secondary survival outcomes included 24 hour, discharge and favorable neurologic survival on hospital discharge. Descriptive, univariate, and multivariable analysis to evaluate the association of vasopressin with survival outcomes were performed.


RESULTS
Only 5% of patients received vasopressin in this review. Vasopressin was most often given in a pediatric hospital (57%) and in and intensive care setting (76.6%). Patients who were given vasopressin had longer arrest duration (median 37 minutes) vs. those who did not (24 minutes) (p = 0.004). In multivariate analysis, vasopressin was associated with worse ROSC but no difference in 24 hours or discharge survival.


CONCLUSIONS
Vasopressin was given infrequently in in-hospital cardiac arrest. It was most likely to be given in an intensive care setting, and in a pediatric hospital. Multivariate analysis shows an association with vasopressin use and worse ROSC.
Duncan
Jay M
JM
Pediatric Intensive Care Unit, Cook's Children Medical Center, Fort Worth, TX, USA. jay.duncan@cookchildrens.org
Meaney
Peter
P
Simpson
Pippa
P
Berg
Robert A
RA
Nadkarni
Vinay
V
Schexnayder
Stephen
S
D000293:Adolescent; D000572:American Heart Association; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D004502:Education, Medical, Continuing; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007297:Inpatients; D007362:Intensive Care Units; D008297:Male; D012042:Registries / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States; D014667:Vasopressins / Q000627:therapeutic use*
D014667:Vasopressins