In-hospital versus out-of-hospital pediatric cardiac arrest: a multicenter cohort study.
OBJECTIVE
: To describe a large multicenter cohort of pediatric cardiac arrest (CA) with return of circulation (ROC) from either the in-hospital (IH) or the out-of-hospital (OH) setting and to determine whether significant differences related to pre-event, arrest event, early postarrest event characteristics, and outcomes exist that would be critical in planning a clinical trial of therapeutic hypothermia (TH).


METHODS
: Retrospective cohort study.


METHODS
: Fifteen Pediatric Emergency Care Applied Research Network sites.


METHODS
: Patients aged 24 hours to 18 years with either IH or OH CA who had a history of at least 1 minute of chest compressions and ROC for at least 20 minutes were eligible.


METHODS
: None.


RESULTS
: A total of 491 patients met study entry criteria with 353 IH cases and 138 OH cases. Major differences between the IH and OH cohorts were observed for patient prearrest characteristics, arrest event initial rhythm described, and arrest medication use. Several postarrest interventions were used differently, however, the use of TH was similar (<5%) in both cohorts. During the 0-12-hour interval following ROC, OH cases had lower minimum temperature and pH, and higher maximum serum glucose recorded. Mortality was greater in the OH cohort (62% vs. 51%, p = 0.04) with the cause attributed to a neurologic indication much more frequent in the OH than in the IH cohort (69% vs. 20%; p < 0.01).


CONCLUSIONS
: For pediatric CA with ROC, several major differences exist between IH and OH cohorts. The finding that the etiology of death was attributed to neurologic indications much more frequently in OH arrests has important implications for future research. Investigators planning to evaluate the efficacy of new interventions, such as TH, should be aware that the IH and OH populations differ greatly and require independent clinical trials.
Moler
Frank W
FW
Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA. fmoler@umich.edu
Meert
Kathleen
K
Donaldson
Amy E
AE
Nadkarni
Vinay
V
Brilli
Richard J
RJ
Dalton
Heidi J
HJ
Clark
Robert S B
RS
Shaffner
Donald H
DH
Schleien
Charles L
CL
Statler
Kimberly
K
Tieves
Kelly S
KS
Hackbarth
Richard
R
Pretzlaff
Robert
R
van der Jagt
Elise W
EW
Levy
Fiona
F
Hernan
Lynn
L
Silverstein
Faye S
FS
Dean
J Michael
JM
D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007036:Hypothermia, Induced; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis