title: Multicenter cohort study of in-hospital pediatric cardiac arrest.
abstract: OBJECTIVE
  1) To describe clinical characteristics, hospital courses, and outcomes of a cohort of children cared for within the Pediatric Emergency Care Applied Research Network who experienced in-hospital cardiac arrest with sustained return of circulation between July 1, 2003 and December 31, 2004, and 2) to identify factors associated with hospital mortality in this population. These data are required to prepare a randomized trial of therapeutic hypothermia on neurobehavioral outcomes in children after in-hospital cardiac arrest.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Fifteen children's hospitals associated with Pediatric Emergency Care Applied Research Network.
  
  
  METHODS
  Patients between 1 day and 18 years of age who had cardiopulmonary resuscitation and received chest compressions for >1 min, and had a return of circulation for >20 mins.
  
  
  METHODS
  None.
  
  
  RESULTS
  A total of 353 patients met entry criteria; 172 (48.7%) survived to hospital discharge. Among survivors, 132 (76.7%) had good neurologic outcome documented by Pediatric Cerebral Performance Category scores. After adjustment for age, gender, and first documented cardiac arrest rhythm, variables available before and during the arrest that were independently associated with increased mortality included pre-existing hematologic, oncologic, or immunologic disorders, genetic or metabolic disorders, presence of an endotracheal tube before the arrest, and use of sodium bicarbonate during the arrest. Variables associated with decreased mortality included postoperative cardiopulmonary resuscitation. Extending the time frame to include variables available before, during, and within 12 hours following arrest, variables independently associated with increased mortality included the use of calcium during the arrest. Variables associated with decreased mortality included higher minimum blood pH and pupillary responsiveness.
  
  
  CONCLUSIONS
  Many factors are associated with hospital mortality among children after in-hospital cardiac arrest and return of circulation. Such factors must be considered when designing a trial of therapeutic hypothermia after cardiac arrest in pediatric patients.
authors.affiliation: Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA. kmeert@med.wayne.edu
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Meert
authors.forename: Amy
authors.initials: A
authors.lastname: Donaldson
authors.forename: Vinay
authors.initials: V
authors.lastname: Nadkarni
authors.forename: Kelly S
authors.initials: KS
authors.lastname: Tieves
authors.forename: Charles L
authors.initials: CL
authors.lastname: Schleien
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Brilli
authors.forename: Robert S B
authors.initials: RS
authors.lastname: Clark
authors.forename: Donald H
authors.initials: DH
authors.lastname: Shaffner
authors.forename: Fiona
authors.initials: F
authors.lastname: Levy
authors.forename: Kimberly
authors.initials: K
authors.lastname: Statler
authors.forename: Heidi J
authors.initials: HJ
authors.lastname: Dalton
authors.forename: Elise W
authors.initials: EW
authors.lastname: van der Jagt
authors.forename: Richard
authors.initials: R
authors.lastname: Hackbarth
authors.forename: Robert
authors.initials: R
authors.lastname: Pretzlaff
authors.forename: Lynn
authors.initials: L
authors.lastname: Hernan
authors.forename: J Michael
authors.initials: JM
authors.lastname: Dean
authors.forename: Frank W
authors.initials: FW
authors.lastname: Moler
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014481:United States / Q000453:epidemiology