Multicenter cohort study of in-hospital pediatric cardiac arrest.
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.
Meert
Kathleen L
KL
Children's Hospital of Michigan, Wayne State University, Detroit, MI, USA. kmeert@med.wayne.edu
Donaldson
Amy
A
Nadkarni
Vinay
V
Tieves
Kelly S
KS
Schleien
Charles L
CL
Brilli
Richard J
RJ
Clark
Robert S B
RS
Shaffner
Donald H
DH
Levy
Fiona
F
Statler
Kimberly
K
Dalton
Heidi J
HJ
van der Jagt
Elise W
EW
Hackbarth
Richard
R
Pretzlaff
Robert
R
Hernan
Lynn
L
Dean
J Michael
JM
Moler
Frank W
FW
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