Post-resuscitative clinical features in the first hour after achieving sustained ROSC predict the duration of survival in children with non-traumatic out-of-hospital cardiac arrest.
OBJECTIVE
Although sustained return of spontaneous circulation (ROSC) can be initially established after resuscitation from non-traumatic out-of-hospital cardiac arrest (OHCA) in some children, many of the children lose spontaneous circulation during hospital stay and do not survive to discharge. The aim of this study was to determine the clinical features during the first hour after ROSC that may predict survival to hospital discharge.


METHODS
We retrospectively evaluated the medical records of 228 children who presented to the emergency department without spontaneous circulation following non-traumatic OHCA during the period January 1996 to December 2008. Among these children, 80 achieved sustained ROSC for at least 20 min. The post-resuscitative clinical features during the first hour after achieving sustained ROSC that correlated with survival, median duration of survival, and death were analyzed.


RESULTS
Among the 80 children who achieved sustained ROSC for at least 20 min, 28 survived to hospital discharge and 6 had good neurologic outcomes (PCPC scale=1 or 2). Post-resuscitative clinical features associated with survival included sinus cardiac rhythm (p=0.012), normal heart rate (p=0.008), normal blood pressure (p<0.001), urine output>1 ml/kg/h (p=0.002), normal skin color (p=0.016), lack of cardiopulmonary resuscitation (CPR)-induced rib fracture (p=0.044), initial Glasgow Coma Scale score>7 (p<0.001), and duration of in-hospital CPR<or=10 min (p<0.001). Furthermore, these variables were also significantly associated with the duration of survival (all p<0.05).


CONCLUSIONS
The most important predictors of survival to hospital discharge in children with OHCA who achieve sustained ROSC are a normal heart rate, normal blood pressure, and an initial urine output>1 ml/kg/h.
Lin
Yan-Ren
YR
Department of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan. h6213.lac@gmail.com
Li
Chao-Jui
CJ
Wu
Tung-Kung
TK
Chang
Yu-Jun
YJ
Lai
Shih-Chang
SC
Liu
Tzu-An
TA
Hsiao
Ming-Hau
MH
Chou
Chu-Chung
CC
Chang
Chin-Fu
CF
D000293:Adolescent; D001775:Blood Circulation / Q000502:physiology*; D001794:Blood Pressure / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D015600:Glasgow Coma Scale; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012151:Resuscitation; D012189:Retrospective Studies; D013997:Time Factors; D014556:Urine