Outcomes after in-hospital cardiac arrest in children with cardiac disease: a report from Get With the Guidelines--Resuscitation.
BACKGROUND
Small studies suggest that children experiencing a cardiac arrest after undergoing cardiac surgery have better outcomes than other groups of patients, but the survival outcomes and periarrest variables of cardiac and noncardiac pediatric patients have not been compared.


RESULTS
All cardiac arrests in patients <18 years of age were identified from Get With the Guidelines-Resuscitation from 2000 to 2008. Cardiac arrests occurring in the neonatal intensive care unit were excluded. Of 3323 index cardiac arrests, 19% occurred in surgical-cardiac, 17% in medical-cardiac, and 64% in noncardiac (trauma, surgical-noncardiac, and medical-noncardiac) patients. Survival to hospital discharge was significantly higher in the surgical-cardiac group (37%) compared with the medical-cardiac group (28%; adjusted odds ratio, 1.8; 95% confidence interval, 1.3-2.5) and the noncardiac group (23%; adjusted odds ratio, 1.8; 95% confidence interval, 1.4-2.4). Those in the cardiac groups were younger and less likely to have preexisting noncardiac organ dysfunction, but were more likely to have ventricular arrhythmias as their first pulseless rhythm, to be monitored and hospitalized in the intensive care unit at the time of cardiac arrest, and to have extracorporeal cardiopulmonary resuscitation compared with those in the noncardiac group. There was no survival advantage for patients in the medical-cardiac group compared with those in the noncardiac group when adjusted for periarrest variables.


CONCLUSIONS
Children with surgical-cardiac disease have significantly better survival to hospital discharge after an in-hospital cardiac arrest compared with children with medical-cardiac disease and noncardiac disease.
Children's Mercy Hospitals and Clinics, 2401 Gillham Rd., Kansas City, MO 64108, USA. lort8112@yahoo.com
Laura
L
Ortmann
Parthak
P
Prodhan
Jeffrey
J
Gossett
Stephen
S
Schexnayder
Robert
R
Berg
Vinay
V
Nadkarni
Adnan
A
Bhutta
D000293:Adolescent; D006348:Cardiac Surgical Procedures; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D006331:Heart Diseases / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate