title: Survival trends in pediatric in-hospital cardiac arrests: an analysis from Get With the Guidelines-Resuscitation.
abstract: BACKGROUND
  Despite ongoing efforts to improve the quality of pediatric resuscitation, it remains unknown whether survival in children with in-hospital cardiac arrest has improved.
  
  
  RESULTS
  Between 2000 and 2009, we identified children (<18 years of age) with an in-hospital cardiac arrest at hospitals with >3 years of participation and >5 cases annually within the national Get With The Guidelines-Resuscitation registry. Multivariable logistic regression was used to examine temporal trends in survival to discharge. We also explored whether trends in survival were attributable to improvement in acute resuscitation or postresuscitation care and examined trends in neurological disability among survivors. Among 1031 children at 12 hospitals, the initial cardiac arrest rhythm was asystole and pulseless electrical activity in 874 children (84.8%) and ventricular fibrillation and pulseless ventricular tachycardia in 157 children (15.2%), with an increase in cardiac arrests due to pulseless electrical activity over time (P for trend <0.001). Risk-adjusted rates of survival to discharge increased from 14.3% in 2000 to 43.4% in 2009 (adjusted rate ratio per year, 1.08; 95% confidence interval, 1.01-1.16; P for trend=0.02). Improvement in survival was driven largely by an improvement in acute resuscitation survival (risk-adjusted rates: 42.9% in 2000, 81.2% in 2009; adjusted rate ratio per year: 1.04; 95% confidence interval, 1.01-1.08; P for trend=0.006). Moreover, survival trends were not accompanied by higher rates of neurological disability among survivors over time (unadjusted P for trend=0.32), suggesting an overall increase in the number of survivors without neurological disability over time.
  
  
  CONCLUSIONS
  Rates of survival to hospital discharge in children with in-hospital cardiac arrests have improved over the past decade without higher rates of neurological disability among survivors.
authors.affiliation: University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA. saket-girotra@uiowa.edu
authors.forename: Saket
authors.initials: S
authors.lastname: Girotra
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.forename: Paul S
authors.initials: PS
authors.lastname: Chan
mesh_terms: D000293:Adolescent; D000572:American Heart Association; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D005260:Female; D017408:Guidelines as Topic; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D017063:Outcome Assessment, Health Care; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States