title: Cardiopulmonary resuscitation in hospitalized children with cardiovascular disease: estimated prevalence and outcomes from the kids' inpatient database.
abstract: OBJECTIVE
  Hospitalized children with cardiovascular disease may be at increased risk of cardiac arrest; however, little data exist regarding prevalence, risk factors, or outcomes of cardiopulmonary resuscitation in these patients. We sought to characterize national estimates of cardiopulmonary resuscitation and death after cardiopulmonary resuscitation for hospitalized children with cardiovascular disease.
  
  
  METHODS
  A total of 3,739 hospitals in 38 states participating in Kids' Inpatient Database.
  
  
  METHODS
  Retrospective analysis of the 2000, 2003, and 2006 Healthcare Cost and Utilization Project Kids' Inpatient Database was performed. Sample weighting was employed to produce national estimates.
  
  
  RESULTS
  Cardiovascular disease was identified in 2.2% of the estimated 22,175,468 (95% confidence interval 21,391,343-22,959,592) hospitalizations. Cardiopulmonary resuscitation occurred in 0.74% (3,698; 95% confidence interval 3,205-4,191) of hospitalizations of children with cardiovascular disease, compared with 0.05% (11,726; 95% confidence interval 10,647-12,805) without cardiovascular disease (odds ratio 13.8, 95% confidence interval 12.8-15.0). The highest frequency of cardiopulmonary resuscitation occurred with myocarditis (3.0% of admissions), heart failure (2.0%), and coronary pathology (2.0%). Compared with other forms of cardiovascular disease identified in this study, single-ventricle patients were the only subgroup who exhibited a higher mortality after cardiopulmonary resuscitation (mortality 65% vs. 55%; odds ratio 1.7 [95% confidence interval 1.2-2.6]), while those who had undergone cardiac surgery exhibited a lower mortality rate (mortality 48% vs. 57%; odds ratio 0.6 [95% confidence interval 0.5-0.8]).
  
  
  CONCLUSIONS
  Cardiopulmonary resuscitation occurs in approximately 7 per 1,000 hospitalizations of children with cardiovascular disease, a rate greater than ten-fold that observed in hospitalizations of children without cardiovascular disease. Single-ventricle patients demonstrated increased mortality after cardiopulmonary resuscitation, while recent cardiac surgery was associated with a reduced odds of death after cardiopulmonary resuscitation. Further studies are needed to confirm these findings and develop techniques to prevent cardiac arrest in this high-risk population.
authors: Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA. adamlowry@gmail.com
authors: Adam W
authors: AW
authors: Lowry
authors: Jarrod D
authors: JD
authors: Knudson
authors: Antonio G
authors: AG
authors: Cabrera
authors: Daniel E
authors: DE
authors: Graves
authors: David L S
authors: DL
authors: Morales
authors: Joseph W
authors: JW
authors: Rossano
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000401:mortality / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D015995:Prevalence; D012189:Retrospective Studies; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult