Ratio of PICU versus ward cardiopulmonary resuscitation events is increasing.
OBJECTIVE
The aim of this study was to evaluate the relative frequency of pediatric in-hospital cardiopulmonary resuscitation events occurring in ICUs compared to general wards. We hypothesized that the proportion of pediatric cardiopulmonary resuscitation provided in ICUs versus general wards has increased over the past decade, and this shift is associated with improved resuscitation outcomes.


METHODS
Prospective and observational study.


METHODS
Total of 315 hospitals in the American Heart Association's Get With The Guidelines-Resuscitation database.


METHODS
Total of 5,870 pediatric cardiopulmonary resuscitation events between January 1, 2000 and September 14, 2010. Cardiopulmonary resuscitation events were defined as external chest compressions longer than 1 minute.


METHODS
None.


RESULTS
The primary outcome was proportion of total ICU versus general ward cardiopulmonary resuscitation events over time evaluated by chi-square test for trend. Secondary outcome included return of spontaneous circulation following the cardiopulmonary resuscitation event. Among 5,870 pediatric cardiopulmonary resuscitation events, 5,477 (93.3%) occurred in ICUs compared to 393 (6.7%) in inpatient wards. Over time, significantly more of these cardiopulmonary resuscitation events occurred in the ICU compared to the wards (test for trend: p<0.01), with a prominent shift noted between 2003 and 2004 (2000-2003: 87-91% vs 2004-2010: 94-96%). In a multivariable model controlling for within center variability and other potential confounders, return of spontaneous circulation increased in 2004-2010 compared with 2000-2003 (relative risk, 1.08; 95% CI, 1.03-1.13).


CONCLUSIONS
In-hospital pediatric cardiopulmonary resuscitation is much more commonly provided in ICUs than in wards, and the proportion has increased significantly over the past decade, with concomitant increases in return of spontaneous circulation.
1Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 2Department of Pediatrics, University of Utah, Salt Lake City, UT. 3Division of Critical Care Medicine, Department of Pediatrics, National Institute of Child Health and Human Development, Bethesda, MD. 4Division of Critical Care Medicine, Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA. 5Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI. 6Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Children's Hospital Los Angeles, Los Angeles, CA. 7Division of Critical Care Medicine, Department of Pediatrics, University of Michigan and Mott Children's Hospital, Ann Arbor, MI. 8Division of Critical Care Medicine, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ. 9Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO. 10Division of Critical Care Medicine, Department of Pediatrics, Children's National Medical Center, Washington, DC. 11Department of Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.
Robert A
RA
Berg
Robert M
RM
Sutton
Richard
R
Holubkov
Carol E
CE
Nicholson
J Michael
JM
Dean
Rick
R
Harrison
Sabrina
S
Heidemann
Kathleen
K
Meert
Christopher
C
Newth
Frank
F
Moler
Murray
M
Pollack
Heidi
H
Dalton
Allan
A
Doctor
David
D
Wessel
John
J
Berger
Thomas
T
Shanley
Joseph
J
Carcillo
Vinay M
VM
Nadkarni
D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D002648:Child; D016001:Confidence Intervals; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D010362:Patients' Rooms / Q000706:statistics & numerical data*; D015143:Philadelphia; D016012:Poisson Distribution; D011446:Prospective Studies; D012042:Registries; D016019:Survival Analysis