title: Systematic review and meta-analysis of outcomes after cardiopulmonary arrest in childhood.
abstract: BACKGROUND
  Cardiopulmonary arrest in children is an uncommon event, and often fatal. Resuscitation is often attempted, but at what point, and under what circumstances do continued attempts to re-establish circulation become futile? The uncertainty around these questions can lead to unintended distress to the family and to the resuscitation team.
  
  
  OBJECTIVE
  To define the likely outcomes of cardiopulmonary resuscitation in children, within different patient groups, related to clinical features.
  
  
  METHODS
  MEDLINE, MEDLINE in-Process & Other non-Indexed Citations, EMBASE, Cochrane database of systematic reviews and Cochrane central register of trials, Database of Abstracts of Reviews of Effects (DARE), the Health Technology Assessment database, along with reference lists of relevant systematic reviews and included articles.
  
  
  METHODS
  Prospective cohort studies which derive or validate a clinical prediction model of outcome following cardiopulmonary arrest.
  
  
  METHODS
  Children or young people (aged 0 - 18 years) who had cardiopulmonary arrest and received an attempt at resuscitation, excluding resuscitation at birth.
  
  
  METHODS
  Risk of bias assessment developed the Hayden system for non-randomised studies and QUADAS2 for decision rules. Synthesis undertaken by narrative, and random effects meta-analysis with the DerSimonian-Laird estimator.
  
  
  RESULTS
  More than 18,000 episodes in 16 data sets were reported. Meta-analysis was possible for survival and one neurological outcome; others were reported too inconsistently. In-hospital patients (average survival 37.2% (95% CI 23.7 to 53.0%)) have a better chance of survival following cardiopulmonary arrest than out-of-hospital arrests (5.8% (95% CI 3.9% to 8.6%)). Better neurological outcome was also seen, but data were too scarce for meta-analysis (17% to 71% 'good' outcomes, compared with 2.8% to 3.2%).
  
  
  CONCLUSIONS
  Lack of consistent outcome reporting and short-term neurological outcome measures limited the strength of conclusions that can be drawn from this review.
  
  
  CONCLUSIONS
  There is a need to collaboratively, prospectively, collect potentially predictive data on these rare events to understand more clearly the predictors of survival and long-term neurological outcome.
  PROSPERO 2013:CRD42013005102.
authors.affiliation: Centre for Reviews and Dissemination, University of York, York, United Kingdom; Leeds Children's Hospital, Leeds General Infirmary, Leeds, United Kingdom.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Phillips
authors.affiliation: York District General Hospital, York, United Kingdom.
authors.forename: Bryonnie
authors.initials: B
authors.lastname: Scott
authors.affiliation: Hull Royal Infirmary, Kingston-upon-Hull, United Kingdom.
authors.forename: Simon J
authors.initials: SJ
authors.lastname: Carter
authors.affiliation: Leeds Children's Hospital, Leeds General Infirmary, Leeds, United Kingdom.
authors.forename: Matthew
authors.initials: M
authors.lastname: Taylor
authors.affiliation: Sheffield Children's Hospital, Sheffield, United Kingdom.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Peirce
authors.affiliation: Nottingham Children's Hospital, Nottingham Hospitals NHS Trust, Nottingham, United Kingdom.
authors.forename: Patrick
authors.initials: P
authors.lastname: Davies
authors.affiliation: St Mary's Hospital, Imperial College NHS Healthcare Trust, London, United Kingdom.
authors.forename: Ian K
authors.initials: IK
authors.lastname: Maconochie
mesh_terms: D000293:Adolescent; D000367:Age Factors; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D003657:Decision Making; D006323:Heart Arrest / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011446:Prospective Studies; D016896:Treatment Outcome