title: Incidence and Outcomes of Cardiopulmonary Resuscitation in PICUs.
abstract: OBJECTIVE
  To determine the incidence of cardiopulmonary resuscitation in PICUs and subsequent outcomes.
  
  
  METHODS
  Multicenter prospective observational study of children younger than 18 years old randomly selected and intensively followed from PICU admission to hospital discharge in the Collaborative Pediatric Critical Care Research Network December 2011 to April 2013.
  
  
  RESULTS
  Among 10,078 children enrolled, 139 (1.4%) received cardiopulmonary resuscitation for more than or equal to 1 minute and/or defibrillation. Of these children, 78% attained return of circulation, 45% survived to hospital discharge, and 89% of survivors had favorable neurologic outcomes. The relative incidence of cardiopulmonary resuscitation events was higher for cardiac patients compared with non-cardiac patients (3.4% vs 0.8%, p <0.001), but survival rate to hospital discharge with favorable neurologic outcome was not statistically different (41% vs 39%, respectively). Shorter duration of cardiopulmonary resuscitation was associated with higher survival rates: 66% (29/44) survived to hospital discharge after 1-3 minutes of cardiopulmonary resuscitation versus 28% (9/32) after more than 30 minutes (p < 0.001). Among survivors, 90% (26/29) had a favorable neurologic outcome after 1-3 minutes versus 89% (8/9) after more than 30 minutes of cardiopulmonary resuscitation.
  
  
  CONCLUSIONS
  These data establish that contemporary PICU cardiopulmonary resuscitation, including long durations of cardiopulmonary resuscitation, results in high rates of survival-to-hospital discharge (45%) and favorable neurologic outcomes among survivors (89%). Rates of survival with favorable neurologic outcomes were similar among cardiac and noncardiac patients. The rigorous prospective, observational study design avoided the limitations of missing data and potential selection biases inherent in registry and administrative data.
authors.affiliation: 1Department of Anesthesiology and Critical Care, the Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 2Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT. 3Department of Pediatrics, University of Michigan, Ann Arbor, MI. 4Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI. 5Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA. 6Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, CA. 7Department of Pediatrics, Children's National Medical Center, Washington DC. 8Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA. 9Department of Child Health, Phoenix Children's Hospital and University of Arizona College of Medicine-Phoenix, Phoenix, AZ. 10Departments of Pediatrics and Biochemistry, Washington University School of Medicine, St. Louis, MO. 11Branch of Trauma and Critical Illness of the Eunice Kennedy Shriver National Institutes of Child Health and Human Development, the National Institutes of Health, Bethesda, MD. 12Department of Pediatrics, Children's National Medical Center, George Washington University School of Medicine, Washington DC.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berg
authors.forename: Vinay M
authors.initials: VM
authors.lastname: Nadkarni
authors.forename: Amy E
authors.initials: AE
authors.lastname: Clark
authors.forename: Frank
authors.initials: F
authors.lastname: Moler
authors.forename: Kathleen
authors.initials: K
authors.lastname: Meert
authors.forename: Rick E
authors.initials: RE
authors.lastname: Harrison
authors.forename: Christopher J L
authors.initials: CJ
authors.lastname: Newth
authors.forename: Robert M
authors.initials: RM
authors.lastname: Sutton
authors.forename: David L
authors.initials: DL
authors.lastname: Wessel
authors.forename: John T
authors.initials: JT
authors.lastname: Berger
authors.forename: Joseph
authors.initials: J
authors.lastname: Carcillo
authors.forename: Heidi
authors.initials: H
authors.lastname: Dalton
authors.forename: Sabrina
authors.initials: S
authors.lastname: Heidemann
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Shanley
authors.forename: Athena F
authors.initials: AF
authors.lastname: Zuppa
authors.forename: Allan
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authors.lastname: Doctor
authors.forename: Robert F
authors.initials: RF
authors.lastname: Tamburro
authors.forename: Tammara L
authors.initials: TL
authors.lastname: Jenkins
authors.forename: J Michael
authors.initials: JM
authors.lastname: Dean
authors.forename: Richard
authors.initials: R
authors.lastname: Holubkov
authors.forename: Murray M
authors.initials: MM
authors.lastname: Pollack
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D010351:Patient Discharge; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors