Abstract 10316: Variables Influencing Outcome of Cardiac Arrest in a Pediatric Cardiac Intensive Care Unit
Background: Prior study of cardiac arrests in pediatric cardiac intensive care units (PCICU) has focused on the influence of clinical factors on outcome. The impact of systems factors (i.e. environment and personnel) on outcome after cardiac arrest in the PCICU has not been studied.
Methods: We retrospectively reviewed every cardiac arrest event in our PCICU from 2006-2008. Cardiac arrest was defined as any event where chest compressions were performed. Successful resuscitation was defined as either return of spontaneous circulation (ROSC) or successful cannulation to ECMO. Differences in resuscitation rates were assessed across categorical systems variables using logistic regression.
Results: There were 125 arrests occurring in 102 PCICU admissions; 82% of admissions were post-surgical (33% single ventricle). Median patient age was 2 months. The rate of successful resuscitation was 86% (ROSC 76%, ECMO 10%). The hospital mortality rate was 52% for patients who had a cardiac arrest. The rate of successful resuscitation was 90% during the week and 74% during weekends (p=0.02). Success was significantly more likely when the primary nurse had ≥1 year of experience in the PCICU (56% <1 year vs. 88% ≥ 1 year, p=0.02). There was an indication of greater likelihood of successful resuscitation when the PCICU bed census was higher (88% when bed census >80% vs. 71% when census ≤80%, p=0.08). The rate of successful resuscitation was no different when senior ICU attending physicians were on-call at the time of arrest compared to junior or part-time ICU staff (89% vs. 84%, p=0.45). Attending physician presence at the onset of arrest resulted in an 84% success rate vs. 87% in cases where the attending was not present at onset (p=0.69).
Conclusions: Our data suggest that systems factors may impact outcome after cardiac arrest in the PCICU. Arrests occurring on weekends were less likely to be resuscitated successfully. Greater experience of the patient's primary nurse was associated with higher rates of successful resuscitation, as was a higher unit bed census at the time of arrest. However, the likelihood of successful resuscitation of cardiac arrest in a dedicated PCICU was not associated with attending physician experience or presence at the onset of arrest.
- © 2010 by American Heart Association, Inc.