Abstract 155: International Comparison of Pediatric In-Hospital Cardiac Arrest: Impact of Critical Care Settings for Hospital Safety and Outcome. From the Japanese Registry of CPR for In-Hospital Cardiac Arrest
Background: Number of paediatric intensive care unit (PICU) is scant in Japan (only 1 PICU bed available for more than 80,000 children). It may affect hospital safety issue relating to the paediatric in-hospital cardiac arrest (IHCA). We investigated the epidemiology of IHCA including location of events from domestic IHCA registration and performed international comparison.
Methods: Japanese Registry of Cardiopulmonary Resuscitation (J-RCPR) was established to accumulate events of IHCA. J-RCPR registered 491 adult events in 12 general hospitals, and 156 paediatric events in 4 children's hospitals from 2002 to 2009. Event location, etiology, and prognosis were analyzed. J-RCPR data was compared between children and adults. National paediatric data was compared to those from National Registry of Cardiopulmonary Resuscitation (NRCPR).
Results: From J-RCPR data, bradycardia was the most common first documented rhythm in children (36%, n=56). Major cause of adult CPA was arrhythmia (31%, n=150), whereas in children the main causes were hypotension (47%, n=73), acute respiratory insufficiency (28%, n=44). In children, over all ROSC was achieved to 56% (n=88) in J-RCPR versus 52% (n=459) in NRCPR. Paediatric survival to hospital discharge was 26% (n=41) in J-RCPR versus 27% (n=236) in NRCPR. J-RCPR showed 48% (n=75) paediatric events occurred in PICU versus 65% (n=570) in NRCPR, and up to 27% (n=40) paediatric events occurred in general ward in Japan versus only 14% (n=123) in NRCPR (p<0.05). Survival to hospital discharge was achieved in 27% (n=20) cases arrested in PICU versus 25% (n=10) cases arrested in general ward from J-RCPR data.
Conclusion: International comparison in paediatric IHCA showed similar tendency except for the event location. J-RCPR showed significantly low IHCA prevalence in PICU and high prevalence in general ward, which indicates poor compliance of preventive PICU admission before cardiac arrest in children with respiratory failure and shock. Although it didn’t show statistical difference of outcome, it revealed poor hospital safety in Japanese children's hospital. It might be led by the difference of intensive care circumstances between Japan and North America, and by poor number of PICU beds in Japan, which needs to be corrected.
- © 2011 by American Heart Association, Inc.