Abstract 16598: Survival Trends in Pediatric In-Hospital Cardiac Arrests: An Analysis from Get With The Guidelines-Resuscitation
BACKGROUND: Despite ongoing efforts to improve the quality of pediatric resuscitation, it remains unknown whether survival in children with in-hospital cardiac arrest has improved.
METHODS: Between 2000 and 2009, we identified children (< 18 years) with an in-hospital cardiac arrest at hospitals with > 3 years of participation and > 5 cases annually within the national Get With The Guidelines-Resuscitation registry. Multivariable logistic regression was used to examine temporal trends in survival to discharge. We also explored whether trends in survival were due to improvement in acute resuscitation or post-resuscitation care and examined trends in rates of neurological disability among survivors.
RESULTS: Among 1031 children at 12 hospitals, the initial cardiac arrest rhythm was asystole and pulseless electrical activity (PEA) in 874 children (84.8%) and ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) in 157 children (15.2%), with a decrease in cardiac arrests due to VF and pulseless VT over time (P for trend <0.001). Risk-adjusted rates of survival to discharge increased from 14.3% in 2000 to 43.5% in 2009 (adjusted rate ratio per 1-year 1.08; 95% CI [1.01,1.16]; P for trend 0.02). Improvement in survival was largely driven by an improvement in acute resuscitation survival (risk adjusted rates: 42.9% in 2000, 80.5% in 2009; adjusted rate ratio per 1-year: 1.04; 95% CI [1.01,1.08]; P for trend 0.005) and was not accompanied by higher rates of neurological disability among survivors over time (unadjusted P for trend 0.32). Temporal trends in survival were similar between important patient subgroups (Figure).
CONCLUSION: Rates of survival to hospital discharge in children with in-hospital cardiac arrests has improved over the past decade without higher rates of neurological disability among survivors.
- © 2012 by American Heart Association, Inc.