Abstract 249: Cardiac Arrest in the Emergency Department: A Comparison of Pediatric and Adult Outcomes and Care Processes
Background: About 10% of in-hospital cardiopulmonary arrest (CPA) events occur in the Emergency Department (ED). Published outcomes from CPA in the ED are discrepant between adults and children, with much worse survival among children. Reasons for these differences are unclear. We hypothesize a greater prevalence of unfavorable cardiorespiratory physiology among pediatric patients, and less optimal processes of care as a result of lower frequency occurrences among children in the ED.
Methods: Retrospective cohort study from the Get With The Guidelines - Resuscitation database. All patients whose CPA event occurred in the ED were included. Univariate comparison between children (age <18 yo) and adults (age > 18 yo) was done for Utstein outcomes (ROSC, 24 hr survival, survival to discharge) as well as patient factors (illness category, pre-existing conditions), event factors (initial rhythm, pulse sequence, total duration), and times to interventions; χ2 analysis was used for categorical variables, t-testing for continuous variables.
Results: 706/10947 (6.4%) of pediatric CPA events and 18473/189,653 (9.7%) of adult CPA events occurred in the ED. Median age for adults was 65 yr (IQR 52 - 77 yr), 21 months for children (IQR 3 mos - 10 yr). Children had a greater prevalence of respiratory insufficiency (51% vs. 43%, p<0.001), septicemia (10% vs. 7%, p=0.05), and trauma (18% vs. 6%, p<0.001). Shockable initial rhythm was less common in children (17% vs. 31%, p<0.001) and CPR prior to pulselessness was more common (28% vs. 8%, p<0.001). In children, total duration of CPR was longer (28.6 + 1.0 mins vs. 22.9 + 0.3 mins, p<0.001) and time to epinephrine was shorter (2.2 + 0.4 mins vs. 2.8 + 0.1 mins, p=0.03). Times to compressions, airway, and defibrillation did not differ significantly. 24 hour survival was worse among children (26% vs. 33%, p=0.001); ROSC (49% vs. 52%) and survival to discharge (26% vs. 24%) did not differ significantly.
Conclusions: Compared with adults, 24 hour survival is worse among children with CPA in the ED; other outcomes are less discrepant than in previously published studies. Pediatric CPA in the ED more commonly occurs from respiratory insufficiency or shock. Differences in outcomes do not appear related to timing of critical interventions.
- © 2012 by American Heart Association, Inc.