Abstract 299: Trends and Outcomes of In-Patient Pediatric Cardiopulmonary Resuscitation
Purpose: Continual efforts have aimed to improve outcomes in children requiring cardiopulmonary resuscitation (CPR). However, few data have assessed how these efforts have impacted post-CPR survival in children’s hospitals. The purpose of this study was to describe the incidence, outcomes, and risk factors associated with in-patient mortality after pediatric CPR.
Methods: A multi-institutional, retrospective review of the Pediatric Health Information System (PHIS) database, an administrative database of 42 United States tertiary care children’s hospitals, was performed. All hospitalizations in children <18 years during which CPR was performed from 2004-2012 were included. Mortality was the primary outcome measure. Yearly trend analysis was performed using linear regression. Risk factors assessed for their association with mortality included age, sex, and specific cardiac factors (the presence of congenital heart disease [CHD], concurrent cardiac surgery, and cardiomyopathy [CM]). Factors associated with mortality were assessed by Chi-square analysis and expressed as odds ratio (OR) and 95% confidence interval (CI). A CI not crossing 0 was considered significant.
Results: There were >4.6 million hospitalizations of which 11,213 (0.2%) involved a CPR event. Overall in-patient mortality after CPR was 50%. Although there was a significant increasing yearly trend in the number of in-patient CPR events (p = 0.003), yearly mortality significantly decreased (p<0.001). Mortality was significantly higher in adolescents (OR 1.5 CI 1.3-1.7) and neonates (OR 1.4 CI 1.3-1.5). Among in-patients, CHD was present in 4,931 hospitalizations (44%), concurrent cardiac surgery in 1,656 (14.8%), and CM in 537 (4.8%). Mortality was lower in hospitalizations involving CHD (OR 0.7, CI 0.6-0.7), CM (OR 0.8, CI 0.7-0.9), and cardiac surgery (OR 0.5, CI 0.4-0.5). Gender was not significantly associated with mortality (p = 0.61).
Conclusions: CPR in hospitalized children is a rare event associated with high, but improving mortality. Adolescents and neonates are at higher risk for mortality after CPR. Cardiac risk factors in hospitalized children undergoing CPR are associated with lower mortality.
- © 2013 by American Heart Association, Inc.