Abstract 20240: Ventricular Functional Recovery and Neurologic Function After In-Hospital Cardiac Arrest in Pediatric Patients
Introduction: In-hospital cardiac arrest in pediatric patients remains to have high mortality. Despite survival, recovery of ventricular and preservation of neurological function are major concerns.
Hypothesis: We analyzed in-hospital cardiac arrest in pediatric patients to find predictors of mortality, assess ventricular recovery and identify causes for poor neurologic outcome.
Methods: Between 2009 and 2013, 103 patients had an in-hospital cardiac arrest at our institution. Mean age at the event was 0.3y (IQR 0.1-1.2), mean body weight 4.3kg (IQR 3.1-8.2). Retrospective chart review included patient characteristics, length of cardiopulmonary esuscitation (CPR), use of extracorporeal CPR (ECPR), pre-/post event echocardiographic variables, blood gas analysis and Pediatric Cerebral Performance Category (PCPC). Median follow up was 1.1±1.3y.
Results: Prior to cardiac arrest, 75(72.8%) patients had cardiac surgery, 23(22.3%) had multiple procedures. In-hospital mortality was 38.8%, survival at the end of follow-up was 47.2%. Cardiac arrest >15min had worse survival than ≤15min (p<.0005). Cox regression identified length of arrest (p=.025), pre arrest LV (p=.020) and RV function (p=.036), number of arrests (p=.046) and post resuscitation PCPC (p<.0005) as predictors for mortality. Ventricular function returned to pre arrest level in 84.5%. ECPR had worse PCPC than conventional CPR (p=.015). Compared to pre arrest PCPC, neurologic function was unchanged in CPR patients (p=.180), but worse after ECPR (p=.001). ECPR had longer arrest times than CPR (34.17±8.63min vs. 34.17±22.24min, p<.0005). PCPC was better in patients with arrest times ≤15min compared to >15min (p=.015) and correlated with duration of arrest (r=.236, p=.019). Survival was equal between CPR and ECPR (51.2% vs. 40.7%, p=.202).
Conclusions: Duration of cardiac arrest remains a key predictor for survival. Pre arrest ventricular function, repeated arrest and impaired neurologic function after arrest are predictors of death. Ventricular recovery is common. PCPC is associated with duration of arrest. Lower PCPC scores after ECPR seem to be rather an effect of time to return of circulation than an actual consequence of extracorporeal perfusion.
- Cardiac arrest
- Pediatric cardiac intensive care
- Pediatric cardiology
- Cardiopulmonary resuscitation
- Extracorporeal circulation
Author Disclosures: C. Haller: None. L. Zhao: None. R. Parker: None. A. Saedi: None. A. Kato: None. A. Kotsakis: None. L. Mertens: None. A. Guerguerian: None. O. Honjo: None.
- © 2016 by American Heart Association, Inc.