Introduction:
Although registry and administrative data suggest that >6000 children have in-hospital cardiac arrests each year, most occur in pediatric intensive care units (PICUs), and 39% survive to hospital discharge, prospective research quality data on the incidence and outcomes of PICU CPR are not currently available.
Objectives:
To determine the incidence and outcomes CPR provided in PICUs.
Methods:
Multi-center prospective observational study of children <18 years old randomly selected and intensively followed from PICU admission to hospital discharge in the NICHD-funded Collaborative Pediatric Critical Care Research Network from December 2011 to April 2013.
Results:
Among 10,078 children enrolled, 139 (1.4%) received CPR for ≥1 minute and/or defibrillation. Of these children, 78% attained return of circulation, 45% survived to hospital discharge, and 89% of survivors had favorable neurological outcomes. The relative incidence of CPR events was higher for cardiac patients compared with non-cardiac patients (3.4% versus 0.8%, p<0.001), but survival rate to hospital discharge with favorable neurological outcome was not statistically different (41% versus 39%, respectively). Shorter duration of CPR was associated with higher survival rates: 66% [29/44] survived to hospital discharge after 1-3 minutes of CPR versus 28% [9/32] after >30 minutes, p<0.001. Among survivors, 26/29 (90%) had a favorable neurological outcome after 1-3 minutes versus 8/9 (89%) after >30 minutes of CPR.
Conclusions:
These data establish that contemporary PICU CPR, including long durations of CPR, results in high rates of survival to hospital discharge (45%) and favorable neurologic outcomes among survivors (89%). Rates of survival with favorable neurologic outcomes were similar among cardiac and non-cardiac patients. The rigorous prospective, observational study design avoided the limitations of missing data and potential selection biases inherent in registry and administrative data.
Pharmaceutical Interventions on Hospital Discharge Prescriptions: Prospective Observational Study Highlighting Challenges for Community Pharmacists
