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J Pediatr Intensive Care
DOI: 10.1055/s-0044-1782524
Original Article

Risk Factors and Outcomes for Recurrent Pediatric In-Hospital Cardiac Arrest: Retrospective Cohort Study from the American Heart Association's Get with the Guidelines-Resuscitation Registry

Maria E. Frazier
1   Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
,
Stephanie R. Brown
2   Department of Pediatrics, Emory University, Atlanta, Georgia, United States
3   Division of Pediatric Critical Care Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Amanda O'Halloran
4   Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
5   Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Tia Raymond
6   Department of Pediatrics, Cardiac Critical Care, Medical City Children's Hospital, Dallas, Texas, United States
,
Monica E. Kleinman
7   Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, United States
,
Robert M. Sutton
4   Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
5   Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Joan Roberts
8   University of Washington, Seattle, Washington, United States
9   Division of Pediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, Washington, United States
,
Ken Tegtmeyer
1   Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
10   Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
,
Heather A. Wolfe
4   Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
5   Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Vinay Nadkarni
4   Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
5   Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, United States
,
Maya Dewan
1   Division of Critical Care Medicine, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
10   Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
11   James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States
,
for the American Heart Association's Get With The Guidelines®- Resuscitation Investigators › Author Affiliations
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Abstract

Objective We aimed to describe the risk factors and outcomes of recurrent in-hospital cardiac arrest (IHCA) in a large pediatric cohort.

Methods A retrospective cohort study of patients ≤18 years from the American Heart Association's Get With The Guidelines®-Resuscitation Registry with single or recurrent IHCA who achieved return of spontaneous circulation and were not placed on extracorporeal membrane oxygenation with their initial IHCA were included. Patients were categorized into two groups for analysis: (1) single IHCA or (2) recurrent ICHA. Initial IHCAs from each category were analyzed and compared. Continuous variables were expressed as medians with interquartile ranges and compared via rank sum test. Categorical variables were expressed as percentages and compared via chi square test. Outcomes were assessed in a matched cohort.

Results A total of 10,019 patients, 2,225 (22.2%) experienced a recurrent IHCA. Recurrent IHCA patients were more likely to be medical cardiac (21.3 vs. 19%; p = 0.01) or trauma patients (7.5 vs. 5.3%; p < 0.001) and have higher acuity (27.8 vs. 22.7%; p < 0.001). Initial IHCA for recurrent IHCA patients were more likely to occur in the pediatric intensive care unit (44.2 vs. 39.6%; p < 0.001) or cardiac intensive care unit (11.5 vs. 9.5%; p = 0.006) versus other inpatient locations. There was no difference in initial IHCA duration between groups. After matching, patients with a recurrent IHCA had a lower rate of survival to hospital discharge (42.1 vs. 65.3%; p < 0.001).

Conclusion In a matched cohort, patients with recurrent IHCA had lower rates of survival compared with those with a single IHCA. Higher acuity and intensive care unit location during initial IHCA event were associated with increased risk for recurrent IHCA.

Keywords

cardiac arrest - CPR - recurrent arrest - pediatrics - risk factors

* American Heart Association's Get With The Guidelines®-Resuscitation Pediatric Research Task Force members are listed in Appendix A .


Supplementary Material



Publication History

Received: 02 November 2023

Accepted: 16 January 2024

Article published online:
18 March 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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