Rashmitha Dachepally
Cleveland Clinic Children's Hospital
Cleveland, Ohio
Disclosure information not submitted.
Mohammed Hamzah
Dr. Hamzah, MD
Cleveland Clinic Foundation, United States
Disclosure information not submitted.
Sarah Worley
Sarah Worley, MS
Cleveland Clinic Foundation, United States
Disclosure information not submitted.
Title: Predictors of Survival in Pediatric Inpatient Cardiac Arrest
Introduction: The incidence of pediatric in-hospital cardiac arrest (IHCA) is between 2-6%. This study aimed at evaluating the predictors of survival in IHCA.
Methods: A retrospective chart review that included patients with ICHA who received CPR for > 1 min at a tertiary center over the past 5 years (2015- 2020). We included demographics, location of CPR in the hospital, pre-morbid conditions and detailed evaluation of each CPR event. Analysis of risk factors between survivors and non-survivors to discharge was performed on a complete-case basis and all tests were two-tailed and performed at a significance level of 0.05.
Results: A total of 78 IHCA events requiring CPR in 74 children (0-18 years) were assessed. Median duration of CPR was 10 min (IQR: 2-200). Overall, 42 (56 %) children survived to hospital discharge, and 27(36%) children survived to discharge with good neurological outcome. Our preliminary analysis revealed that patients’ demographics including age, weight, ethnicity, sex and location of the CPR did not influence outcome. There were 26 (34%) children with congenital heart disease and 9 (12%) patients who had cardiac surgery. Cyanotic, acyanotic, STAT category or inciting event (hypoxia, hypotension or bradycardia) did not influence the outcome. Factors that improved survival were shorter duration of CPR (4.5 min vs 33 min; p< 0.001), O2 saturation >60% during CPR (p< 0.045) and serum lactate levels < 4 mmol/L (p< 0.004). Factors that negatively impacted survival were a higher number of epinephrine doses per 5 minutes of CPR (8 doses vs. 1 dose, p < 0.001), higher dosage of calcium gluconate >28 mg/kg (IQR: 0-200, p < 0.001), and amount of fluid resuscitation >10 ml/kg (IQR: 0-65, p < 0.001). Patients with hematological/oncological conditions (P< 0.04) had lowest survival rates. Higher blood pressure measurements (systolic, diastolic or mean) during CPR were not associated with impact on survival. Only, 11 of the 78 patients had end tidal CO2 monitoring during CPR and we didn’t not find correlation between end-tidal CO2 measurements and survival.
Conclusion: Based on our preliminary results, we conclude that shorter duration of CPR, higher oxygen saturation levels during CPR and lower serum lactate levels post CPR are associated with survival to discharge in pediatric IHCA patients.