Factors Associated With Pediatric In-Hospital Recurrent Cardiac Arrest

First Author(s)

• 

  Stephanie Brown, MBBS, MS

  Assistant Professor
  University of Oklahoma
  Oklahoma City, Oklahoma

  Disclosure information not submitted.

  Slides and Audio

Co-Author(s)

• JR

  Joan Roberts, MD

  Associate Professor
  Seattle Children's Hospital, University of Washington, United States

  Disclosure information not submitted.

Research Presenters(s)

• 

  Elizabeth Killien, MD, MPH

  Assistant Professor
  Seattle Children's Hospital
  Seattle, Washington

  Disclosure information not submitted.

Co-Author(s)

• TB

  Thomas Brogan, MD

  Professor
  Children's Hospital, United States

  Disclosure information not submitted.
• RF

  Reid Farris, MD, MS

  Associate Professor
  Seattle Childrens Hospital, United States

  Disclosure information not submitted.
• JD

  Jane Di Gennaro, MD, MS

  Associate Professor, Pediatrics
  University of Washington & Seattle Children's Hospital, United States

  Disclosure information not submitted.
• 

  Jessica Barreto Guacaneme, MD, MS

  Fellow
  Boston Childrens Hospital
  Seattle, Washington, United States

  Disclosure information not submitted.
• DM

  David McMullan, MD

  Professor
  Seattle Children's Hospital, United States

  Disclosure information not submitted.
• NW

  Noel Weiss, MD, DrPH

  Professor Emeritus
  University of Washington, United States

  Disclosure information not submitted.

Title: Factors Associated with Pediatric In-Hospital Recurrent Cardiac Arrest

Objective: Identify demographic and clinical factors associated with early recurrent arrest (< 48 hours) and late recurrent arrest (≥48 hours) among pediatric inpatients following an initial in-hospital cardiac arrest.

Methods: Retrospective cohort study of inpatients in a free-standing academic quaternary care children’s hospital. All inpatients < 18 years old with a cardiac arrest event requiring ≥1 minute of cardiopulmonary resuscitation with return of spontaneous circulation sustained for ≥20 minutes at Seattle Children’s Hospital from February 1, 2012 to September 18, 2019.

Results: Of the 237 patients included in this study, 20 (8%) patients had an early recurrent arrest and 30 (13%) had a late recurrent arrest. Older age and severe pre-arrest acidosis were associated with higher risk of early recurrent arrest, OR 1.2 (95% CI 1.1-1.3) per additional year and 4.6 (95% CI 1.2-18.1), respectively. Pre-arrest organ dysfunction was also associated with a higher risk of early recurrent arrest with an OR of 3.3 (95% CI 1.1-9.4) for respiratory dysfunction, OR 1.4 (95% CI 1.1-1.9) for each additional dysfunctional organ system and OR 1.1 (95% CI 1-1.2) for every one-point increase in PELOD2 score. Neonatal illness category was associated with a lower risk of late recurrent arrest, OR 0.3 (95% CI 0.1-0.96) and severe post-arrest acidosis was associated with a higher risk of late recurrent arrest, OR 4.2 (95% CI 1.1-15).

Conclusions: Several demographic and clinical factors offer some ability to identify children who sustain a recurrent cardiac arrest, offering a potential opportunity for intervention to prevent early recurrent arrest.