Ryan Morgan, MD, MTR
Assistant Professor of Anesthesia, Critical Care, & Pediatrics
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Heather Wolfe, MD,
Pediatric Critical Care Attending Physician
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Ron Reeder, PhD
Associate Professor
University of Utah, United States
Disclosure information not submitted.
Jessica Alvey, MS
Biostatistician III
University of Utah, United States
Disclosure information not submitted.
Aisha Frazier, MD, MPH
Attending Physician
Nemours Alfred I. duPont Hospital for Children, United States
Disclosure information not submitted.
Stuart Friess, MD
Associate Professor of Pediatrics
Washington University in St. Louis School of Medicine, United States
Disclosure information not submitted.
Patrick McQuillen, MD
Professor
University of California San Francisco Medical Center, United States
Disclosure information not submitted.
Kathleen Meert, MD, FCCM (she/her/hers)
Professor and Chairman of Pediatrics
Children's Hospital of Michigan
Detroit, Michigan, United States
Disclosure information not submitted.
.jpg "Vinay Nadkarni, MD, MS, FCCM (he/him/his) photo")
Vinay Nadkarni, MD, MS, FCCM (he/him/his)
Professor, Anesthesiology, Critical Care and Pediatrics
University of Pennsylvania Perelman School of Medicine, CHOP
Media, Pennsylvania, United States
Disclosure information not submitted.
Ashley Siems, MD, MEd
MD, MEd
Johns Hopkins All Children's Hospital, United States
Disclosure information not submitted.
Matthew Sharron, MD
Associate Professor
Children's National Hospital / George Washington University School of Medicine, United States
Disclosure information not submitted.
Andrew Yates, MD
Associate Professor of Pediatrics
Nationwide Children's Hospital, United States
Disclosure information not submitted.
Robert Berg, MD, MCCM (he/him/his)
Division Chief, Pediatric Critical Care Medicine
Children's Hospital of Philadelphia
Merion Station, Pennsylvania, United States
Disclosure information not submitted.
Robert Sutton, MD, FCCM
Professor of Anesthesia, Critical Care, & Pediatrics
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Title: The Impact of the COVID-19 Pandemic on Pediatric Cardiopulmonary Resuscitation Quality and Outcomes
Introduction: Although children have lower rates of infection and mortality from coronavirus disease 2019 (COVID-19), the COVID-19 pandemic resulted in adaptations to resuscitation systems of care that extend to pediatrics. The impact of the pandemic and these changes on pediatric in-hospital cardiac arrest (IHCA) outcomes is unknown.
Methods: Subjects included children ≤18 years old and ≥37 weeks corrected gestational age who received chest compressions while admitted to one of the 18 ICUs of The ICU-RESUScitation Project (NCT028374497), a prospective, multicenter, cluster randomized interventional trial. In this secondary analysis, patients were classified according to the date of CPR as “pre-pandemic” (3/1/2019 – 2/29/2020) or “pandemic” (3/1/2020 – 2/28/2021). Clinical characteristics, intra- and post-arrest physiologic measurements, event outcomes, and hospital survival data were compared between groups with univariable analyses and multivariable logistic and linear regression models controlling for predetermined covariates. The primary outcome was survival to hospital discharge with favorable neurologic outcome (Pediatric Cerebral Performance Category score ≤3 or no worse than baseline).
Results: In the 429 children meeting inclusion criteria, those with IHCAs during the pandemic period were more likely to have hypotension as the immediate cause of arrest (56% vs. 45%; p=0.03). Cardiac arrest physiology, chest compression mechanics, CPR quality metrics, and post-arrest physiologic and quality of care metrics were similar between the two periods. Survival with favorable neurologic outcome occurred in 102/195 (52%) subjects during the pandemic vs. 140/234 (60%) pre-pandemic (p=0.12). There were no differences in immediate event outcomes, survival to discharge, or total functional status score (FSS) at discharge. After adjustment for confounders, survivors in the pandemic period had larger increases in FSS (worse) compared to baseline (+1.19 [95% CI: 0.35-2.04] FSS points; p< 0.01) and had nearly twice the odds (aOR 1.88 [95% CI: 1.03-3.46]; p=0.04) of having a new morbidity (FSS change ≥3) compared to pre-pandemic.
Conclusions: In the first year of the COVID-19 pandemic, pediatric IHCA survival rates did not differ from the year prior, but functional status at hospital discharge was worse among survivors.