Elsevier

Resuscitation

Volume 64, Issue 1, January 2005, Pages 79-85
Resuscitation

Long-term outcome of paediatric cardiorespiratory arrest in Spain

https://doi.org/10.1016/j.resuscitation.2004.07.010Get rights and content

Abstract

Objective:

To analyse the final outcome of cardiorespiratory arrest (CRA) in children and the neurological and functional state of survivors at 1 year.

Methods:

An 18-month prospective, multicentre study analysing out-of-hospital and in-hospital CRA in children was carried out; 283 children between 7 days and 17 years of age were included. CRA and resuscitation data were registered according to Utstein style. The outcome variables were: sustained return of spontaneous circulation (initial survival), and survival at 1 year (final survival). The status of survivors was evaluated by means of the paediatric cerebral performance category (PCPC) scale and the paediatric overall performance category (POPC) scale at Paediatric Intensive Care Unit discharge, at hospital discharge, and at 1 year follow-up.

Results:

In 283 children, 311 CRA episodes, 73 respiratory arrests (23.5%) and 238 cardiac arrests (76.5%) were analysed. Seventeen children suffered more than one CRA episode (range: 2–6). The initial survival was 60.2% and 1-year survival was 33.2%. The final survival was significantly higher in respiratory arrest than in cardiac arrest patients (70.0% versus 21.1%) (P < 0.0001). After 1 year follow-up, 87.3% of patients had scores 1 or 2 on the PCPC scale and 84.0% had scores 1 or 2 in the POPC scale; these results indicate that 1 year after CRA, the majority of survivors had normal neurological and functional status or showed only mild disability.

Conclusions:

Prognosis of CRA in children continues to be poor in terms of survival but quite good in terms of neurological and functional status among survivors. Additional strategies and efforts are needed to improve the short-term prognosis of paediatric CRA. However, the long-term outcome of survivors is reassuring.

Introduction

Cardiorespiratory arrest (CRA) mortality remains very high both in adults [1], [2], [3], [4], [5] and children [6], [7], [8], [9], [10]. Besides the mortality, short- and long-term morbidity, and specifically, neuro-psychological status of patients after resuscitation, is a main concern. Some studies, restricted to adult patients, have assessed the long-term prognosis after CRA [2], [11], the neuro-psychological disabilities and the quality of life of survivors [12]. There are few studies including a significant number of subjects that have analysed the survival of children who experienced CRA [9], [10]. Until to the present some retrospective investigations have been done to assess the long-term neurological outcome of resuscitated children [13], [14], [15], [16], [17], [18], but only one prospective work that evaluated the long-term prognosis and sequelae of paediatric in-hospital CRA, in a single centre, is available [9].

We have carried out a prospective and multicentre study to know the current characteristics of paediatric CRA in Spain [19]. In this study, we report the long-term outcome of the survivors with special focus on the final cerebral and general performance status.

Section snippets

Patients and methods

An invitation to participate was sent to all the Paediatric Intensive Care Units (PICU), Paediatric Departments and out-of-hospital Emergency Medical Systems in Spain [20]. A protocol was drawn up in accordance with the Utstein style guidelines [21], [22]. Patients aged from 7 days to 18 years were eligible for the study if they had presented with respiratory arrest (RA), defined as the absence of respiration requiring assisted ventilation, or cardiac arrest (CA), defined as the absence of a

Results

From 1 April 1998 to 30 September 1999 we collected 311 CRA episodes, 73 respiratory arrest (23.5%) and 238 cardiac arrest (76.5%), that occurred in 283 children, with a mean age of 48 ± 54.4 months (range: 7 days to 17 years). Seventeen children (7.1%) suffered more than one CRA episode (range: 2–6).

Discussion

As far as we know, this is the first prospective multicentre study that analyses the long-term functional outcome of in-hospital and out-of-hospital CRA in children. Only one previously published study, done in a single centre, has analysed in-hospital paediatric CRA following the Utstein style, including long-term outcome aspects [9]. Survival of paediatric CRA has been dismal in most studies in the past; however, the crude long-term survival in this study has been 33%, a figure slightly

Acknowledgment

This study has been supported by a grant from the Fondo de Investigaciones Sanitarias 00/028.

References (25)

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    Finally, our study is limited by lack of long-term neurological follow-up and the use of only a global measure of neurological function, the PCPC, as a neurological outcome. However, previous studies suggest that neurological status at discharge is not substantially different from status at 6 months and 1 year after arrest, and the PCPC is the standard for Utstein reporting.12,21,22 Finally it is possible that the existing GWTG-R data elements fail to capture other, unmeasured confounders of outcomes, despite the use of suitable analytical techniques.

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A Spanish and Portuguese translated version of the Abstract and Keywords of this article appears at doi:10.1016/j.resuscitation.2004.07.010.

1

Collaborators in the work: Jesús López-Herce, Cristina García, Angel Carrillo (Hospital Gregorio Marañón, Madrid), Pedro Domínguez (Hospital Valle de Hebrón, Barcelona), Maria A. García (Hospital del Niño Jesús, Madrid), Custodio Calvo (Hospital Materno Infantil, Málaga), Miguel A. Delgado (Hospital Infantil La Paz, Madrid), Antonio Rodríguez-Núñez (Hospital Clínico Universitario, Santiago), Jose A. Alonso (Hospital Virgen de la Salud, Toledo), Julio Melendo (Hospital Miguel Servet, Zaragoza), Corsino Rey (Hospital Central de Asturias, Oviedo), Teresa Hermana (Hospital de Cruces, Baracaldo), Josefina Cano (Hospital Virgen del Rocío, Sevilla), Francisco Romero (Servicio de Urgencias 061, Jaén), Servando Pantoja (Hospital Puerta del Mar, Cádiz), Carlos Lucena (061 de Almería), Pere Plaja (Hospital de Palamós, Gerona), Ana Concheiro (Hospital San Juan de Dios, Barcelona), Alvaro Díaz (Hospital de Tarrasa, Barcelona), Ricardo Martino (Hospital Príncipe de Asturias, Alcalá de Henares), Maria V. Esteban (Hospital Princesa de España, Jaén), Nieves de Lucas (SAMUR, Madrid), Esther Ocete (Hospital Clínico de Granada), Juan I. Muñoz (Hospital Reina Sofía, Córdoba), Maria A. Rodríguez (Hospital Comarcal da Barbanza, Coruña), Susana Simó (Servicio de Urgencias 061, Barcelona), Eduard Solé (Hospital Arnaú de Villanova, Lérida), Enrio Jiménez (Hospital del Mar, Barcelona), Rosario Alvarez (Hospital de Jarrio, Asturias), Víctor Canduela (Hospital de Laredo, Cantabria), Antonio Fernández (Hospital San Agustín, Linares), Amelia Sánchez-Galindo (Hospital Juan Canalejo, La Coruña), R. Closa (Hospital Juan XXIII, Barcelona), P. Villalobos (Hospital de Figueras, Gerona), Orenci Urraca (Hospital Nens, Barcelona), Federico Pérez (Hospital Josep Trueta, Gerona), Antonio Torres (Hospital San Juan de Dios, Úbeda), Miguel Labay (Hospital Obispo Polanco, Teruel), Ma Luisa Masiques (Hospital de Mollet, Barcelona), Fátima Aborto (Hospital Juan Ramón Jiménez, Huelva), Narcisa Palomino (Hospital Ciudad de Jaén, Jaén), Abadía, Hospital de la Selva, Gerona), Monserrat Miquel (Hospital San Celoni, Barcelona), Antonio Gómez Calzado (Hospital Virgen Macarena, Sevilla), Jose M Bellón and Maria La Calle (Gregorio Marañón Hospital, statistical data analysis).

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