Clinical paperSurvey of outcome of CPR in pediatric in-hospital cardiac arrest in a medical center in Taiwan☆
Introduction
Although cardiopulmonary resuscitation (CPR) has been available for children for more than 50 years,1 the results remain far from satisfactory. As the Utstein template is suggested as the standard for reporting the outcomes of CPR,2 there are several studies of in-hospital cardiac arrests (IHCA) in children, such as national registry of cardiopulmonary resuscitation (NRCPR) in United States,3, 4 Canada,5, 6 South America,7 Australia,8 and European countries.9, 10, 11, 12 These data are lacking for Asian countries. The goal of this study was to report the outcomes of IHCA among pediatric patients in our institute and compare them to those of Western countries.
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Hospital setting
NTUH is a university-affiliated tertiary teaching hospital, with a 120-bed pediatric department. The hospital has a 13-bed pediatric intensive care unit (PICU). According to hospital policy, there are always manpower and monitoring devices within the PICU or emergency department in the hospital so that there is no need to call for a CPR team when IHCA occurs in these locations. Otherwise, the pediatric CPR team helps manage any cardiorespiratory arrest outside the aforementioned areas, such as
Results
During the study period, 316 cardiac arrests occurred that resulted in CPR; the incidence was 0.9% out of 35,497 pediatric admissions and 5.7% out of 5514 PICU admissions, which was higher than the report from Australia (0.1 and 2.4%, respectively)8 and Canada (0.94% for PICU admissions),6 but lower than in Finland (0.7 and 7.5%)12and Brazil (2.14 and 19%).7 In this cohort, 228 patients (72.2%) ever achieved ROSC, 174 patients (55.1%) had 24-h survival, 66 patients (20.9%) survived to discharge
Discussion
We describe the outcomes of CPR for pediatric IHCA at National Taiwan University Hospital, based on Utstein template. The overall hospital survival was 20.9% and 16.1% of the patients had favorable good neurological outcomes. Of the 252 patients who received conventional CPR, 60.7% had sustained ROSC, 48.0% had 24 h survival, 19.8% survival to discharge, 17.9% survived 1 year and only 15.5% had good neurological outcomes. We also identified the risk factors that were associated with poor
Conclusions
In conclusion, about 20.9% of the children who had IHCA at National Taiwan University Hospital survived to discharge and 16.1% had good neurological outcomes at discharge. This is comparable to previous reports, but more hematologic/oncologic patients are included than previous studies. Several factors are associated with poor outcomes, including hematologic and oncologic disease, long CPR duration, and vasoactive infusions before IHCA. Besides, CPR during off-work hours resulted in inferior
Conflict of interest
There is no financial or personal relationship with other people or organizations that could inappropriately influence our work in this report.
Acknowledgments
We thank Dr. Fu-Chang Hu, National Center of Excellence for General Clinical Trial and Research, National Taiwan University Hospital and College of Public Health, National Taiwan University, for his help in the statistical computing and logistic regression analysis of the data.
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Sodium bicarbonate administration during in-hospital pediatric cardiac arrest: A systematic review and meta-analysis
2021, ResuscitationCitation Excerpt :Matos et al. demonstrated that CPR duration was an independent factor associated with increased mortality.50 In our meta-analysis, several included studies also revealed a significant increase in CPR duration in the non-survival group and SB was administered more frequently to patients with prolonged cardiac arrest.11,32–37 Therefore, SB administration might be a last-ditch effort to obtain ROSC rather than a factor that caused a decreased survival rate.
European Resuscitation Council Guidelines 2021: Paediatric Life Support
2021, ResuscitationCitation Excerpt :appendix RR 31.3).143 Since 2010, one narrative review732 and nine observational trials were published describing the association between the administration of sodium bicarbonate (or THAM) and outcomes in paediatric CA (appendix RR 31.4).14,730,733–738 Whilst these studies are likely to be confounded by the association between administration of sodium bicarbonate and longer CPR duration, none provide any evidence to change the recommendation that bicarbonate should not be given routinely in paediatric CA.
Cardiopulmonary resuscitation (CPR) in children with heart disease
2018, Critical Heart Disease in Infants and ChildrenThe epidemiology and outcomes of pediatric in-hospital cardiopulmonary arrest in the United States during 1997 to 2012
2016, ResuscitationCitation Excerpt :One study that examined national temporal trends of adult IHCA incidence demonstrated an increase in IHCA event rate from 2003 to 2007.13 Pediatric IHCA incidence rates range from 1.1/1000 to 21/1000.1–4 It is difficult to compare these results for trend analysis because of the heterogeneity among the studies.
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2009.01.006.