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Factors associated with mortality in pediatric in-hospital cardiac arrest: a prospective multicenter multinational observational study

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Abstract

Purpose

To analyze prognostic factors associated with in-hospital cardiac arrest (CA) in children.

Methods

A prospective, multicenter, multinational, observational study was performed on pediatric in-hospital CA in 12 countries and included 502 children between 1 month and 18 years. The primary endpoint was survival at hospital discharge. Univariate and multivariate logistic regression analyses were performed to assess the influence of each factor on mortality.

Results

Return of spontaneous circulation was achieved in 69.5 % of patients; 39.2 % survived to hospital discharge and 88.9 % of survivors had good neurological outcome. The pre-arrest factors related to mortality were lower Human Development Index [odds ratio (OR) 2.32, 95 % confidence interval (CI) 1.28–4.21], oncohematologic disease (OR 3.33, 95 % CI 1.60–6.98), and treatment with inotropic drugs at the time of CA (OR 2.35, 95 % CI 1.55–3.56). CA and resuscitation factors related to mortality were CA due to neurological disease (OR 5.19, 95 % CI 1.49–18.73) and duration of cardiopulmonary resuscitation greater than 10 min (OR 4.00, 95 % CI 1.49–18.73). Factors related to survival were CA occurring in the pediatric intensive care unit (PICU) (OR 0.38, 95 % CI 0.16–0.86) and shockable rhythm (OR 0.26, 95 % CI 0.09–0.73).

Conclusions

In-hospital CA in children has a low survival but most of the survivors have a good neurological outcome. Some prognostic risk factors cannot be modified, making it important to focus efforts on improving hospital organization to care for children at risk of CA in the PICU and, in particular, in other hospital areas.

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Acknowledgments

This study was supported in part by grant RT02377 from the Science and Technology for Development (CYTED) Program and by grant PI081167 from Carlos III Institute of Health, Spain.

Author information

Authors and Affiliations

  1. Pediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Dr Castelo 47, 28009, Madrid, Spain

    Jesús López-Herce, Jimena del Castillo & Angel Carrillo Álvarez

  2. Hospital Escuela, Tegucigalpa, Honduras

    Martha Matamoros

  3. Hospital Valle de Hebrón, Barcelona, Spain

    Sonia Cañadas

  4. Hospital Niño Jesús, Tucumán, Argentina

    Ana Rodriguez-Calvo

  5. Ospedale Bambinu Gesu, Rome, Italy

    Corrado Cecchetti

  6. Hospital Clínico Universitario de Santiago de Compostela, Santiago, Spain

    Antonio Rodriguez-Núñez

Authors
  1. Jesús López-Herce
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  2. Jimena del Castillo
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  3. Martha Matamoros
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  4. Sonia Cañadas
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  5. Ana Rodriguez-Calvo
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  6. Corrado Cecchetti
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  7. Antonio Rodriguez-Núñez
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  8. Angel Carrillo Álvarez
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Consortia

Iberoamerican Pediatric Cardiac Arrest Study Network RIBEPCI

Corresponding author

Correspondence to Jesús López-Herce.

Additional information

The investigators of the Iberoamerican Pediatric Cardiac Arrest Study are listed in the Appendix.

List of the investigators of the Iberoamerican Pediatric Cardiac Arrest Study

List of the investigators of the Iberoamerican Pediatric Cardiac Arrest Study

Network: Jesús López-Herce, Jimena del Castillo, Javier Urbano, Angel Carrillo, Jose María Bellón (Hospital General Universitario Gregorio Marañón, Madrid, Spain), Martha Matamoros, Roger Rodriguez, Allison Callejas, Douglas Carranza (Hospital Escuela, Tegucigalpa, Honduras), Sonia Cañadas, Pedro Dominguez (Hospital Valle de Hebrón, Barcelona, Spain), Ana Rodriguez Calvo, Lorenzo Marcos (Hospital Niño Jesús, Tucumán, Argentina), Corrado Cecchetti (Ospedale Bambinu Gesu, Roma, Italy), Marta Silva (Hospital San Joao, Porto, Portugal), Regina Grigolli Cesar (Irmandade da Santa Casa de Misericordia, Sao Paulo, Brasil), Javier Pilar Orive (Hospital de Cruces, Baracaldo, Spain), Ana María Nieva (Hospital de Niños Ricardo Gutiérrez, Buenos Aires, Argentina), Antonio Rodríguez-Nuñez (Hospital Clínico Universitario, Santiago de Compostela, Spain), Marta Parada (Hospital Pediatrico, Coimbra, Portugal), María Angeles García Teresa (Hospital Niño Jesús, Madrid, Spain), Di Prietro Pasquale (Ospedale Gaslini, Genova, Italy), Miguel Angel Delgado (Hospital Universitario La Paz, Madrid, Spain), Mauricio Fernández, Hospital Pablo Tobón Uribe, Medellín, Colombia), Roxana Flavia Jaén (Hospital Británico, Buenos Aires, Argentina), Juan Garbayo Solana (Hospital Reina Sofía, Córdoba, España), Raúl Borrego Domínguez (Hospital Virgen de la Salud, Toledo, Spain), Víctor Monreal (Hospital Roberto del Río, Santiago de Chile, Chile), Cristina Molinos (Hospital de Cabueñes, Asturias, Spain), Iolster Thomas (Hospital Universitario Austral, Buenos Aires, Argentina), Ricardo Iramaín (Hospital Nacional de Asunción, Asunción, Paraguay), Juan Carlos de Carlos (Hospital Son Dureta, Palma de Mallorca, Spain), Corsino Rey Galán (Hospital Central de Asturias, Oviedo, Spain), Olivia Pérez Quevedo (Hospital Materno Infantil de Las Palmas, Las Palmas de Gran Canaria, Spain), Adriana Koliski (Hospital da clinicas da UFPR, Curitiba, Brasil), Santiago Campos (Hospital SOLCA, Quito, Ecuador), Alfredo Reparaz (Complexo Hospitalario Universitario de Vigo, Vigo, Spain), Sivia Sánchez Pérez (Corporacion Parc Taul, Sabadell, Spain), Deolinda Matos (Hospital García de Orta, Almada, Portugal), Claudia Carolina Benaroya Hospital Regional Río Gallegos, Río Gallegos, Argentina), Lourdes Marroquín Yañez (Hospital Infantil de México Federico Gómez, México), Antonio de Francisco (Hospital Germans Trias i Pujol, Barcelona, Spain).

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López-Herce, J., del Castillo, J., Matamoros, M. et al. Factors associated with mortality in pediatric in-hospital cardiac arrest: a prospective multicenter multinational observational study. Intensive Care Med 39, 309–318 (2013). https://doi.org/10.1007/s00134-012-2709-7

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  • DOI: https://doi.org/10.1007/s00134-012-2709-7

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