Elsevier

Resuscitation

Volume 71, Issue 3, December 2006, Pages 301-309
Resuscitation

Clinical paper
Effectiveness and long-term outcome of cardiopulmonary resuscitation in paediatric intensive care units in Spain

https://doi.org/10.1016/j.resuscitation.2005.11.020Get rights and content

Summary

Objective

To analyse the immediate effectiveness of resuscitation and long-term outcome of children who suffered a cardiorespiratory arrest when admitted to paediatric intensive care units (PICU).

Design and setting

Secondary analysis of data from an 18-month prospective, multicentre study analysing cardiorespiratory arrest in children in 16 paediatric intensive care units in Spain.

Patients and methods

We studied 116 children between 7 days and 17 years of age. Data were recorded according to the Utstein style. Analysed outcome variables were sustained return of spontaneous circulation (ROSC), survival to hospital discharge and survival at 1 year. Neurological and general performance outcome was assessed by means of the Paediatric Cerebral Performance Category (PCPC) and the Paediatric Overall Performance Category (POPC) scales.

Interventions

None.

Measurements and results

In 80 patients (69%) ROSC was achieved and it was sustained >20 min in 69 (59.5%). At one-year follow-up, 40 children (34.5%) were alive. Survival was not associated with sex, age or weight of patients. Mortality from cardiac arrest was higher than respiratory arrest (69.8% versus 40%, p = 0.01). Patients with sepsis had a higher mortality than other diagnostic groups. Mechanically ventilated children and those treated with vasoactive drugs had a higher mortality. Initial mortality was slightly higher in patients with slow ECG rhythms (35.7%) compared to those with ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) (27.2%). Duration of resuscitation effort was correlated with mortality (p < 0.0001). Patients who required one or more doses of adrenaline had also a higher mortality (77.8% versus 20.7%, p < 0.0001) and survivors needed less doses of adrenaline (0.85 ± 1.14 versus 4.4 ± 2.9, p < 0.0001). At hospital discharge 86.8 and 84.6% of patients had scores 1 or 2 (normal or near-normal) in the PCPC and POPC scales. At 1-year follow-up these figures were 90.8 and 86.3%, respectively.

Conclusion

One-third of children who suffer a cardiac or respiratory arrest when admitted to PICU survive, and most of them had a good long-term neurological and functional outcome. The duration of cardiopulmonary resuscitation attempts is the best indicator of mortality.

Introduction

Critically ill children have a high risk of complications that can lead to cardiorespiratory arrest (CRA). Resuscitation includes procedures and treatments that are immediately available in the critical care setting and the best possible results in terms of survival and neurological outcome should be obtained.1, 2, 3 However, little has been published about the actual effectiveness and long-term outcome of resuscitation in this subset of patients, and most of the data are difficult to interpret because the studies have been retrospective or included patients having suffered CRA at different in-hospital sites.4, 5, 6, 7, 8

The Utstein style provides uniform guidelines for reporting characteristics and outcome for in-hospital and out-of-hospital CRA in children.8, 10 To date, only one prospective study that analyses, in a single centre, the outcome of in-hospital CRA in children following the Utstein style guidelines has been reported.5

The purpose of the present study was to provide an Utstein style prospective and multicentre report of children who suffered a CRA when admitted to PICU and to evaluate factors associated with survival as well as short and long-term neurological outcome.

Section snippets

Patients and methods

An invitation to participate in the study was sent to 26 paediatric intensive care units (PICU) in Spain.11, 12 A protocol was drawn up in accordance with the Utstein style guidelines.9, 10 This is a secondary analysis of data from a study of cardiopulmonary arrest in Spain; the methodology and primary results of which have been described elsewhere.11, 12 Patients admitted to PICU and aged from 7 days to 18 years were eligible to be included in the present study if they presented emergency

Results

We studied 116 children who presented with a cardiorespiratory arrest while they were hospitalised in 16 PICUs (in-PICU CRA), 71 males (61.2%) and 45 females (38.8%), with a mean age of 37.7 ± 48.7 months (range: 0.1–204 months) and mean weight of 14.3 ± 15.6 kg (range: 2.3–80 kg). This population represents 41% of the 283 children with CRA previously reported.11, 12

In 80 patients (69.0%) resuscitation (CPR) achieved ROSC, that was sustained in 69 (59.5%). In 20 patients (17.2%) restoration of

Discussion

Cardiorespiratory arrest is a rare but relatively expected event in critically ill children.1, 7, 8 However, there is a surprisingly lack of data about the immediate and long-term results of CPR in this specific population.1, 2, 3, 4, 5, 6, 7 The aim of our study was to focus on the data of paediatric CRA occurring in all types of patients admitted to PICU, and to assess the long-term neurological outcome. This is the first prospective and multicentre study of paediatric CPR in PICUs using the

Conflict of interest

None.

Acknowledgment

This study has been supported by a Grant from the Fondo de Investigaciones Sanitarias, 00/0288.

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A Spanish translated version of the summary of this article appears as Appendix in the online version at doi:10.1016/j.resuscitation.2005.11.020.

1

List of study collaborators: Antonio Rodríguez-Núñez (Hospital Clínico Universitario, Santiago de Compostela), Jesús López-Herce, Cristina García, Angel Carrillo (Hospital G.U. Gregorio Marañón, Madrid), Custodio Calvo (Hospital Materno-Infantil, Malaga), Pedro Domínguez (Hospital Vall d’Hebrón, Barcelona), Miguel Angel Delgado (Hospital Infantil La Paz, Madrid), Maria A. García (Hospital Niño Jesús, Madrid), Corsino Rey (Hospital Central de Asturias, Oviedo), Teresa Hermana (Hospital de Cruces, Baracaldo), Jose A. Alonso (Hospital Virgen de la Salud, Toledo), Julio Melendo (Hospital Miguel Servet, Zaragoza), Josefina Cano (Hospital Virgen del Rocío, Sevilla), Servando Pantoja (Hospital Puerta del Mar, Cádiz), Alvaro Díaz (Hospital Tarrasa, Barcelona), Ricardo Martino (Hospital Príncipe de Asturias, Alcalá de Henares), Maria V. Esteban (Hospital Princesa de España, Jaén), Esther Ocete (Hospital Clínico, Granada), Juan I. Muñoz (Hospital Reina Sofía, Córdoba), Amelia Sánchez-Galindo (Hospital Juan Canalejo, La Coruña), Antonio Gómez Calzado (Hospital Virgen Macarena, Sevilla). Statistical data analysis: Jose M Bellón and Maria La Calle (Gregorio Marañón Hospital, Madrid).

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