Elsevier

Resuscitation

Volume 84, Issue 12, December 2013, Pages 1685-1690
Resuscitation

Clinical paper
The epidemiology and resuscitation effects of cardiopulmonary arrest among hospitalized children and adolescents in Beijing: An observational study

https://doi.org/10.1016/j.resuscitation.2013.08.007Get rights and content

Abstract

Aim

To investigate the epidemiology and resuscitation effects of cardiopulmonary arrest among hospitalized children and adolescents in Beijing.

Methods

A prospective multicentre study was conducted in four hospitals in urban/suburban areas of Beijing. Patients aged 1 month–18 years with cardiopulmonary arrest and received cardiopulmonary resuscitation (CPR) who were consecutively hospitalised during the study period (1 September 2008–31 December 2010) were enrolled. Data was collected and analyzed using the “in-hospital Utstein style”. Neurological outcome was assessed with the pediatric cerebral performance category (PCPC) among patients who survived.

Result

201 of 108,673 hospitalized patients (0.18%) had cardiopulmonary arrest during their hospitalization. Of these, 174 patients underwent CPR. The most common causes of cardiopulmonary arrest were the diseases of respiratory system (29.3%) and circulatory system (19.0%). The most common initial rhythm was bradycardia (72.4%). About 108 patients (62.1%) had restoration of spontaneous circulation (ROSC). Forty-nine patients (28.2%) survived to hospital discharge, 25 (14.5%) survived 6 months post discharge, and 21 (12.1%) survived 1 year post discharge. Out of the 21 patients who survived 1 year after hospital discharge, 18 had good neurological outcome. Multivariate logistic regression analysis showed age, duration of CPR and endotracheal intubation performed before cardiopulmonary arrest were independent factors of cardiopulmonary resuscitation effect.

Conclusion

The prevalence of in-hospital cardiopulmonary arrest in children and adolescents is low. The long-term result of children and adolescents survived from cardiopulmonary resuscitation is quite good. Age, CPR duration and endotracheal intubation performed before cardiopulmonary arrest were independent factors of cardiopulmonary resuscitation effect.

Introduction

The prevalence of cardiopulmonary arrest in children is low. It is between 0.08% and 2.0% among hospitalised children1, 2, 3 while it ranges from 2.4% to 19% in pediatric intensive care units (PICU).1, 2, 3, 4 The survival rates of children discharged from the hospital with cardiopulmonary resuscitation (CPR) have significantly improved during the last decade.1, 2, 3, 4, 5, 6 However, the long-term prognosis of survived children has been studied less.2, 3, 4, 5, 7, 8 The use of Utstein styles allows the comparison with the results of different studies.9, 10, 11

The prevalence and outcomes of pediatric cardiopulmonary arrest are not well-characterized in China mainland. The objective of this research was to study the epidemiology of cardiopulmonary arrest among hospitalised children in Beijing. Secondary objectives included assessment of resuscitation effect and analysis of influential factors on restoration of spontaneous circulation and survival to hospital discharge.

Section snippets

Setting

A prospective, multicentre observational study was conducted in four hospitals in urban or suburban areas of Beijing – 3 tertiary hospitals and 1 secondary hospital. Two of the tertiary hospitals provided medical and surgical pediatric services including emergency care, cardiac surgery and pediatric intensive care. More than 40,000 patients were admitted to these 2 hospitals each year .The other 2 hospitals provided only medical services, and about 6000 patients were admitted each year to these

Results

108,673 patients (excluding neonates) admitted to the four hospitals and 3076 admitted to PICU during the study period (between 1 September 2008 and 31 December 2010) were enrolled in the study. Of the hospitalised patients, 201 (0.18%) had cardiopulmonary arrest during their hospitalization, and 168 of the 3076 PICU patients had cardiopulmonary arrest while they were at the hospital.

Discussion

In this study, the prevalence of cardiopulmonary arrest among hospitalised patients was observed to be 0.18%, while in patients who were admitted to the ICU it was 5.5%. The survival rate to discharge 10 years ago was 14.7%3, while another recent report suggested 48.7%6. In the current study, survival rate to discharge was 28.2%. The differences in survival rate to discharge may be attributed to the different types of patients included in different studies. The prospective investigation by Reis

Conclusion

The prevalence of in-hospital cardiopulmonary arrest in children and adolescents is low. The long-term neurological outcome of children and adolescents who survived from CPR is quite good. Age, CPR duration and endotracheal intubation performed before cardiopulmonary arrest were the independent factors of CPR effect.

Conflict of interest statement

None.

Acknowledgements

Here we would like to thank Dr Chan Yoke Hwee and Dr Fu Sheng from PICU and division of medicine, Singapore KK Women's and Children's Hospital for their review, revises and comments for this manuscript.

And also we would like to thank Duke-NUS/SingHealth Academic Medicine Research Institute and Ms. Taara Madhavan (Associate, Duke-NUS Graduate Medical School) in editing this manuscript.

This study has been supported by a grant from Capital Medical Development Scientific Research Foundation (Grant

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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2013.08.007

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