Factors Associated with Pediatric In-Hospital Recurrent Cardiac Arrest

Abstract

The objective of this article was to identify demographic and clinical factors associated with early recurrent arrest (RA; <48 hours) and late RA (≥48 hours) among pediatric inpatients following an initial in-hospital cardiac arrest. A retrospective cohort study of inpatients was performed in a free-standing academic quaternary care children's hospital. All inpatients were <18 years old with a cardiac arrest event requiring ≥1 minute of cardiopulmonary resuscitation with the return of spontaneous circulation sustained for ≥20 minutes at Seattle Children's Hospital from February 1, 2012, to September 18, 2019. Of the 237 included patients, 20 (8%) patients had an early RA and 30 (13%) had a late RA. Older age and severe prearrest acidosis were associated with a higher risk of early RA, odds ratios (OR) = 1.2 (95% confidence interval [CI]: 1.1–1.3) per additional year and 4.6 (95% CI: 1.2–18.1), respectively. Prearrest organ dysfunction was also associated with a higher risk of early RA with an OR of 3.3 (95% CI: 1.1–9.4) for respiratory dysfunction, OR = 1.4 (95% CI: 1.1–1.9) for each additional dysfunctional organ system, and OR = 1.1 (95% CI: 1–1.2) for every one-point increase in PELOD2 score. The neonatal illness category was associated with a lower risk of late RA, OR 0.3 (95% CI: 0.1–0.97), and severe postarrest acidosis was associated with a higher risk of late RA, OR = 4.2 (95% CI: 1.1–15). Several demographic and clinical factors offer some ability to identify children who sustain a recurrent cardiac arrest, offering a potential opportunity for intervention to prevent early recurrent arrest.

Keywords

resuscitation - extracorporeal life support - cardiac arrest - inpatients

Publication History

Received: 22 August 2021

Accepted: 27 November 2021

Article published online:
03 January 2022

• References

• 1 Knudson JD, Neish SR, Cabrera AG. et al. Prevalence and outcomes of pediatric in-hospital cardiopulmonary resuscitation in the United States: an analysis of the Kids' Inpatient Database. Crit Care Med 2012; 40 (11) 2940-2944
• 2 Gupta P, Pasquali SK, Jacobs JP. et al; American Heart Association's Get With the Guidelines–Resuscitation Investigators. Outcomes following single and recurrent in-hospital cardiac arrests in children with heart disease: a report from American Heart Association's Get With the Guidelines Registry-Resuscitation. Pediatr Crit Care Med 2016; 17 (06) 531-539
• 3 Callaway CW, Donnino MW, Fink EL. et al. Part 8: Post-cardiac arrest care: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2015; 132 (18, Suppl 2): S465-S482
• 4 Girotra S, Spertus JA, Li Y, Berg RA, Nadkarni VM, Chan PS. American Heart Association Get With the Guidelines–Resuscitation Investigators. Survival trends in pediatric in-hospital cardiac arrests: an analysis from Get With the Guidelines-Resuscitation. Circ Cardiovasc Qual Outcomes 2013; 6 (01) 42-49
• 5 Joffe AR, Lequier L, Robertson CMT. Pediatric outcomes after extracorporeal membrane oxygenation for cardiac disease and for cardiac arrest: a review. ASAIO J 2012; 58 (04) 297-310
• 6 Tajik M, Cardarelli MG. Extracorporeal membrane oxygenation after cardiac arrest in children: what do we know?. Eur J Cardiothorac Surg 2008; 33 (03) 409-417
• 7 Gupta P, Yan K, Chow V. et al. Variability of characteristics and outcomes following cardiopulmonary resuscitation events in diverse ICU settings in a single, tertiary care children's hospital*. Pediatr Crit Care Med 2014; 15 (03) e128-e141
• 8 Matos RI, Watson RS, Nadkarni VM. et al; American Heart Association's Get With The Guidelines–Resuscitation (Formerly the National Registry of Cardiopulmonary Resuscitation) Investigators. Duration of cardiopulmonary resuscitation and illness category impact survival and neurologic outcomes for in-hospital pediatric cardiac arrests. Circulation 2013; 127 (04) 442-451
• 9 Leteurtre S, Martinot A, Duhamel A. et al. Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study. Lancet 2003; 362 (9379): 192-197
• 10 R Core Team. 2020 R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Accessed on 11/09/2021 at: https://www.R-project.org/
• 11 Robin X, Turck N, Hainard A. et al. pROC: an open-source package for R and S+ to analyze and compare ROC curves. BMC Bioinformatics 2011; 12: 77
• 12 Lüdecke D. 2021 sjPlot: data visualization for statistics in social science. R package version 2.8.9. Accessed on 11/09/2021 at: https://CRAN.R-project.org/package=sjPlot
• 13 Zeileis A, Köll S, Graham N. Various versatile variances: an object-oriented implementation of clustered covariances in R. J Stat Softw 2020; 95 (01) 1-36
• 14 Zeileis A. Econometric computing with HC and HAC covariance matrix estimators. J Stat Softw 2004; 11 (10) 1-17
• 15 Typpo KV, Petersen NJ, Markovitz BPMM. Day one MODS is associated with poor functional outcome and mortality in the pediatric intensive care unit. Pediatr Crit Care Med 2009; 10 (05) 562-570
• 16 Typpo K, Watson RS, Bennett TD, Farris RWD, Spaeder MC, Petersen NJ. Pediatric Existing Data Analysis (PEDAL) Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI) Network. Outcomes of day 1 multiple organ dysfunction syndrome in the PICU. Pediatr Crit Care Med 2019; 20 (10) 914-922
• 17 Brown SR, Brogan TV, McMullan DM, Roberts JS. Outcomes after in-hospital pediatric recurrent cardiac arrests. Pediatr Crit Care Med 2020; 21 (11) e981-e987
• 18 Alnabelsi T, Annabathula R, Shelton J. et al. Predicting in-hospital mortality after an in-hospital cardiac arrest: a multivariate analysis. Resusc Plus 2020; 4 (July): 100039
• 19 Meaney PA, Nadkarni VM, Cook EF. et al; American Heart Association National Registry of Cardiopulmonary Resuscitation Investigators. Higher survival rates among younger patients after pediatric intensive care unit cardiac arrests. Pediatrics 2006; 118 (06) 2424-2433