TY - JOUR
T1 - Multicenter cohort study of out-of-hospital pediatric cardiac arrest
AU - Moler, Frank W.
AU - Donaldson, Amy E.
AU - Meert, Kathleen
AU - Brilli, Richard J.
AU - Nadkarni, Vinay
AU - Shaffner, Donald H.
AU - Schleien, Charles L.
AU - Clark, Robert S.B.
AU - Dalton, Heidi J.
AU - Statler, Kimberly
AU - Tieves, Kelly S.
AU - Hackbarth, Richard
AU - Pretzlaff, Robert
AU - Van Der Jagt, Elise W.
AU - Pineda, Jose
AU - Hernan, Lynn
AU - Dean, J. Michael
N1 - Funding Information:
Supported, in part, by the Eunice Kennedy Shriver National Institutes of Health, National Institute of Child Health and Human Development, Rockville, MD (grants HD044955 and HD050531 to FWM) . The Pediatric Emergency Care Applied Research Network (PECARN) is supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration, Emergency Medical Services for Children Program of the Maternal and Child Health Bureau, Rockville, MD (cooperative agreements U03MC00001, U03MC00003, U03MC00006, U03MC00007, and U03MC00008) .
PY - 2011/1
Y1 - 2011/1
N2 - Objectives: To describe a large cohort of children with out-of-hospital cardiac arrest with return of circulation and to identify factors in the early postarrest period associated with survival. These objectives were for planning an interventional trial of therapeutic hypothermia after pediatric cardiac arrest. Methods: A retrospective cohort study was conducted at 15 Pediatric Emergency Care Applied Research Network clinical sites over an 18-month study period. All children from 1 day (24 hrs) to 18 yrs of age with out-of-hospital cardiac arrest and a history of at least 1 min of chest compressions with return of circulation for at least 20 mins were eligible. Measurements and main results: One hundred thirty-eight cases met study entry criteria; the overall mortality was 62% (85 of 138 cases). The event characteristics associated with increased survival were as follows: weekend arrests, cardiopulmonary resuscitation not ongoing at hospital arrival, arrest rhythm not asystole, no atropine or NaHCO3, fewer epinephrine doses, shorter duration of cardiopulmonary resuscitation, and drowning or asphyxial arrest event. For the 0- to 12-hr postarrest return-of-circulation period, absence of any vasopressor or inotropic agent (dopamine, epinephrine) use, higher lowest temperature recorded, greater lowest pH, lower lactate, lower maximum glucose, and normal pupillary responses were all associated with survival. A multivariate logistic model of variables available at the time of arrest, which controlled for gender, age, race, and asystole or ventricular fibrillation/ventricular tachycardia anytime during the arrest, found the administration of atropine and epinephrine to be associated with mortality. A second model using additional information available up to 12 hrs after return of circulation found 1) preexisting lung or airway disease; 2) an etiology of arrest drowning or asphyxia; 3) higher pH, and 4) bilateral reactive pupils to be associated with lower mortality. Receiving more than three doses of epinephrine was associated with poor outcome in 96% (44 of 46) of cases. Conclusions: Multiple factors were identified as associated with survival after out-of-hospital pediatric cardiac arrest with the return of circulation. Additional information available within a few hours after the return of circulation may diminish outcome associations of factors available at earlier times in regression models. These factors should be considered in the design of future interventional trials aimed to improve outcome after pediatric cardiac arrest.
AB - Objectives: To describe a large cohort of children with out-of-hospital cardiac arrest with return of circulation and to identify factors in the early postarrest period associated with survival. These objectives were for planning an interventional trial of therapeutic hypothermia after pediatric cardiac arrest. Methods: A retrospective cohort study was conducted at 15 Pediatric Emergency Care Applied Research Network clinical sites over an 18-month study period. All children from 1 day (24 hrs) to 18 yrs of age with out-of-hospital cardiac arrest and a history of at least 1 min of chest compressions with return of circulation for at least 20 mins were eligible. Measurements and main results: One hundred thirty-eight cases met study entry criteria; the overall mortality was 62% (85 of 138 cases). The event characteristics associated with increased survival were as follows: weekend arrests, cardiopulmonary resuscitation not ongoing at hospital arrival, arrest rhythm not asystole, no atropine or NaHCO3, fewer epinephrine doses, shorter duration of cardiopulmonary resuscitation, and drowning or asphyxial arrest event. For the 0- to 12-hr postarrest return-of-circulation period, absence of any vasopressor or inotropic agent (dopamine, epinephrine) use, higher lowest temperature recorded, greater lowest pH, lower lactate, lower maximum glucose, and normal pupillary responses were all associated with survival. A multivariate logistic model of variables available at the time of arrest, which controlled for gender, age, race, and asystole or ventricular fibrillation/ventricular tachycardia anytime during the arrest, found the administration of atropine and epinephrine to be associated with mortality. A second model using additional information available up to 12 hrs after return of circulation found 1) preexisting lung or airway disease; 2) an etiology of arrest drowning or asphyxia; 3) higher pH, and 4) bilateral reactive pupils to be associated with lower mortality. Receiving more than three doses of epinephrine was associated with poor outcome in 96% (44 of 46) of cases. Conclusions: Multiple factors were identified as associated with survival after out-of-hospital pediatric cardiac arrest with the return of circulation. Additional information available within a few hours after the return of circulation may diminish outcome associations of factors available at earlier times in regression models. These factors should be considered in the design of future interventional trials aimed to improve outcome after pediatric cardiac arrest.
KW - cardiac arrest
KW - children
KW - cohort study
KW - mortality
KW - out of hospital
KW - outcome
KW - pediatric
KW - randomized controlled trial
KW - return of circulation
KW - therapeutic hypothermia
UR - http://www.scopus.com/inward/record.url?scp=78651259626&partnerID=8YFLogxK
U2 - 10.1097/CCM.0b013e3181fa3c17
DO - 10.1097/CCM.0b013e3181fa3c17
M3 - Article
C2 - 20935561
AN - SCOPUS:78651259626
SN - 0090-3493
VL - 39
SP - 141
EP - 149
JO - Critical care medicine
JF - Critical care medicine
IS - 1
ER -