In the Journals

Survival after pediatric in-hospital cardiac arrest varies widely in US

Survival rates after pediatric in-hospital cardiac arrest varied significantly across hospitals that participated in the American Heart Association’s Get With The Guidelines-Resuscitation registry, according to new study results.

Using registry data from 2006 to 2010, the researchers identified 1,551 cases of pediatric in-hospital cardiac arrest at 164 hospitals. They then developed and validated a model to predict survival to hospital discharge after pediatric in-hospital cardiac arrest. For this study, they calculated risk-standardized rates of cardiac arrest at 30 participating hospitals with at least 10 pediatric cardiac arrest cases.

Of the 1,551 pediatric patients, 31% were neonates, 23.1% infants, 23.1% younger children and 22.8% older children. More than 87% had a nonshockable cardiac arrest rhythm; 53.8% had a first documented rhythm of pulseless electric activity and 33.9% with asystole, according to the study.

Thirty-five percent of pediatric patients with an in-hospital cardiac arrest survival to discharge. Factors significantly associated with survival included age, cardiac arrest rhythm and location, use of mechanical ventilation or IV vasoactive agents, illness category, and the presence of acute nonstroke neurological events, major trauma, hypotension, metabolic or electrolyte abnormalities, renal insufficiency or sepsis.

Researchers noted that the model had good discrimination, with a C-statistic of 0.71, and yielded similar results after bootstrap-corrected validation (C-statistic of 0.69).

When the model was applied to the 30 hospitals with at least 10 cases of pediatric in-hospital cardiac arrest, unadjusted survival rates varied significantly and ranged from 0% to 61% (median 37%). After risk-standardization, the variation persisted, but was somewhat reduced (range 29%-48%; median 37%), according to the results.

“Leveraging these models, future studies can identify best practices at high-performing hospitals to improve survival outcomes for pediatric cardiac arrest,” the researchers wrote.

Disclosure: One researcher reports consulting for the AHA.

Survival rates after pediatric in-hospital cardiac arrest varied significantly across hospitals that participated in the American Heart Association’s Get With The Guidelines-Resuscitation registry, according to new study results.

Using registry data from 2006 to 2010, the researchers identified 1,551 cases of pediatric in-hospital cardiac arrest at 164 hospitals. They then developed and validated a model to predict survival to hospital discharge after pediatric in-hospital cardiac arrest. For this study, they calculated risk-standardized rates of cardiac arrest at 30 participating hospitals with at least 10 pediatric cardiac arrest cases.

Of the 1,551 pediatric patients, 31% were neonates, 23.1% infants, 23.1% younger children and 22.8% older children. More than 87% had a nonshockable cardiac arrest rhythm; 53.8% had a first documented rhythm of pulseless electric activity and 33.9% with asystole, according to the study.

Thirty-five percent of pediatric patients with an in-hospital cardiac arrest survival to discharge. Factors significantly associated with survival included age, cardiac arrest rhythm and location, use of mechanical ventilation or IV vasoactive agents, illness category, and the presence of acute nonstroke neurological events, major trauma, hypotension, metabolic or electrolyte abnormalities, renal insufficiency or sepsis.

Researchers noted that the model had good discrimination, with a C-statistic of 0.71, and yielded similar results after bootstrap-corrected validation (C-statistic of 0.69).

When the model was applied to the 30 hospitals with at least 10 cases of pediatric in-hospital cardiac arrest, unadjusted survival rates varied significantly and ranged from 0% to 61% (median 37%). After risk-standardization, the variation persisted, but was somewhat reduced (range 29%-48%; median 37%), according to the results.

“Leveraging these models, future studies can identify best practices at high-performing hospitals to improve survival outcomes for pediatric cardiac arrest,” the researchers wrote.

Disclosure: One researcher reports consulting for the AHA.