57-Risk Factors and Outcomes for Recurrent Pediatric In-Hospital Cardiac Arrest
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Pediatrics, Resuscitation, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Maria Frazier

Introduction/Hypothesis: Recurrent in-hospital cardiac arrest (IHCA) is associated with morbidity and mortality in children, yet little is known about risk factors. The objective was to identify the patient and event characteristics during an index(first) IHCA associated with an increased risk for recurrent IHCA.

Methods: Retrospective cohort of consecutive patients reported to the Pediatric Resuscitation Quality Collaborative with age ≤18-years and IHCA with CPR for >1 minute. Patients were excluded for Neonatal ICU location, if died during index IHCA arrest, or if placed on ECMO during index IHCA. Recurrent arrest was defined as ≥2 IHCA within the same hospitalization. Categorical variables were expressed as percentages and compared via chi square test. Continuous variables were expressed as medians with interquartile ranges (IQR) and compared via rank sum test. Outcome analysis was adjusted with Bonferroni correction.

Results: From July 2015-May 2020, 80/506 (16%) IHCA patients met recurrent IHCA inclusion criteria. Patient Factors: Recurrent IHCA patients were older with a median age of 4.9 years (IQR:0.6-9.1) vs. 0.9 years (IQR:0.3-5); p=0.01, and more likely to have pre-existing conditions including congenital malformation (28% vs.16%; p=0.02) and metabolic electrolyte abnormalities (30% vs. 15%; p=0.0001). Event Factors: The median duration of the index CPR event was shorter for those with a recurrent arrest, 5 minutes, (IQR:3-14) vs. 8 minutes (IQR:4-21); p=0.05. Location of arrest, immediate cause of CPR, and medications administered index CPR were not significantly different. Outcomes: Recurrent IHCA was associated with worse survival to ICU discharge (34% vs. 65%, p=0.0004), worse survival to hospital discharge (32% vs. 60%, p=0.0004), and worse neurologic outcome defined as PCPC ˃2 (61% vs. 32% p=0.024).

Conclusions: Several patient and event factors (older age, pre-existing conditions, shorter duration of index event) were associated with risk for recurrent cardiac arrest. Recurrent IHCA was consistently associated with worse survival outcomes. Better understanding of modifiable risk factors and mitigation of recurrent IHCA may inform interventions that prevent recurrent IHCA and improve patient outcomes.


Meta Tag
Content Type Presentation
Knowledge Area Pediatrics
Knowledge Area Resuscitation
Knowledge Level Advanced
Membership Level Select
Tag Cardiac Arrest
Year 2021
Pediatric in-hospital cardiac arrests
recurrent arrest risk factors
survival rates
multi-center approach
long-term follow-up


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