Prevalence and Outcomes of CPR in Pediatric In-Hospital Cardiac Arrest: A 7-year Experience at a Single Center in Thailand

Background: Children with in-hospital cardiac arrest (IHCA) has variety outcome in difference centers and country.

Objective: The objective in this study was to report the prevalence, characteristic and outcomes of IHCA and also evaluate associated factors in survival.

Methods: A retrospective study including children aged 1 month to 18 years were diagnosed with cardiac arrest and received cardiopulmonary resuscitation between January 2010 and December 2016. Descriptive and logistic regressions analysis was used to analyze factors that related to the return of spontaneous circulation (ROSC) and survival.

Results: Total of admission was 32,122. Of 88 patients (0.27%) were enrolled. Median age of patients was 1.21. The first documented rhythm was pulseless electrical activity (43%). The overall sustained ROSC and survival rate were 62.5% and 15.9%, respectively. Of 78% of those who survived had favorable neurological outcome. The most common cause of IHCA was septic shock. Ischemic cause, development of subsequent asystole and receiving CPR more than 20 minutes had significant higher sustained ROSC rate (p<0.05). Multivariate analysis to adjust for the clinical variables significantly associated with failure ROSC confirmed that patients with prolonged duration of cardiopulmonary resuscitation (CPR) and subsequent asystole had higher failure ROSC (p<0.05). However, patients who received vasoactive medications less than two drugs had higher hospital survival rate (p=0.024).

Conclusion: Duration of CPR was the most important factor associated with achieved ROSC, whereas number of vasoactive medications was the factor associated with hospital survival rate.