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367 Post Resuscitative Factors Influencing Survival after In-Hospital Pediatric Cardiac Arrest
  1. J del Castillo1,2,
  2. J López-Herce1,2 European-Latinoamerican Study Group of Cardiac Arrest in Children
  1. 1Hospital General Universitario Gregorio Marañón
  2. 2Red Iberoaemericana de Estudio de la Parada Cardiaca en la Infancia, Madrid, Spain

Abstract

Background and Aims In-hospital pediatric cardiac arrest (CA) achieves high return of spontaneous circulation (ROSC) rates but survival to hospital discharge is low. The aim of this study was to determine post-resuscitative features that may influence survival.

Methods Prospective, international, observational, multicentric study. CA in children between 1 month and 18 years were analyzed using the Utstein template. Post-resuscitative clinical features after achieving sustained ROSC that correlated with survival to discharge were analyzed.

Results 563 episodes of in-hospital CA in 502 patients were evaluated. 346 (68.9%) achieved ROSC for at least 20 minutes. 180 of them (52%) survived to hospital discharge. Cardiac rhythm at the time of ROSC was sinus rhythm in 56.5% of the survivors and 43.5% of non survivors (p=0.03). 74% of the patients were mechanically ventilated and 68.7% received inotropic drugs with no statistically significant differences observed between survivors and non survivors. Survivors received significantly lower mean dopamine (10.2 vs 13.4 mcg/kg/min; p=0.002) and dobutamine (10.1vs 12.3 mcg/kg/min; p=0.03) doses. Patients who survived had significantly higher mean pH (7.26 vs 7.17; p=0.02), and HCO3 (20.2 vs 18.4; p=0.04), and lower base excess (–5.6 vs –8.2 p=0.02) and lactic acid (5.3 vs 7.7; p= 0.006) values one hour after ROSC. Patients who survived had higher mean PO2 values and lower mean PCO2 values, but these differences did not achieve statistical signification.

Conclusion In-hospital pediatric CA, the post ROSC factors associated with mortality were cardiac rhythm, metabolic acidosis and doses of inotropic drugs.

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