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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