[Cardiopulmonary resuscitation in nine pediatric intensive care units of the Argentine Republic]

Abstract

Introduction: The cardiopulmonary resuscitation (CPR) is a common setting in the pediatric intensive care unit (PICU). There are very few reports or publications that evaluate the form of CPR administered in children.

Objectives: 1) Identify the etiology and epidemiology of the CPR in the PICU. 2) Describe how to conduct CPR. 3) Describe the drugs used. 4) Knowing the patient outcomes. 5) Knowing CPR training of physicians in the PICU.

Patients and methods: All children with cardiopulmonary arrest who were resuscitated in the PICU between 01/04/2004- 31/03/2005. A prospective cohort study.

Results: There were 2065 admissions in nine 9 PICU and CPR was conducted in 132 patients (6.39%). Most common etiologies of PCR were hypoxia and hypotension (65.9% of total). The initial rates of PCR were 43.94% bradycardia, asystolia 43.18%, 9.85% ventricular arrhythmias. The average beginning of time of CPR was 0.08 minutes (SD 0.25) and the average total duration was 25.91 minutes (SD 18.56). Patients who require drugs were 131. The number (mean) dose of adrenaline was 4.03 (SD 2.78). Increased number of doses of adrenaline was associated with less chance of recovery of spontaneous circulation (ROSC), OR 0.48 95% CI 0.37-0.63. (p= 0.000). The duration of CPR was inversely associated and significantly related to achieve ROSC, OR 0.93 95% CI 0.87-0.99. One hundred and four (78.79%) patients died and 28 survived. All survived were discharged from PICU, but 26 from hospital. In 22 patients there were not evidence of severe neurological damage when discharged home.

Conclusions: Most common etiologies of PCR were hypoxia and shock. Most children received drugs. The drugs most used were the association adrenaline-bicarbonate and adrenaline alone. The chances of recovery were not favorable when CPR was conducted for over sixty minutes or more than six doses of adrenaline were given, without response. CPR in PICU children has a high mortality. Most patients discharged from hospital, had neurological normal state or slight disability. PICU physicians were highly trained in CPR with resuscitation courses.