Ratio of PICU versus ward cardiopulmonary resuscitation events is increasing

doi:10.1097/CCM.0b013e31828cf0c0

. 2013 Oct;41(10):2292-7.

doi: 10.1097/CCM.0b013e31828cf0c0.

Ratio of PICU versus ward cardiopulmonary resuscitation events is increasing

Collaborators, Affiliations

Collaborators

Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network and for the American Heart Association’s Get With the Guidelines-Resuscitation (formerly the National Registry of Cardiopulmonary Resuscitation) Investigators:
Robert A Berg, Heidi Dalton, Frank Moler, Vinay Nadkarni, Paul S Chan, Mary Mancini, Emilie Allen, Robert Clark, Michael W Donnino, Brian Eigel, Lana Gent, Robert T Faillace, Elizabeth A Hunt, Lynda Knight, Kenneth LaBresh, Peter C Laussen, Marilyn Morris, Graham Nichol, Joseph P Ornato, Mary Ann Peberdy, Chris Parshuram, Comilla Sasson, Mindy Smyth, Arno L Zaritsky

Affiliation

¹ 1Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 2Department of Pediatrics, University of Utah, Salt Lake City, UT. 3Division of Critical Care Medicine, Department of Pediatrics, National Institute of Child Health and Human Development, Bethesda, MD. 4Division of Critical Care Medicine, Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA. 5Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI. 6Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Children's Hospital Los Angeles, Los Angeles, CA. 7Division of Critical Care Medicine, Department of Pediatrics, University of Michigan and Mott Children's Hospital, Ann Arbor, MI. 8Division of Critical Care Medicine, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ. 9Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO. 10Division of Critical Care Medicine, Department of Pediatrics, Children's National Medical Center, Washington, DC. 11Department of Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.

PMID: 23921270
PMCID: PMC3783604
DOI: 10.1097/CCM.0b013e31828cf0c0

Ratio of PICU versus ward cardiopulmonary resuscitation events is increasing

Robert A Berg et al. Crit Care Med. 2013 Oct.

. 2013 Oct;41(10):2292-7.

doi: 10.1097/CCM.0b013e31828cf0c0.

Collaborators

Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network and for the American Heart Association’s Get With the Guidelines-Resuscitation (formerly the National Registry of Cardiopulmonary Resuscitation) Investigators:
Robert A Berg, Heidi Dalton, Frank Moler, Vinay Nadkarni, Paul S Chan, Mary Mancini, Emilie Allen, Robert Clark, Michael W Donnino, Brian Eigel, Lana Gent, Robert T Faillace, Elizabeth A Hunt, Lynda Knight, Kenneth LaBresh, Peter C Laussen, Marilyn Morris, Graham Nichol, Joseph P Ornato, Mary Ann Peberdy, Chris Parshuram, Comilla Sasson, Mindy Smyth, Arno L Zaritsky

Affiliation

¹ 1Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. 2Department of Pediatrics, University of Utah, Salt Lake City, UT. 3Division of Critical Care Medicine, Department of Pediatrics, National Institute of Child Health and Human Development, Bethesda, MD. 4Division of Critical Care Medicine, Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA. 5Division of Critical Care Medicine, Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI. 6Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Children's Hospital Los Angeles, Los Angeles, CA. 7Division of Critical Care Medicine, Department of Pediatrics, University of Michigan and Mott Children's Hospital, Ann Arbor, MI. 8Division of Critical Care Medicine, Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ. 9Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO. 10Division of Critical Care Medicine, Department of Pediatrics, Children's National Medical Center, Washington, DC. 11Department of Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA.

PMID: 23921270
PMCID: PMC3783604
DOI: 10.1097/CCM.0b013e31828cf0c0

Abstract

Objectives: The aim of this study was to evaluate the relative frequency of pediatric in-hospital cardiopulmonary resuscitation events occurring in ICUs compared to general wards. We hypothesized that the proportion of pediatric cardiopulmonary resuscitation provided in ICUs versus general wards has increased over the past decade, and this shift is associated with improved resuscitation outcomes.

Design: Prospective and observational study.

Setting: Total of 315 hospitals in the American Heart Association's Get With The Guidelines-Resuscitation database.

Patients: Total of 5,870 pediatric cardiopulmonary resuscitation events between January 1, 2000 and September 14, 2010. Cardiopulmonary resuscitation events were defined as external chest compressions longer than 1 minute.

Interventions: None.

Measurements and main results: The primary outcome was proportion of total ICU versus general ward cardiopulmonary resuscitation events over time evaluated by chi-square test for trend. Secondary outcome included return of spontaneous circulation following the cardiopulmonary resuscitation event. Among 5,870 pediatric cardiopulmonary resuscitation events, 5,477 (93.3%) occurred in ICUs compared to 393 (6.7%) in inpatient wards. Over time, significantly more of these cardiopulmonary resuscitation events occurred in the ICU compared to the wards (test for trend: p<0.01), with a prominent shift noted between 2003 and 2004 (2000-2003: 87-91% vs 2004-2010: 94-96%). In a multivariable model controlling for within center variability and other potential confounders, return of spontaneous circulation increased in 2004-2010 compared with 2000-2003 (relative risk, 1.08; 95% CI, 1.03-1.13).

Conclusions: In-hospital pediatric cardiopulmonary resuscitation is much more commonly provided in ICUs than in wards, and the proportion has increased significantly over the past decade, with concomitant increases in return of spontaneous circulation.

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Figures

**Figure 1**
Utstein consort diagram. CPR, cardiopulmonary resuscitation; ICU, intensive care unit.

**Figure 2**
Proportion of in-hospital CPR events occurring in an ICU vs. general ward. *Over time, significantly more events occurred in the ICU compared to the general wards (test for trend: p<0.01). A prominent shift in location was noted between 2003 and 2004 (2000 – 003: 87 – 91% vs. 2004 – 2010: 94 - 96%)

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Comment in

Ratio of PICU to ward cardiac arrest is increasing: so what?
DeCaen AR, Joffe AR. DeCaen AR, et al. Crit Care Med. 2013 Oct;41(10):2438-9. doi: 10.1097/CCM.0b013e3182913699. Crit Care Med. 2013. PMID: 24060773 No abstract available.

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References

1. Slonim AD, Patel KM, Ruttimann UE. Pollack MM: Cardiopulmonary resuscitation in pediatric intensive care units. Crit Care Med. 1997;25:1951–5. - PubMed
1. Peddy SB, Hazinski MF, Laussen PC, et al. Cardiopulmonary resuscitation: special considerations for infants and children with cardiac disease. Cardiol Young. 2007;2:116–26. - PubMed
1. Randolph AG, Gonzales CA, Cortellini L, Yeh TS. Growth of pediatric intensive care units in the United States from 1995 to 2001. J Pediatr. 2004;144:792–8. - PubMed
1. Nadkarni VM, Larkin GL, Peberdy MA, et al. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA. 2006;295:50–7. - PubMed
1. Meert KL, Donaldson A, Nadkarni V, et al. Multicenter cohort study of in-hospital pediatric cardiac arrest. Pediatr Crit Care Med. 2009;10:544–53. - PMC - PubMed

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[1] Slonim AD, Patel KM, Ruttimann UE. Pollack MM: Cardiopulmonary resuscitation in pediatric intensive care units. Crit Care Med. 1997;25:1951–5. - PubMed

[2] Slonim AD, Patel KM, Ruttimann UE. Pollack MM: Cardiopulmonary resuscitation in pediatric intensive care units. Crit Care Med. 1997;25:1951–5. - PubMed

[3] Peddy SB, Hazinski MF, Laussen PC, et al. Cardiopulmonary resuscitation: special considerations for infants and children with cardiac disease. Cardiol Young. 2007;2:116–26. - PubMed

[4] Peddy SB, Hazinski MF, Laussen PC, et al. Cardiopulmonary resuscitation: special considerations for infants and children with cardiac disease. Cardiol Young. 2007;2:116–26. - PubMed

[5] Randolph AG, Gonzales CA, Cortellini L, Yeh TS. Growth of pediatric intensive care units in the United States from 1995 to 2001. J Pediatr. 2004;144:792–8. - PubMed

[6] Randolph AG, Gonzales CA, Cortellini L, Yeh TS. Growth of pediatric intensive care units in the United States from 1995 to 2001. J Pediatr. 2004;144:792–8. - PubMed

[7] Nadkarni VM, Larkin GL, Peberdy MA, et al. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA. 2006;295:50–7. - PubMed

[8] Nadkarni VM, Larkin GL, Peberdy MA, et al. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA. 2006;295:50–7. - PubMed

[9] Meert KL, Donaldson A, Nadkarni V, et al. Multicenter cohort study of in-hospital pediatric cardiac arrest. Pediatr Crit Care Med. 2009;10:544–53. - PMC - PubMed

[10] Meert KL, Donaldson A, Nadkarni V, et al. Multicenter cohort study of in-hospital pediatric cardiac arrest. Pediatr Crit Care Med. 2009;10:544–53. - PMC - PubMed

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Ratio of PICU versus ward cardiopulmonary resuscitation events is increasing

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Ratio of PICU versus ward cardiopulmonary resuscitation events is increasing

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