Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Jan 1;171(1):39-45.
doi: 10.1001/jamapediatrics.2016.2535.

Survival Rates Following Pediatric In-Hospital Cardiac Arrests During Nights and Weekends

Farhan Bhanji  1 , Alexis A Topjian  2 , Vinay M Nadkarni  2 , Amy H Praestgaard  3 , Elizabeth A Hunt  4 , Adam Cheng  5 , Peter A Meaney  2 , Robert A Berg  2 ; American Heart Association’s Get With the Guidelines–Resuscitation Investigators
Affiliations

Survival Rates Following Pediatric In-Hospital Cardiac Arrests During Nights and Weekends

Farhan Bhanji et al. JAMA Pediatr. .

Abstract

Importance: Nearly 6000 hospitalized children in the United States receive cardiopulmonary resuscitation (CPR) annually. Little is known about whether the survival of these children is influenced by the time of the event (eg, nighttime or weekends). Differences in survival could have important implications for hospital staffing, training, and resource allocation.

Objective: To determine whether outcomes after pediatric in-hospital cardiac arrests differ during nights and weekends compared with days/evenings and weekdays.

Design, setting, and participants: This study included a total of 354 hospitals participating in the American Heart Association's Get With the Guidelines-Resuscitation registry from January 1, 2000, to December 12, 2012. Index cases (12 404 children) from all children younger than 18 years of age receiving CPR for at least 2 minutes were included. Data analysis was performed in December 2014 and June 2016. We aggregated hourly blocks of time, using previously defined time intervals of day/evening and night, as well as weekend. Multivariable logistic regression models were used to examine the effect of independent variables on survival to hospital discharge. We used a combination of a priori variables based on previous literature (including age, first documented rhythm, location of event in hospital, extracorporeal CPR, and hypotension as the cause of arrest), as well as variables that were identified in bivariate generalized estimating equation models, and maintained significance of P ≤ .15 in the final multivariable models.

Main outcomes and measures: The primary outcome measure was survival to hospital discharge, and secondary outcomes included return of circulation lasting more than 20 minutes and 24-hour survival.

Results: Of 12 404 children (56.0% were male), 8731 (70.4%) experienced a return of circulation lasting more than 20 minutes, 7248 (58.4%) survived for 24 hours, and 4488 (36.2%) survived to hospital discharge. After adjusting for potential confounders, we found that the rate of survival to hospital discharge was lower during nights than during days/evenings (adjusted odds ratio, 0.88 [95% CI, 0.80-0.97]; P = .007) but was not different between weekends and weekdays (adjusted odds ratio, 0.92 [95% CI, 0.84-1.01]; P = .09).

Conclusions and relevance: The rate of survival to hospital discharge was lower for pediatric CPR events occurring at night than for CPR events occurring during daytime and evening hours, even after adjusting for many potentially confounding patient-, event-, and hospital-related factors.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.
Rate of Survival to Hospital Discharge by Hour of Day When Cardiopulmonary Resuscitation Occurred
Figure 2.
Figure 2.
Rate of Survival to Hospital Discharge by Day of Week When Cardiopulmonary Resuscitation Occurred
See this image and copyright information in PMC

Comment in

References

    1. Knudson JD, Neish SR, Cabrera AG, et al. Prevalence and outcomes of pediatric in-hospital cardiopulmonary resuscitation in the United States: an analysis of the Kids’ Inpatient Database. Crit Care Med. 2012;40(11):2940–2944. - PubMed
    1. Moler FW, Meert K, Donaldson AE, et al.; Pediatric Emergency Care Applied Research Network. In-hospital versus out-of-hospital pediatric cardiac arrest: a multicenter cohort study. Crit Care Med. 2009;37(7):2259–2267. - PMC - PubMed
    1. Reis AG, Nadkarni V, Perondi MB, Grisi S, Berg RA. A prospective investigation into the epidemiology of in-hospital pediatric cardiopulmonary resuscitation using the international Utstein reporting style. Pediatrics. 2002;109(2):200–209. - PubMed
    1. Kleinman ME, Chameides L, Schexnayder SM, et al. Part 14: pediatric advanced life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2010;122(18)(suppl3):S876–S908. - PubMed
    1. Girotra S, Spertus JA, Li Y, Berg RA, Nadkarni VM, Chan PS; American Heart Association Get With the Guidelines–Resuscitation Investigators. Survival trends in pediatric in-hospital cardiac arrests: an analysis from Get With the Guidelines-Resuscitation. Circ Cardiovasc Qual Outcomes. 2013;6(1):42–49. - PMC - PubMed