Multicenter Study

. 2021 Dec:169:60-66.

doi: 10.1016/j.resuscitation.2021.10.015. Epub 2021 Oct 18.

Risk factors and outcomes for recurrent paediatric in-hospital cardiac arrest: Retrospective multicenter cohort study

Collaborators, Affiliations

Collaborators

PediRES-Q Collaborative Investigators:
Kamal Abulebda¹⁰, Diane Atkins¹¹, Shilpa Balikai¹¹, Marc Berg¹², Robert Berg¹³, Utpal Bhalala¹⁴, Matthew S Braga¹⁵, Corinne Buysse¹⁶, Corrado Cecchetti¹⁷, Adam Cheng¹⁸, Andrea Christoff¹⁹, Kelly Corbett¹⁵, Allan DeCaen²⁰, Gabry de Jong¹⁶, Jimena Del Castillo²¹, Maya Dewan²², Aaron Donoghue¹³, Jordan Duval-Arnould²³, Ivie Esangbedo²⁴, Michael Flaherty²⁵, Stuart Friess²⁶, Sandeep Gangadharan²⁷, Orsola Gawronski¹⁷, Jonathan Gilleland¹⁸, Heather Griffis²⁸, Richard Hanna¹³, Helen Harvey²⁹, Ilana Harwayne-Gidansky³⁰, Sarah Haskell¹¹, Jennifer Hayes³¹, Kiran Heber³², Betsy Hunt²³, Takanari Ikeyama³³, Priti Jani³⁴, Kaitlin Jones³², Monica Kleinman³⁵, Lynda Knight³⁶, Hiroshi Kurosawa³⁷, Javier Lasa³⁸, Kasper Glerup Lauridsen³⁹, Tara Lemoine⁴⁰, Tensing Maa⁴¹, Dori-Ann Martin¹⁸, Elizabeth Masse⁴², Luz Marina Mejia⁴³, Michael Meyer⁴⁴, Yee Hui Mok⁴⁵, Ryan Morgan¹³, Vinay Nadkarni¹³, Sholeen Nett¹⁵, Dana Niles¹³, Michelle Olson⁴⁶, Tara Petersen⁴⁴, Gene Ong⁴⁵, Prakad Rajapreyar⁴⁴, Tia Raymond⁴⁷, Joan Roberts⁴², Lindsay Ryerson²⁰, Anita Sen⁴⁸, Marcy Singleton¹⁵, Sophie Skellet⁴⁹, Daniel Stromberg⁵⁰, Felice Su³⁶, Robert Sutton¹³, Todd Sweberg⁵¹, Oscar Tegg¹⁹, Ken Tegtmeyer⁵², Alexis Topjian¹³, Wendy Van Ittersum⁵³, Javier Urbano Villaescusa²¹, Ichiro Watanabe⁵⁴, Denise Welsby⁴⁹, Jesse Wenger⁴², Heather Wolfe¹³, Andrea Yeo⁵⁵, Pricilla Yu²⁴

Affiliations

¹ Riley Hospital for Children, Indianapolis, IN, USA. Electronic address: Maria.Frazier@cchmc.org.
² University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA; Lucile Packard Children's Hospital, Palo Alto, CA, USA.
³ The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Children's Hospital of San Antonio, San Antonio, TX, USA.
⁴ Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
⁵ The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
⁶ Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.
⁷ Ospedale Pediatrico Bambino Gesù, Rome, Italy; Alberta Children's Hospital, Calgary, AB, Canada.
⁸ Riley Hospital for Children, Indianapolis, IN, USA; Children's Hospital at Westmead, Sydney, NSW, Australia.
⁹ Riley Hospital for Children, Indianapolis, IN, USA; Children's Hospital at Westmead, Sydney, NSW, Australia; Stollery Children's Hospital, Edmonton, AB, Canada.
¹⁰ Department of Paediatrics, Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
¹¹ Department of Pediatrics, University of Oklahoma, Norman, OK, USA.
¹² Division of Pediatric Critical Care Medicine, Oklahoma Children's Hospital, Oklahoma City, OK, USA.
¹³ Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
¹⁴ Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
¹⁵ Department of Paediatrics, Cardiac Critical Care, Medical City Children's Hospital, Dallas, TX, USA.
¹⁶ Division of Critical Care Medicine, Boston Children's Hospital, Boston, MA, USA.
¹⁷ University of Washington, Seattle, WA, USA.
¹⁸ Division of Paediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, WA, USA.
¹⁹ Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
²⁰ James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
²¹ Hospital Maternoinfantil Gregorio Marañón, Madrid, Spain.
²² Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
²³ Johns Hopkins University School of Medicine, Baltimore, MD, USA.
²⁴ UT Southwestern Dallas Children's Medical Center, Dallas, TX, USA.
²⁵ Massachusetts General Hospital, Boston, MA, USA.
²⁶ St. Louis Children's Hospital, St. Louis, MO, USA.
²⁷ Mount Sinai Kravis Children's Hospital, New York, NY, USA.
²⁸ Healthcare Analytics Unit, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
²⁹ Rady Children's Hospital, San Diego, CA, USA.
³⁰ Stony Brook Hospital, Stony Brook, NY, USA.
³¹ Children's Hospital of Orange County, Los Angeles, CA, USA.
³² Children's Healthcare of Atlanta, Atlanta, GA, USA.
³³ Aichi Children's Health and Medical Center, Obu, Aichi, Japan.
³⁴ The University of Chicago Medicine Comer Children's Hospital, Chicago, IL, USA.
³⁵ Boston Children's Hospital, Boston, MA, USA.
³⁶ Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA.
³⁷ Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan.
³⁸ Texas Children's Hospital, Houston, TX, USA.
³⁹ Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Aarhus University Hospital, Aarhus, Denmark.
⁴⁰ Valley Children's Hospital, Madera, CA, USA.
⁴¹ Nationwide Children's Hospital, Columbus, OH, USA.
⁴² Seattle Children's Hospital, Seattle, WA, USA.
⁴³ Instituto de Ortopedia Infantil Roosevelt, Bogota, Colombia.
⁴⁴ Children's Hospital of Wisconsin, Milwaukee, WI, USA.
⁴⁵ KK Women's & Children's Hospital, Singapore.
⁴⁶ Children's Hospital of Richmond, Richmond, VA, USA.
⁴⁷ Medical City Children's Hospital, Dallas, TX, USA.
⁴⁸ NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.
⁴⁹ Great Ormond Street Hospital, London, UK.
⁵⁰ Dell Children's Medical Center, Austin, TX, USA.
⁵¹ Cohen Children's Medical Center, New Hyde Park, NY, USA.
⁵² Cincinnati Children's Hospital, Cincinnati, OH, USA.
⁵³ Akron Children's Hospital, Akron, OH, USA.
⁵⁴ Tokyo Metropolitan Children's Hospital, Fuchū, Tokyo, Japan.
⁵⁵ National University Children's Medical Institute, Singapore.

PMID: 34673152
PMCID: PMC12448236
DOI: 10.1016/j.resuscitation.2021.10.015

Multicenter Study

Risk factors and outcomes for recurrent paediatric in-hospital cardiac arrest: Retrospective multicenter cohort study

Maria E Frazier et al. Resuscitation. 2021 Dec.

. 2021 Dec:169:60-66.

doi: 10.1016/j.resuscitation.2021.10.015. Epub 2021 Oct 18.

Collaborators

PediRES-Q Collaborative Investigators:
Kamal Abulebda¹⁰, Diane Atkins¹¹, Shilpa Balikai¹¹, Marc Berg¹², Robert Berg¹³, Utpal Bhalala¹⁴, Matthew S Braga¹⁵, Corinne Buysse¹⁶, Corrado Cecchetti¹⁷, Adam Cheng¹⁸, Andrea Christoff¹⁹, Kelly Corbett¹⁵, Allan DeCaen²⁰, Gabry de Jong¹⁶, Jimena Del Castillo²¹, Maya Dewan²², Aaron Donoghue¹³, Jordan Duval-Arnould²³, Ivie Esangbedo²⁴, Michael Flaherty²⁵, Stuart Friess²⁶, Sandeep Gangadharan²⁷, Orsola Gawronski¹⁷, Jonathan Gilleland¹⁸, Heather Griffis²⁸, Richard Hanna¹³, Helen Harvey²⁹, Ilana Harwayne-Gidansky³⁰, Sarah Haskell¹¹, Jennifer Hayes³¹, Kiran Heber³², Betsy Hunt²³, Takanari Ikeyama³³, Priti Jani³⁴, Kaitlin Jones³², Monica Kleinman³⁵, Lynda Knight³⁶, Hiroshi Kurosawa³⁷, Javier Lasa³⁸, Kasper Glerup Lauridsen³⁹, Tara Lemoine⁴⁰, Tensing Maa⁴¹, Dori-Ann Martin¹⁸, Elizabeth Masse⁴², Luz Marina Mejia⁴³, Michael Meyer⁴⁴, Yee Hui Mok⁴⁵, Ryan Morgan¹³, Vinay Nadkarni¹³, Sholeen Nett¹⁵, Dana Niles¹³, Michelle Olson⁴⁶, Tara Petersen⁴⁴, Gene Ong⁴⁵, Prakad Rajapreyar⁴⁴, Tia Raymond⁴⁷, Joan Roberts⁴², Lindsay Ryerson²⁰, Anita Sen⁴⁸, Marcy Singleton¹⁵, Sophie Skellet⁴⁹, Daniel Stromberg⁵⁰, Felice Su³⁶, Robert Sutton¹³, Todd Sweberg⁵¹, Oscar Tegg¹⁹, Ken Tegtmeyer⁵², Alexis Topjian¹³, Wendy Van Ittersum⁵³, Javier Urbano Villaescusa²¹, Ichiro Watanabe⁵⁴, Denise Welsby⁴⁹, Jesse Wenger⁴², Heather Wolfe¹³, Andrea Yeo⁵⁵, Pricilla Yu²⁴

Affiliations

¹ Riley Hospital for Children, Indianapolis, IN, USA. Electronic address: Maria.Frazier@cchmc.org.
² University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA; Lucile Packard Children's Hospital, Palo Alto, CA, USA.
³ The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Children's Hospital of San Antonio, San Antonio, TX, USA.
⁴ Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
⁵ The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
⁶ Erasmus MC-Sophia Children's Hospital, Rotterdam, Netherlands.
⁷ Ospedale Pediatrico Bambino Gesù, Rome, Italy; Alberta Children's Hospital, Calgary, AB, Canada.
⁸ Riley Hospital for Children, Indianapolis, IN, USA; Children's Hospital at Westmead, Sydney, NSW, Australia.
⁹ Riley Hospital for Children, Indianapolis, IN, USA; Children's Hospital at Westmead, Sydney, NSW, Australia; Stollery Children's Hospital, Edmonton, AB, Canada.
¹⁰ Department of Paediatrics, Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
¹¹ Department of Pediatrics, University of Oklahoma, Norman, OK, USA.
¹² Division of Pediatric Critical Care Medicine, Oklahoma Children's Hospital, Oklahoma City, OK, USA.
¹³ Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
¹⁴ Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
¹⁵ Department of Paediatrics, Cardiac Critical Care, Medical City Children's Hospital, Dallas, TX, USA.
¹⁶ Division of Critical Care Medicine, Boston Children's Hospital, Boston, MA, USA.
¹⁷ University of Washington, Seattle, WA, USA.
¹⁸ Division of Paediatric Critical Care Medicine, Seattle Children's Hospital, Seattle, WA, USA.
¹⁹ Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
²⁰ James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
²¹ Hospital Maternoinfantil Gregorio Marañón, Madrid, Spain.
²² Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
²³ Johns Hopkins University School of Medicine, Baltimore, MD, USA.
²⁴ UT Southwestern Dallas Children's Medical Center, Dallas, TX, USA.
²⁵ Massachusetts General Hospital, Boston, MA, USA.
²⁶ St. Louis Children's Hospital, St. Louis, MO, USA.
²⁷ Mount Sinai Kravis Children's Hospital, New York, NY, USA.
²⁸ Healthcare Analytics Unit, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
²⁹ Rady Children's Hospital, San Diego, CA, USA.
³⁰ Stony Brook Hospital, Stony Brook, NY, USA.
³¹ Children's Hospital of Orange County, Los Angeles, CA, USA.
³² Children's Healthcare of Atlanta, Atlanta, GA, USA.
³³ Aichi Children's Health and Medical Center, Obu, Aichi, Japan.
³⁴ The University of Chicago Medicine Comer Children's Hospital, Chicago, IL, USA.
³⁵ Boston Children's Hospital, Boston, MA, USA.
³⁶ Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA.
³⁷ Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo, Japan.
³⁸ Texas Children's Hospital, Houston, TX, USA.
³⁹ Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, PA, USA; Aarhus University Hospital, Aarhus, Denmark.
⁴⁰ Valley Children's Hospital, Madera, CA, USA.
⁴¹ Nationwide Children's Hospital, Columbus, OH, USA.
⁴² Seattle Children's Hospital, Seattle, WA, USA.
⁴³ Instituto de Ortopedia Infantil Roosevelt, Bogota, Colombia.
⁴⁴ Children's Hospital of Wisconsin, Milwaukee, WI, USA.
⁴⁵ KK Women's & Children's Hospital, Singapore.
⁴⁶ Children's Hospital of Richmond, Richmond, VA, USA.
⁴⁷ Medical City Children's Hospital, Dallas, TX, USA.
⁴⁸ NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, USA.
⁴⁹ Great Ormond Street Hospital, London, UK.
⁵⁰ Dell Children's Medical Center, Austin, TX, USA.
⁵¹ Cohen Children's Medical Center, New Hyde Park, NY, USA.
⁵² Cincinnati Children's Hospital, Cincinnati, OH, USA.
⁵³ Akron Children's Hospital, Akron, OH, USA.
⁵⁴ Tokyo Metropolitan Children's Hospital, Fuchū, Tokyo, Japan.
⁵⁵ National University Children's Medical Institute, Singapore.

PMID: 34673152
PMCID: PMC12448236
DOI: 10.1016/j.resuscitation.2021.10.015

Abstract

Aim of study: Recurrent in-hospital cardiac arrest (IHCA) is associated with morbidity and mortality in adults. We aimed to describe the risk factors and outcomes for paediatric recurrent IHCA.

Methods: Retrospective cohort study of patients ≤18 years old with single or recurrent IHCA. Recurrent IHCA was defined as ≥2 IHCA within the same hospitalization. Categorical variables expressed as percentages and compared via Chi square test. Continuous variables expressed as medians with interquartile ranges and compared via rank sum test. Outcomes assessed in a propensity match cohort.

Results: From July 1, 2015 to January 26, 2021, 139/894 (15.5%) patients experienced recurrent IHCA. Compared to patients with a single IHCA, recurrent IHCA patients were more likely to be trauma and less likely to be surgical cardiac patients. Median duration of cardiopulmonary resuscitation (CPR) was shorter in the recurrent IHCA (5 vs. 11 min; p < 0.001) with no difference in IHCA location or immediate cause of CPR. Patients with recurrent IHCA had worse survival to intensive care unit (ICU) discharge (31% vs. 52%; p < 0.001), and worse survival to hospital discharge (30% vs. 48%; p < 0.001) in unadjusted analyses and after propensity matching, patients with recurrent IHCA still had worse survival to ICU (34% vs. 67%; p < 0.001) and hospital (31% vs. 64%; p < 0.001) discharge.

Conclusion: When examining those with a single vs. a recurrent IHCA, event and patient factors including more pre-existing conditions and shorter duration of CPR were associated with risk for recurrent IHCA. Recurrent IHCA is associated with worse survival outcomes following propensity matching.

Keywords: CPR; Cardiac arrest; Paediatrics; Recurrent arrest; Risk factors.

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Conflict of interest statement

Conflicts of Interest

Robert Michael Sutton receives grant funding from the NIH, and is Chair of the Paediatric Research Task Force of the AHA’s Get with the Guidelines Resuscitation registry and a main author of the PALS Guidelines. All other authors deny conflicts of interest.

Figures

**Fig. 1 –. STROBE diagram for cohort description.**

**Fig. 2 –. Time between return of spontaneous circulation (ROSC) and recurrent in-hospital cardiac arrest (IHCA) in hours.**

Fig. 3 –. Kaplan-Meier Curve demonstrating survival differences in patients with recurrent IHCA versus single IHCA. For patients who survived to hospital discharge, 30 days (720 h) was used as a censored survival time.

See this image and copyright information in PMC

References

1. Holmberg MJ, Ross CE, Fitzmaurice GM, et al. Annual incidence of adult and pediatric in-hospital cardiac arrest in the United States. Circ Cardiovasc Qual Outcomes 2019;12 e005580. - PMC - PubMed
1. Girotra S, Spertus JA, Li Y, et al. Survival trends in pediatric in-hospital cardiac arrests: an analysis from Get With the Guidelines-Resuscitation. Circ Cardiovasc Qual Outcomes 2013;6:42–9. - PMC - PubMed
1. Gupta P, Pasquali SK, Jacobs JP, et al. Outcomes following single and recurrent in-hospital cardiac arrests in children with heart disease: a report from American Heart Association’s get with the guidelines registry-resuscitation. Pediatr Crit Care Med 2016;17:531–9. - PubMed
1. Chan ML, Spertus JA, Tang Y, Starks MA, Chan PS. Implications of a recurrent in-hospital cardiac arrest on survival and neurological outcomes. Am Heart J 2018;202:139–43. - PMC - PubMed
1. Brown SR, Brogan TV, McMullan DM, Roberts JS. Outcomes after in-hospital pediatric recurrent cardiac arrests. Pediatr Crit Care Med 2020;21:e981–7. - PubMed

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Risk factors and outcomes for recurrent paediatric in-hospital cardiac arrest: Retrospective multicenter cohort study

Collaborators

Affiliations

Risk factors and outcomes for recurrent paediatric in-hospital cardiac arrest: Retrospective multicenter cohort study

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Research Materials