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Multicenter Study
. 2022 Nov 1;23(11):860-871.
doi: 10.1097/PCC.0000000000003040. Epub 2022 Jul 27.

Calcium Administration During Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest in Children With Heart Disease Is Associated With Worse Survival-A Report From the American Heart Association's Get With The Guidelines-Resuscitation (GWTG-R) Registry

Gurpreet S Dhillon  1   2 , Monica E Kleinman  2 , Steven J Staffa  2 , Sarah A Teele  3 , Ravi R Thiagarajan  3 ; American Heart Association’s Get With The Guidelines - Resuscitation (GWTG-R) Investigators
Affiliations
Multicenter Study

Calcium Administration During Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest in Children With Heart Disease Is Associated With Worse Survival-A Report From the American Heart Association's Get With The Guidelines-Resuscitation (GWTG-R) Registry

Gurpreet S Dhillon et al. Pediatr Crit Care Med. .

Abstract

Objectives: IV calcium administration during cardiopulmonary resuscitation (CPR) for pediatric in-hospital cardiac arrest (IHCA) is associated with worse survival. We evaluated survival to hospital discharge in children with heart disease (HD), where calcium is more frequently administered during CPR.

Design: Retrospective study of a multicenter registry database.

Setting: Data reported to the American Heart Association's (AHA) Get With The Guidelines-Resuscitation registry.

Patients: Children younger than 18 years with HD experiencing an index IHCA event requiring CPR between January 2000 and January 2019. Using propensity score matching (PSM), we selected matched cohorts of children receiving and not receiving IV calcium during CPR and compared the primary outcome of survival to hospital discharge.

Interventions: None.

Measurements and main results: We included 4,556 children with HD experiencing IHCA. Calcium was administered in 1,986 (44%), more frequently in children younger than 1 year old (65% vs 35%; p < 0.001) and surgical cardiac (SC) compared with medical cardiac patients (51% vs 36%; p < 0.001). Calcium administration during CPR was associated with longer duration CPR (median 27 min [interquartile range (IQR): 10-50 min] vs 5 min [IQR, 2-16 min]; p < 0.001) and more frequent extracorporeal-CPR deployment (25% vs 8%; p < 0.001). In the PSM cohort, those receiving calcium had decreased survival to hospital discharge (39% vs 46%; p = 0.02) compared with those not receiving calcium. In a subgroup analysis, decreased discharge survival was only seen in SC cohorts.

Conclusions: Calcium administration during CPR for children with HD experiencing IHCA is common and is associated with worse survival. Administration of calcium during CPR in children with HD should be restricted to specific indications as recommended by the AHA CPR guidelines.

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Conflict of interest statement

Dr. Kleinman disclosed that she is vice-chair for the Pediatric Research Task Force, American Heart Association Get with The Guidelines-Resuscitation. Dr. Thiagarajan received funding from Society of Critical Care Medicine and Extracorporeal Life Support Organization, and he was supported by the Callaghan Family Chair in Cardiac Critical Care. The remaining authors have disclosed that they do not have any potential conflicts of interest.

References

    1. Girotra S, Spertus JA, Li Y, et al.; 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; 6:42–49
    1. Berg MD, Nadkarni VM, Zuercher M, et al.: In-hospital pediatric cardiac arrest. Pediatr Clin North Am. 2008; 55:589–604, x
    1. Slonim AD, Patel KM, Ruttimann UE, et al.: Cardiopulmonary resuscitation in pediatric intensive care units. Crit Care Med. 1997; 25:1951–1955
    1. Parra DA, Totapally BR, Zahn E, et al.: Outcome of cardiopulmonary resuscitation in a pediatric cardiac intensive care unit. Crit Care Med. 2000; 28:3296–3300
    1. Gupta P, Jacobs JP, Pasquali SK, et al.: Epidemiology and outcomes after in-hospital cardiac arrest after pediatric cardiac surgery. Ann Thorac Surg. 2014; 98:2138–2143; discussion 2144

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