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. 2023 Jan 1;24(1):17-24.
doi: 10.1097/PCC.0000000000003104. Epub 2022 Nov 16.

Characteristics and Outcomes of Cardiac Arrest in Adult Patients Admitted to Pediatric Services: A Descriptive Analysis of the American Heart Association's Get With The Guidelines-Resuscitation Data

Amanda J O'Halloran  1 , Anne V Grossestreuer  2 , Lakshman Balaji  2 , Catherine E Ross  2   3 , Mathias J Holmberg  2   4 , Michael W Donnino  2   5 , Monica E Kleinman  6 ; American Heart Association’s Get With The Guidelines-Resuscitation Investigators
Affiliations

Characteristics and Outcomes of Cardiac Arrest in Adult Patients Admitted to Pediatric Services: A Descriptive Analysis of the American Heart Association's Get With The Guidelines-Resuscitation Data

Amanda J O'Halloran et al. Pediatr Crit Care Med. .

Abstract

Objectives: Differences between adult and pediatric in-hospital cardiac arrest (IHCA) are well-described. Although most adults are cared for on adult services, pediatric services often admit adults, particularly those with chronic conditions. The objective of this study is to describe IHCA in adults admitted to pediatric services.

Design: Retrospective cohort analysis from the American Heart Association's Get With The Guidelines-Resuscitation registry of a subpopulation of adults with IHCA while admitted to pediatric services. Multivariable logistic regression was used to evaluate adjusted survival outcomes and compare outcomes between age groups (18-21, 22-25, and ≥26 yr old).

Setting: Hospitals contributing to the Get With The Guidelines-Resuscitation registry.

Patients: Adult-aged patients (≥ 18 yr) with an index pulseless IHCA while admitted to a pediatric service from 2000 to 2018.

Interventions: None.

Measurements and main results: A total of 491 adult IHCAs were recorded on pediatric services at 17 sites, during the 19 years of review, and these events represented 0.1% of all adult IHCAs. In total, 221 cases met inclusion criteria with 139 events excluded due to an initial rhythm of bradycardia with poor perfusion. Median patient age was 22 years (interquartile range, 19-28 yr). Ninety-eight percent of patients had at least one pre-existing condition. Return of spontaneous circulation occurred in 63% of events and 30% of the patients survived to discharge. All age groups had similar rates of survival to discharge (range 26-37%; p = 0.37), and survival did not change over the study period (range 26-37%; p = 0.23 for adjusted survival to discharge).

Conclusions: In this cohort of adults with IHCA while admitted to a pediatric service, we failed to find an association between survival outcomes and age. Additional research is needed to better understand resuscitation in this population.

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Conflict of interest statement

Dr. Ross’ institution received funding from the National Heart, Lung, and Blood Institute (NHLBI). Dr. Ross’s work is supported by NHLBI: K23HL148312. Drs. Ross and Donnino received support for article research from the National Institutes of Health (NIH). Dr. Donnino disclosed that he is a volunteer for the American Heart Association (AHA). Dr. Donnino’s work is funded in part by the NIH grants K24HL127101 and R01HL136705. Dr. Kleinman disclosed that she is the vice chair of the AHA Get with the Guidelines-Resuscitation Pediatric Task Force. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Identification of Cohort of Adult-Aged Patients Admitted to Pediatric Services
Figure 2.
Figure 2.
Location of Cardiac Arrest for Adult-Aged Patients on Pediatric Services Over Time

Events occurring in locations other than the ICU or non-ICU patient wards were excluded from this analysis.

Figure 3.
Figure 3.
Unadjusted and Adjusted Cardiac Arrest Outcomes of Adult-Aged Patients on Pediatric Services Over Time

Adjusted analysis includes sex, age at cardiac arrest, initial pulseless rhythm, location of arrest, and whether the patient had a preexisting cardiac illness.

See this image and copyright information in PMC

Comment in

References

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    1. Berg RA, Sutton RM, Holubkov R, et al. Ratio of PICU versus ward cardiopulmonary resuscitation events is increasing. Crit Care Med 2013; 41:2292–2297 - PMC - 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. J Am Med Assoc 2006; 295:50–57 - PubMed
    1. Girotra S, Nallamothu BK, Spertus JA, et al. Trends in survival after in-hospital cardiac arrest. N Engl J Med 2012; 367:1912–1920 - PMC - PubMed
    1. Holmberg MJ, Wiberg S, Ross CE, et al. Trends in Survival after Pediatric In-Hospital Cardiac Arrest in the United States. Circulation 2019; 140:1398–1408 - PMC - PubMed

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