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. 2024 Jul 1;7(7):e2424670.
doi: 10.1001/jamanetworkopen.2024.24670.

Characteristics of Pediatric In-Hospital Cardiac Arrests and Resuscitation Duration

Amanda O'Halloran  1   2 , Ryan W Morgan  1 , Kevin Kennedy  3 , Robert A Berg  1 , Cody-Aaron Gathers  1   2 , Maryam Y Naim  1 , Vinay Nadkarni  1 , Ron Reeder  4 , Alexis Topjian  1 , Heather Wolfe  1   2 , Monica Kleinman  5 , Paul S Chan  3 , Robert M Sutton  1 ; American Heart Association’s Get With the Guidelines–Resuscitation Investigators
Collaborators, Affiliations

Characteristics of Pediatric In-Hospital Cardiac Arrests and Resuscitation Duration

Amanda O'Halloran et al. JAMA Netw Open. .

Erratum in

  • Error in Abstract.
    [No authors listed] [No authors listed] JAMA Netw Open. 2024 Aug 1;7(8):e2435956. doi: 10.1001/jamanetworkopen.2024.35956. JAMA Netw Open. 2024. PMID: 39196566 Free PMC article. No abstract available.

Abstract

Importance: Cardiopulmonary resuscitation (CPR) duration is associated with cardiac arrest survival.

Objectives: To describe characteristics associated with CPR duration among hospitalized children without return of circulation (ROC) (patient-level analysis) and determine whether hospital median CPR duration in patients without ROC is associated with survival (hospital-level analysis).

Design, setting, and participants: This retrospective cohort study of patients undergoing pediatric in-hospital CPR between January 1, 2000, and December 31, 2021, used data from the Get With the Guidelines-Resuscitation registry. Children receiving chest compressions for at least 2 minutes and/or defibrillation were included in the patient-level analysis. For the hospital-level analysis, sites with at least 20 total events and at least 5 events without ROC were included. Data were analyzed from December 1, 2022, to November 15, 2023.

Exposures: For the patient-level analysis, the exposure was CPR duration in patients without ROC. For the hospital-level analysis, the exposure was quartile of median CPR duration in events without ROC at each hospital.

Main outcomes and measures: For the patient-level analysis, outcomes were patient and event factors, including race and ethnicity and event location; we used a multivariable hierarchical linear regression model to assess factors associated with CPR duration in patients without ROC. For the hospital-level analysis, the main outcome was survival to discharge among all site events; we used a random intercept multivariable hierarchical logistic regression model to examine the association between hospital quartile of CPR duration and survival to discharge.

Results: Of 13 899 events, 3859 patients did not have ROC (median age, 7 months [IQR, 0 months to 7 years]; 2175 boys [56%]). Among event nonsurvivors, median CPR duration was longer in those with initial rhythms of bradycardia with poor perfusion (8.37 [95% CI, 5.70-11.03] minutes; P < .001), pulseless electrical activity (8.22 [95% CI, 5.44-11.00] minutes; P < .001), and pulseless ventricular tachycardia (6.17 [95% CI, 0.09-12.26] minutes; P = .047) (vs asystole). Shorter median CPR duration was associated with neonates compared with older children (-4.86 [95% CI, -8.88 to -0.84] minutes; P = .02), emergency department compared with pediatric intensive car7 e unit location (-4.02 [95% CI, -7.48 to -0.57] minutes; P = .02), and members of racial or ethnic minority groups compared with White patients (-3.67 [95% CI, -6.18 to -1.17]; P = .004). Among all CPR events, the adjusted odds of survival to discharge differed based on hospital quartile of median CPR duration among events without ROC; compared with quartile 1 (15.0-25.9 minutes), the adjusted odds ratio for quartile 2 (26.0-29.4 minutes) was 1.22 (95% CI, 1.09-1.36; P < .001); for quartile 3 (29.5-32.9 minutes), 1.23 (95% CI, 1.08-1.39; P = .002); and for quartile 4 (33.0-53.0 minutes), 1.04 (95% CI, 0.91-1.19; P = .58).

Conclusions and relevance: In this retrospective cohort study of pediatric in-hospital CPR, several factors, including age and event location, were associated with CPR duration in event nonsurvivors. The odds of survival to discharge were lower for patients at hospitals with the shortest and longest median CPR durations among events without ROC. Further studies are needed to determine the optimal duration of CPR during pediatric in-hospital cardiac arrest and to provide training guidelines for resuscitation teams to eliminate disparities in resuscitation care.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr O’Halloran reported receiving grant funding from the American Heart Association (AHA) for statistical support and travel funding and protected time and mentorship from the Children’s Hospital of Philadelphia Department of Anesthesia and Critical Care during the conduct of the study; and grant funding from the National Institutes of Health (NIH) Loan Repayment Program for work on pediatric cardiac arrest outside the submitted work. Dr Naim reported receiving grant funding from the NIH during the conduct of the study. Dr Reeder reported receiving grant funding from the NIH during the conduct of the study. Dr Topjian reported receiving grant funding from the NIH outside the submitted work. Dr Kleinman reported receiving nonfinancial support from the AHA as the chair of the Get With the Guidelines–Resuscitation Pediatric Research Task Force during the conduct of the study and personal fees from Burns White for expert testimony and personal fees from Eiger BioPharmaceuticals Inc outside the submitted work. Dr Chan reported receiving grant funding from the National Heart, Lung, and Blood Institute (NHLBI) and the AHA during the conduct of the study. Dr Sutton reported receiving grant funding from the NIH outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Study Flow Diagram
CPR indicates cardiopulmonary resuscitation; IHCA, in-hospital cardiac arrest; and ROC, return of circulation.
Figure 2.
Figure 2.. Distribution of Cardiopulmonary Resuscitation (CPR) Duration and Hospital Median CPR Duration in Events Without Return of Circulation
Error bars indicate 95% CI.
Figure 3.
Figure 3.. Multivariable Model of Patient-Level Analysis: Key Patient and Event Factors Associated With Cardiopulmonary Resuscitation (CPR) Duration in Events Without Return of Circulation
CICU indicates cardiac intensive care unit (ICU); ED, emergency department; NA, not applicable; NICU, neonatal ICU; OR, operating room; PEA, pulseless electrical activity; PICU, pediatric ICU; VF, ventricular fibrillation; and VT, ventricular tachycardia. aIncludes self-reported American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, other, and unknown.
See this image and copyright information in PMC

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