In-hospital Cardiac-Arrest Survival Triples in Kids

December 19, 2012

Mirroring recent findings in adults, a new study shows that children who experience a cardiac arrest while in the hospital are more and more likely to live, with survival rates almost tripling over the past decade [1]. Dr Saket Girotra (University of Iowa Hospitals and Clinics, Iowa City) and colleagues report their findings online December 18, 2012 in Circulation: Cardiovascular Quality and Outcomes.

"We found a significant improvement in risk-adjusted survival in children who experienced a cardiac arrest in-hospital since 2000. The magnitude of improvement in survival was pretty dramatic, with a nearly threefold improvement, from 14.3% in 2000 to 43.4% in 2009," Girotra told heartwire . And he stressed, "This improvement was not accompanied by any worsening in rates of neurological impairment in these children."

The study is "a benchmark in trying to understand what is going on with outcomes in people who have a cardiac arrest in the hospital," he added, noting, "There has been a lot of emphasis from professional organizations on improving outcomes for in-hospital cardiac arrest. The AHA has come out with guidelines twice within the past decade, and we were interested in knowing whether these and other efforts have led to an improvement in survival over time."

To examine this issue, Girotra and colleagues identified 1031 children under the age of 18 from 12 hospitals within the national Get With the Guidelines--Resuscitation registry who had had an in-hospital cardiac arrest. They examined temporal trends to survival and discharge. The initial cardiac-arrest rhythm was asystole and pulseless electrical activity in 874 kids (84.8%) and ventricular fibrillation and pulseless ventricular tachycardia in 157 children (15.2%), with an increase in cardiac arrests due to pulseless electrical activity over time (p for trend < 0.001).

Improvements occurred in all age categories--neonates, toddlers, and older children--and the overall improvement in survival was largely due to an improvement in the initial resuscitation effort, Girotra said. Risk-adjusted rates of acute resuscitation survival were 42.9% in 2000 and 81.2% in 2009 (adjusted rate ratio per year 1.04; p for trend=0.006).

Improvement in postresuscitation survival was seen but was not statistically significant, although Girotra notes that this group was hindered by small sample size.

"It's hard to tease out what are some of the specific initiatives that would have led to the improvement in survival," Girotra says. "I can speculate that it has to do with better, earlier recognition of patients who are at risk of or having a cardiac arrest; quicker response times; focus on improvement and quality of chest compressions and CPR efforts; and better care of these patients once they have been resuscitated."

However, he stressed that these data do not allow determination of which of these specific factors or combination of factors are responsible for the improvements observed. "Future studies will have to look into this," he said.

The authors report no conflicts of interest.

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