Pediatric In-Hospital Cardiac Arrests: We Have More to Learn About Patient Demographics and Outcomes
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Introduction: Prior pediatric studies show an association between patient demographics and mortality after in-hospital cardiac arrests (IHCA). To our knowledge, this has not been assessed in pediatric intensive care units (PICU). This study aims to evaluate the impact of demographics and code characteristics on outcomes after IHCA in a quaternary referral PICU. Methods: A single center retrospective review of PICU IHCA events from 2010-2021 was performed. Patient demographics included age, gender, race/ethnicity, and language. Primary diagnosis was defined as cardiac or non-cardiac. The use of ECMO, CRRT, or defibrillation were included as code characteristics. The primary outcome was survival to hospital discharge. Adjusted odds of mortality (aOR) were obtained using PRISM III scores to adjust for illness severity. Data obtained via Virtual Pediatric System© and chart review. Results: 377 patients (median age 11 months) had 520 PICU IHCA events. 59.4% identified as White, 16.2% Black, 8.3% Hispanic, and 1.5% Asian. Overall survival was 49%. Adjusting for disease severity, there was no difference in survival rates between females (43.3%) vs. males (54%) [aOR 1.26(p=0.278)] or racial/ethnic groups: Hispanic 39.5% [aOR 1.75(p=0.214)], Asian 25.0% [aOR 4.74(p=0.063)], Black 51.2% [aOR 1.13(p=0.664) vs. White 51.1%. Language had no impact on survival: Spanish 36.8% vs. English 49.3% [aOR 1.08(p=0.912)]. Cardiac diagnosis survival was 54.5% vs. non-cardiac 42.2% [aOR 0.75(p=0.166)]. Although different, survival rates were not statistically significant in patients requiring ECMO (Black 33.3% [OR 1.70(p=0.485), Asian 0% [OR 1.99(p=0.302)] vs. White 45.9%), CRRT (Hispanic 20% [OR 1.49(p=0.999)], Asian 0% [OR: 1.34(p=0.819)] vs. White 27.3%), or defibrillation (Asian 0% vs. White 39.1% [OR 0.60(p=0.999)]). Conclusion: Controlling for illness severity, there were no statistically significant outcome differences based on demographics after IHCA in the PICU. This is inconsistent with previously published data on outcomes following IHCA. While this single center study did not assess CPR performance or post-arrest care, it provides framework for future analysis of IHCA in the PICU and identifying risk factors for mortality in this specific patient population.
Critical Care | Pediatrics
When and Where Presented
Presented at the 2023 Critical Care Congress, Society of Critical Care Medicine; San Francisco, CA; January 21-24, 2023.
LaVoy, Nathan; Cowden, John; Miller, Jenna; Wagner, Asdis Finnsdottir; Hensley, Shekinah; and Pfeiffer, Stephen, "Pediatric In-Hospital Cardiac Arrests: We Have More to Learn About Patient Demographics and Outcomes" (2023). Presentations. 75.