Post-resuscitative clinical features in the first hour after achieving sustained ROSC predict the duration of survival in children with non-traumatic out-of-hospital cardiac arrest☆
Received 31 August 2009; received in revised form 6 January 2010; accepted 10 January 2010. published online 11 February 2010.
Abstract
Aim of the study
Although sustained return of spontaneous circulation (ROSC) can be initially established after resuscitation from non-traumatic out-of-hospital cardiac arrest (OHCA) in some children, many of the children lose spontaneous circulation during hospital stay and do not survive to discharge. The aim of this study was to determine the clinical features during the first hour after ROSC that may predict survival to hospital discharge.
Methods
We retrospectively evaluated the medical records of 228 children who presented to the emergency department without spontaneous circulation following non-traumatic OHCA during the period January 1996 to December 2008. Among these children, 80 achieved sustained ROSC for at least 20min. The post-resuscitative clinical features during the first hour after achieving sustained ROSC that correlated with survival, median duration of survival, and death were analyzed.
Results
Among the 80 children who achieved sustained ROSC for at least 20min, 28 survived to hospital discharge and 6 had good neurologic outcomes (PCPC scale=1 or 2). Post-resuscitative clinical features associated with survival included sinus cardiac rhythm (p=0.012), normal heart rate (p=0.008), normal blood pressure (p<0.001), urine output>1ml/kg/h (p=0.002), normal skin color (p=0.016), lack of cardiopulmonary resuscitation (CPR)-induced rib fracture (p=0.044), initial Glasgow Coma Scale score>7 (p<0.001), and duration of in-hospital CPR≤10min (p<0.001). Furthermore, these variables were also significantly associated with the duration of survival (all p<0.05).
Conclusions
The most important predictors of survival to hospital discharge in children with OHCA who achieve sustained ROSC are a normal heart rate, normal blood pressure, and an initial urine output>1ml/kg/h.
aDepartment of Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan
bDepartment of Emergency Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
cDepartment of Biological Science and Technology and Institute of Biochemical Engineering, National Chiao Tung University, Hsinchu, Taiwan
dEpidemiology and Biostatistics Center, Changhua Christian Hospital, Changhua, Taiwan
eInstitute of Medicine, Chungshan Medical University, Taichung, Taiwan
fInstitute of Environmental Medicine, China Medical University, Taichung, Taiwan
gInstitute of Cellular and System Medicine, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
Corresponding author at: Department of Emergency Medicine, Changhua Christian Hospital, 135 Nanshsiao Street, Changhua 500, Taiwan. Tel.: +886 4 7238595x1374; fax: +886 4 7289233.
ABSTRACT