Abstract
Aim
Cardiopulmonary resuscitation (CPR) in hospitalized infants is a relatively uncommon
but high-risk event associated with mortality. The study objective was to identify
factors associated with mortality and survival among infants who receive CPR in the
neonatal intensive care unit (NICU) or pediatric intensive care unit (PICU).
Methods
Retrospective observational study of infants with an index CPR event in the NICU or
PICU between 1/1/06 and 12/31/18 in the American Heart Association’s Get With The
Guidelines-Resuscitation registry. Associations between patient, event, unit, and
hospital factors and the primary outcome, mortality prior to discharge, were examined
using multivariable logistic regression.
Results
Among 3521 infants who received CPR, 2080 (59%) died before discharge, with 25% mortality
during CPR and 40% within 24 h. Mortality prior to discharge occurred in 65% and 47%
of cases in the NICU and PICU, respectively. Factors most strongly independently associated
with pre-discharge mortality were vasoactive agent before CPR (adjusted odds ratio
(aOR): 2.77, 95% confidence interval (CI) 2.15–3.58), initial pulseless condition
(aOR: 2.38, 95% CI 1.46–3.86) or development of pulselessness (aOR: 2.36, 95% CI 1.78–3.12),
and NICU location compared with PICU (aOR: 3.85, 95% CI 2.86–5.19). Endotracheal intubation
during CPR was associated with decreased odds of pre-discharge mortality (aOR: 0.40,
95% CI 0.33−0.49).
Conclusion
Infants who receive CPR in the intensive care unit experience high mortality rates;
identifiable patient, event, and unit factors increase the odds of mortality. Further
investigation should explore the association between unit type, resuscitation processes,
and mortality.
Keywords
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Article info
Publication history
Published online: June 06, 2021
Accepted:
May 28,
2021
Received in revised form:
May 12,
2021
Received:
March 24,
2021
Footnotes
☆Prior presentation: This work was presented as a webinar as part of the Pediatric Academic Societies Neonatology Summer Webinar Series in June 2020.
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
