Epidemiology and outcomes of infants after cardiopulmonary resuscitation in the neonatal or pediatric intensive care unit from a national registry

  • Sara C. Handley
    Correspondence
    Corresponding author: Roberts Center for Pediatric Research, The Children’s Hospital of Philadelphia, Room 19362, 2716 South Street, Philadelphia, PA 19146, United States.
    Affiliations
    Division of Neonatology, Department of Pediatrics, The Children’s Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States

    Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States

    Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk #210, Philadelphia, PA 19104, United States
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  • Molly Passarella
    Affiliations
    Center for Perinatal and Pediatric Health Disparities Research, The Children’s Hospital of Philadelphia, 2716 South Street 19th Floor, Philadelphia, PA 19146, United States
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  • Tia T. Raymond
    Affiliations
    Department of Pediatrics, Division of Cardiac Critical Care, Medical City Children’s Hospital, 7777 Forest Lane Suite C-300J, Dallas, TX 75230, United States
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  • Scott A. Lorch
    Affiliations
    Division of Neonatology, Department of Pediatrics, The Children’s Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States

    Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States

    Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk #210, Philadelphia, PA 19104, United States

    Center for Perinatal and Pediatric Health Disparities Research, The Children’s Hospital of Philadelphia, 2716 South Street 19th Floor, Philadelphia, PA 19146, United States
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  • Anne Ades
    Affiliations
    Division of Neonatology, Department of Pediatrics, The Children’s Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States

    Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States
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  • Elizabeth E. Foglia
    Affiliations
    Division of Neonatology, Department of Pediatrics, The Children’s Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, United States

    Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, United States
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      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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