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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References
- Cardiopulmonary resuscitation in the newborn intensive care unit.J Paediatr Child Heal. 1998; 34: 503-507
- Outcome following cardiopulmonary resuscitation in the neonate requiring ventilatory assistance.Resuscitation. 2000; 45: 173-180
- Cardiopulmonary resuscitation in hospitalized infants.Early Hum Dev. 2016; 101: 17-22
- Incidence, characteristics, and survival following cardiopulmonary resuscitation in the quaternary neonatal intensive care unit.Resuscitation. 2017; 110: 32-36
- Extensive cardiopulmonary resuscitation for VLBW and ELBW infants: a systematic review and meta-analyses.J Perinatol. 2009; 29: 655-661
- Survival after delivery room cardiopulmonary resuscitation: a national registry study.Resuscitation. 2020; 152: 177-183
- Neonatal delivery room CPR: an analysis of the Get with the Guidelines®—Resuscitation Registry.Resuscitation. 2021; 158: 236-242
- Higher survival rates among younger patients after pediatric intensive care unit cardiac arrests.Pediatrics. 2006; 118: 2424-2433
- The Children’s Hospitals Neonatal Database: an overview of patient complexity, outcomes and variation in care.J Perinatol. 2014; 34: 582-586
- Children’s hospital characteristics and readmission metrics.Pediatrics. 2017; 139
- Evaluating the quality of medical care. 1966.Milbank Q. 2005; 83: 691-729
- Cardiopulmonary resuscitation of adults in the hospital: a report of 14 720 cardiac arrests from the National Registry of Cardiopulmonary.Resuscitation. Resuscitation. 2003; 58: 297-308
- First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults.JAMA. 2006; 295: 50-57
- Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital “Utstein style”.Circulation. 1997; 95: 2213-2239
- Cardiac arrest and cardiopulmonary resuscitation outcome reports: Update and simplification of the Utstein templates for resuscitation registries. A statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian Resuscitation Council, New Zealand Resuscitation Council.Circulation. 2004; 110: 3385-3397
- AHA Annual Survey Data Fiscal Year.2018 (Accessed 1 December 2019, https://www.ahadata.com/)
- Gestational age and outcomes in critical congenital heart disease.Pediatrics. 2017; 140
- Intensive care for extreme prematurity--moving beyond gestational age.N Engl J Med. 2008; 358: 1672-1681
- 20-year survival of children born with congenital anomalies: a population-based study.Lancet. 2010; 375: 649-656
- Survival from in-hospital cardiac arrest during nights and weekends.JAMA. 2008; 299: 785-792
- Association between off-peak hour birth and neonatal morbidity and mortality among very low birth weight infants HHS public access.J Pediatr. 2017; 186: 41-48
- Pulselessness After initiation of cardiopulmonary resuscitation for bradycardia in hospitalized children.Circulation. 2019; 140: 370-378
- Epidemiology and outcomes from out-of-hospital cardiac arrest in children: The resuscitation outcomes consortium epistry-cardiac arrest.Circulation. 2009; 119: 1484-1491
- Association of presence and timing of invasive airway placement with outcomes after pediatric in-hospital cardiac arrest.Resuscitation. 2015; 92: 53-58
- Association between tracheal intubation during pediatric in-hospital cardiac arrest and survival.JAMA. 2016; 316: 1786-1797
- Levels of neonatal care.Pediatrics. 2012; 130: 587-597
- Guidelines and levels of care for pediatric intensive care units.Pediatrics. 2004; 114: 1114-1125
- Modes of death in pediatrics: Differences in the ethical approach in neonatal and pediatric patients.J Pediatr. 2013; 162: 1107-1111
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.
