Abstract
Aim
To evaluate associations between calcium administration and outcomes among children
with in-hospital cardiac arrest and among specific subgroups in which calcium use
is hypothesized to provide clinical benefit.
Methods
This is a secondary analysis of observational data collected prospectively as part
of the ICU-RESUScitation project. Children 37 weeks post-conceptual age to 18 years
who received chest compressions in one of 18 intensive care units from October 2016–March
2021 were eligible. Data included child and event characteristics, pre-arrest laboratory
values, pre- and intra-arrest haemodynamics, and outcomes. Outcomes included sustained
return of spontaneous circulation (ROSC), survival to hospital discharge, and survival
to hospital discharge with favourable neurologic outcome. A propensity score weighted
cohort was used to evaluate associations between calcium use and outcomes. Subgroups
included neonates, and children with hyperkalaemia, sepsis, renal insufficiency, cardiac
surgery with cardiopulmonary bypass, and calcium-avid cardiac diagnoses.
Results
Of 1,100 in-hospital cardiac arrests, median age was 0.63 years (IQR 0.19, 3.81);
450 (41%) received calcium. Among the weighted cohort, calcium use was not associated
with sustained ROSC (aOR, 0.87; CI95 0.61–1.24; p = 0.445), but was associated with lower rates of both survival to hospital discharge
(aOR, 0.68; CI95 0.52–0.89; p = 0.005) and survival with favourable neurologic outcome at hospital discharge (aOR,
0.75; CI95 0.57–0.98; p = 0.038). Among subgroups, calcium use was associated with lower rates of survival
to hospital discharge in children with sepsis and renal insufficiency.
Conclusions
Calcium use was common during paediatric in-hospital cardiac arrest and associated
with worse outcomes at hospital discharge.
Keywords
Abbreviations:
AHA (American Heart Association), CICU (Cardiac Intensive Care Unit), CPR (Cardiopulmonary Resuscitation), ECMO (Extracorporeal Membrane Oxygenation), FSS (Functional Status Scale), GWTG-R (Get With The Guidelines - Resuscitation), ICU (Intensive Care Unit), ICU-RESUS (Intensive Care Unit Resuscitation Project), IHCA (In-Hospital Cardiac Arrest), IRB (Institutional Review Board), NRCPR (National Registry of Cardiopulmonary Resuscitation), PCPC (Paediatric Cerebral Performance Category), PEA (Pulseless Electrical Activity), PICU (Paediatric Intensive Care Unit), PRISM (Paediatric RIsk of Mortality), ROSC (Return of Spontaneous Circulation), VIS (Vasoactive Inotrope Score)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 21, 2022
Accepted:
December 14,
2022
Received in revised form:
December 12,
2022
Received:
October 31,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier B.V. All rights reserved.
