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Survival outcomes of in-hospital cardiac arrest in pediatric patients in the USA

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Abstract

We report on in-hospital cardiac arrest outcomes in the USA. The data were obtained from the National (Nationwide) Inpatient Sample datasets for the years 2000–2017, which includes data from participating hospitals in 47 US states and the District of Columbia. We included pediatric patients (< 18 years of age) with cardiac arrest, and we excluded patients with no cardiopulmonary resuscitation during the hospitalization. Primary outcome of the study was in-hospital mortality after cardiac arrest. A multivariable logistic regression was performed to identify factors associated with survival. A total of 20,654 patients were identified, and 8226 (39.82%) patients survived to discharge. The median length of stay and cost of hospitalization were significantly higher in the survivors vs. non-survivors (LOS 18 days vs. 1 day, and cost $187,434 vs. $45,811, respectively, p < 0.001). In a multivariable model, patients admitted to teaching hospitals, elective admissions, and those admitted on weekdays had higher survival (aOR=1.19, CI: 1.06–1.33; aOR=2.65, CI: 2.37–2.97; and aOR=1.17, CI: 1.07–1.27, respectively). There was no difference in mortality between patients with extracorporeal cardiopulmonary resuscitation (E-CPR) and those with conventional cardiopulmonary resuscitation. E-CPR patients were likely to have congenital heart surgery (51.0% vs. 20.8%).

Conclusion: We highlighted the survival predictors in these events, which can guide future studies aimed at improving outcomes in pediatric cardiac arrest.

What is Known:

• In-hospital cardiac arrest occurs in 2–6% of pediatric intensive care admissions.

• Cardiac arrests had a significant impact on hospital resources and a significantly high mortality rate.

What is New:

• Factors associated with higher survival rates in patients with cardiac arrest: admission to teaching hospitals, elective admissions, and week-day admissions.

• The use of rescue extracorporeal cardiopulmonary resuscitation in refractory cardiac arrest has increased by threefold over the last two decades.

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Data Availability

This is a publicly available data.

Code Availability

N/A

Abbreviations

IHCA:

In-hospital cardiac arrest

ECPR:

Extracorporeal cardiopulmonary resuscitation

ECMO:

Extracorporeal membrane oxygenation

HCUP:

Healthcare Cost and Utilization Project

ICD-9-CM:

International Classification of Diseases, Ninth Revision, Clinical Modification

ICD-10-CM:

International Classification of Diseases, Tenth Revision, Clinical Modification

CPR:

Cardiopulmonary resuscitation

LOS:

Length of hospital stay

CHD:

Congenital heart disease

IQR:

Interquartile range

ELSO:

Extracorporeal Life Support Organization

References

  1. Holmberg MJ, Ross CE, Fitzmaurice GM, Chan PS, Duval-Arnould J, Grossestreuer AV, Yankama T, Donnino MW, Andersen LW, for the American Heart Association’s Get With The Guidelines–Resuscitation Investigators*, Chan P, Grossestreuer AV, Moskowitz A, Edelson D, Ornato J, Berg K, Peberdy MA, Churpek M, Kurz M, Starks MA, Girotra S, Perman S, Goldberger Z, Guerguerian AM, Atkins D, Foglia E, Fink E, Lasa JJ, Roberts J, Bembea M, Gaies M, Kleinman M, Gupta P, Sutton R, Sawyer T (2019) Annual incidence of adult and pediatric in-hospital cardiac arrest in the United States. Circ Cardiovasc Qual Outcomes 12:1–8. https://doi.org/10.1161/CIRCOUTCOMES.119.005580

    Article  Google Scholar 

  2. Berg RA, Nadkarni VM, Clark AE, Moler F, Meert K, Harrison RE, Newth CJ, Sutton RM, Wessel DL, Berger JT, Carcillo J, Dalton H, Heidemann S, Shanley TP, Zuppa AF, Doctor A, Tamburro RF, Jenkins TL, Dean JM, Holubkov R, Pollack MM, Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (2016) Incidence and outcomes of cardiopulmonary resuscitation in PICUs. Crit Care Med 44:798–808. https://doi.org/10.1097/CCM.0000000000001484

    Article  PubMed  PubMed Central  Google Scholar 

  3. Holmberg MJ, Wiberg S, Ross CE, Kleinman M, Hoeyer-Nielsen AK, Donnino MW, Andersen LW, For the American Heart Association’s Get With The Guidelines-Resuscitation Investigators (2019) Trends in survival after pediatric in-hospital cardiac arrest in the United States. Circulation 140:1398–1408. https://doi.org/10.1161/CIRCULATIONAHA.119.041667

    Article  PubMed  PubMed Central  Google Scholar 

  4. Girotra S, Spertus JA, Li Y, Berg RA, Nadkarni VM, Chan PS, for the American Heart Association Get With the Guidelines–Resuscitation Investigators (2013) Survival trends in pediatric in-hospital cardiac arrests an analysis from get with the guidelines-resuscitation. Circ Cardiovasc Qual Outcomes 6:42–49. https://doi.org/10.1161/CIRCOUTCOMES.112.967968

    Article  PubMed  Google Scholar 

  5. Berg RA, Sutton RM, Reeder RW, Berger JT, Newth CJ, Carcillo JA, McQuillen PS, Meert KL, Yates AR, Harrison RE, Moler FW, Pollack MM, Carpenter TC, Wessel DL, Jenkins TL, Notterman DA, Holubkov R, Tamburro RF, Dean JM, Nadkarni VM, Zuppa AF, Graham K, Twelves C, Landis W, DiLiberto MA, Tomanio E, Kwok J, Bell MJ, Abraham A, Sapru A, Alkhouli MF, Heidemann S, Pawluszka A, Hall MW, Steele L, Shanley TP, Weber M, Dalton HJ, Bell AL, Mourani PM, Malone K, Telford R, Coleman W, Peterson A, Thelen J, Doctor A, CPCCRN PICqCPR Investigators (2018) Association between diastolic blood pressure during pediatric in-hospital cardiopulmonary resuscitation and survival. Circulation 137:1784–1795. https://doi.org/10.1161/CIRCULATIONAHA.117.032270

    Article  PubMed  Google Scholar 

  6. Nadkarni VM, Larkin GL, Peberdy MA, Carey SM, Kaye W, Mancini ME, Nichol G, Lane-Truitt T, Potts J, Ornato JP, Berg RA, National Registry of Cardiopulmonary Resuscitation Investigators (2006) First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. J Am Med Assoc 295:50–57. https://doi.org/10.1001/jama.295.1.50

    Article  CAS  Google Scholar 

  7. Agency for Healthcare Research and Quality. Overview of the National (Nationwide) Inpatient Sample (NIS). Available at https://www.hcupus.ahrq.gov/nisoverview.jsp Accessed 23 Sep 2020

  8. Knudson JD, Neish SR, Cabrera AG, Lowry AW, Shamszad P, Morales DL, Graves DE, Williams EA, Rossano JW (2012) Prevalence and outcomes of pediatric in-hospital cardiopulmonary resuscitation in the United States: an analysis of the Kids’ Inpatient Database*. Crit Care Med 40(11):2940–2944. https://doi.org/10.1097/CCM.0b013e31825feb3f

    Article  PubMed  Google Scholar 

  9. Armstrong RA, Kane C, Oglesby F, Barnard K, Soar J, Thomas M (2019) The incidence of cardiac arrest in the intensive care unit: a systematic review and meta-analysis. J Intensive Care Soc 20:144–154. https://doi.org/10.1177/1751143718774713

    Article  PubMed  Google Scholar 

  10. Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, Chamberlain AM, Chang AR, Cheng S, Das SR, Delling FN, Djousse L, Elkind MSV, Ferguson JF, Fornage M, Jordan LC, Khan SS, Kissela BM, Knutson KL, Kwan TW, Lackland DT, Lewis TT, Lichtman JH, Longenecker CT, Loop MS, Lutsey PL, Martin SS, Matsushita K, Moran AE, Mussolino ME, O’Flaherty M, Pandey A, Perak AM, Rosamond WD, Roth GA, Sampson UKA, Satou GM, Schroeder EB, Shah SH, Spartano NL, Stokes A, Tirschwell DL, Tsao CW, Turakhia MP, VanWagner LB, Wilkins JT, Wong SS, Virani SS, On behalf of the American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee (2019) Heart Disease and Stroke Statistics-2019 Update: a report from the American Heart Association. Circulation 139:e56–e528. https://doi.org/10.1161/CIR.0000000000000659

    Article  PubMed  Google Scholar 

  11. Topjian AA, Raymond TT, Atkins D, Chan M, Duff JP, Joyner BL Jr, Lasa JJ, Lavonas EJ, Levy A, Mahgoub M, Meckler GD, Roberts KE, Sutton RM, Schexnayder SM, Pediatric Basic and Advanced Life Support Collaborators (2020) Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 142(16_suppl_2):S469–S523. https://doi.org/10.1161/CIR.0000000000000901

    Article  PubMed  Google Scholar 

  12. Barbaro RP, Paden ML, Guner YS, Raman L, Ryerson LM, Alexander P, Nasr VG, Bembea MM, Rycus PT, Thiagarajan RR, ELSO member centers (2017) Pediatric Extracorporeal Life Support Organization Registry International Report 2016. ASAIO J 63:456–463. https://doi.org/10.1097/MAT.0000000000000603

    Article  PubMed  PubMed Central  Google Scholar 

  13. Lasa JJ, Rogers RS, Localio R, Shults J, Raymond T, Gaies M, Thiagarajan R, Laussen PC, Kilbaugh T, Berg RA, Nadkarni V, Topjian A (2016) Extracorporeal cardiopulmonary resuscitation (E-CPR) during pediatric in-hospital cardiopulmonary arrest is associated with improved survival to discharge. Circulation 133:165–176. https://doi.org/10.1161/CIRCULATIONAHA.115.016082

    Article  PubMed  Google Scholar 

  14. Nishisaki A, Pines JM, Lin R, Helfaer MA, Berg RA, Tenhave T, Nadkarni VM (2012) The impact of 24-hr, in-hospital pediatric critical care attending physician presence on process of care and patient outcomes*. Crit Care Med 40(7):2190–2195. https://doi.org/10.1097/CCM.0b013e31824e1cda

    Article  PubMed  Google Scholar 

  15. Alten JA, Klugman D, Raymond TT, Cooper DS, Donohue JE, Zhang W, Pasquali SK, Gaies MG (2017) Epidemiology and outcomes of cardiac arrest in pediatric cardiac ICUs*. Pediatr Crit Care Med 18:935–943. https://doi.org/10.1097/PCC.0000000000001273

    Article  PubMed  PubMed Central  Google Scholar 

  16. Berg RA, Sutton RM, Holubkov R, Nicholson CE, Dean JM, Harrison R, Heidemann S, Meert K, Newth C, Moler F, Pollack M, Dalton H, Doctor A, Wessel D, Berger J, Shanley T, Carcillo J, Nadkarni VM, Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network and for the American Heart Association’s Get With the Guidelines-Resuscitation (formerly the National Registry of Cardiopulmonary Resuscitation) Investigators (2013) Ratio of PICU versus ward cardiopulmonary resuscitation events is increasing*. Crit Care Med 41:2292–2297. https://doi.org/10.1097/CCM.0b013e31828cf0c0

    Article  PubMed  PubMed Central  Google Scholar 

  17. Topjian AA, de Caen A, Wainwright MS, Abella BS, Abend NS, Atkins DL, Bembea MM, Fink EL, Guerguerian AM, Haskell SE, Kilgannon JH, Lasa JJ, Hazinski MF (2019) Pediatric post-cardiac arrest care: a scientific statement from the American Heart Association. Circulation 140(6):e194–e233. https://doi.org/10.1161/CIR.0000000000000697

    Article  PubMed  Google Scholar 

  18. Berens RJ, Cassidy LD, Matchey J, Campbell D, Colpaert KD, Welch T, Lawson M, Peterson C, O’Flynn J, Dearth M, Tieves KS (2011) Probability of survival based on etiology of cardiopulmonary arrest in pediatric patients. Paediatr Anaesth 21:834–840. https://doi.org/10.1111/j.1460-9592.2010.03479.x

    Article  PubMed  Google Scholar 

  19. Raymond TT, Cunnyngham CB, Thompson MT, Thomas JA, Dalton HJ, Nadkarni VM (2010) Outcomes among neonates, infants, and children after extracorporeal cardiopulmonary resuscitation for refractory inhospital pediatric cardiac arrest: a report from the National Registry of Cardiopulmonary Resuscitation. Pediatr Crit Care Med 11:362–371. https://doi.org/10.1097/PCC.0b013e3181c0141b

    Article  PubMed  Google Scholar 

  20. Khera R, Tang Y, Girotra S, Nadkarni VM, Link MS, Raymond TT, Guerguerian AM, Berg RA, Chan PS, American Heart Association’s Get With the Guidelines-Resuscitation Investigators (2019) Pulselessness after initiation of cardiopulmonary resuscitation for bradycardia in hospitalized children. Circulation 140(5):370–378. https://doi.org/10.1161/CIRCULATIONAHA.118.039048

    Article  PubMed  PubMed Central  Google Scholar 

  21. Morgan RW, Reeder RW, Meert KL, Telford R, Yates AR, Berger JT, Graham K, Landis WP, Kilbaugh TJ, Newth CJ, Carcillo JA, McQuillen PS, Harrison RE, Moler FW, Pollack MM, Carpenter TC, Notterman D, Holubkov R, Dean JM, Nadkarni VM, Berg RA, Sutton RM, Eunice Kennedy Shriver National Institute of Child Health and Human Development/Collaborative Pediatric Critical Care Research Network (CPCCRN) Pediatric Intensive Care Quality of Cardio-Pulmonary Resuscitation (PICqCPR) Investigators (2020) Survival and hemodynamics during pediatric cardiopulmonary resuscitation for bradycardia and poor perfusion versus pulseless cardiac arrest. Crit Care Med 48(6):881–889. https://doi.org/10.1097/CCM.0000000000004308

    Article  PubMed  PubMed Central  Google Scholar 

  22. Bhanji F, Topjian AA, Nadkarni VM, Praestgaard AH, Hunt EA, Cheng A, Meaney PA, Berg RA, for the American Heart Association’s Get With the Guidelines–Resuscitation Investigators (2017) Survival rates following pediatric in-hospital cardiac arrests during nights and weekends. JAMA Pediatr 171:39–45. https://doi.org/10.1001/jamapediatrics.2016.2535

    Article  PubMed  PubMed Central  Google Scholar 

  23. Peberdy MA, Ornato JP, Larkin GL, Braithwaite RS, Kashner TM, Carey SM, Meaney PA, Cen L, Nadkarni VM, Praestgaard AH, Berg RA, National Registry of Cardiopulmonary Resuscitation Investigators (2008) Survival from in-hospital cardiac arrest during nights and weekends. JAMA 299(7):785–792. https://doi.org/10.1001/jama.299.7.785

    Article  CAS  PubMed  Google Scholar 

  24. Burke CR, Chan T, Brogan TV, McMullan DM (2017) Pediatric extracorporeal cardiopulmonary resuscitation during nights and weekends. Resuscitation 114:47–52. https://doi.org/10.1016/j.resuscitation.2017.03.001

    Article  PubMed  Google Scholar 

  25. Bembea MM, Ng DK, Rizkalla N, Rycus P, Lasa JJ, Dalton H, Topjian AA, Thiagarajan RR, Nadkarni VM, Hunt EA, American Heart Association’s Get With The Guidelines – Resuscitation Investigators (2019) Outcomes after extracorporeal cardiopulmonary resuscitation of pediatric in-hospital cardiac arrest: a report from the get with the guidelines-resuscitation and the extracorporeal life support organization registries. Crit Care Med 47:e278–e285. https://doi.org/10.1097/CCM.0000000000003622

    Article  PubMed  Google Scholar 

  26. Ortmann L, Prodhan P, Gossett J, Schexnayder S, Berg R, Nadkarni V, Bhutta A, American Heart Association's Get With the Guidelines–Resuscitation Investigators (2011) Outcomes after in-hospital cardiac arrest in children with cardiac disease: a report from Get With the Guidelines--Resuscitation. Circulation 124(21):2329–2337. https://doi.org/10.1161/CIRCULATIONAHA.110.013466

    Article  PubMed  Google Scholar 

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Author notes

  1. Mohammed Hamzah and Hasan F. Othman contributed equally to this work.

Authors and Affiliations

  1. Department of Pediatric Critical Care, Cleveland Clinic Children’s, 9500 Euclid Ave. M14, Cleveland, OH, 44195, USA

    Mohammed Hamzah

  2. Pediatrics, Michigan State University/Sparrow Health System, Lansing, MI, USA

    Hasan F. Othman

  3. Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA

    Murad Almasri

  4. Department of Pediatrics, University of Wisconsin, Madison, WI, USA

    Awni Al-Subu

  5. Department of Pediatrics Critical Care, Indiana University/Riley Hospital for Children, Indiana University Health Physicians, Indianapolis, IN, USA

    Riad Lutfi

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  1. Mohammed Hamzah
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  2. Hasan F. Othman
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Contributions

Mohammed Hamzah conceptualized and designed the study and drafted the initial manuscript and revised and approved the submitted version. Hasan F. Othman conceptualized and designed the study, drafted the initial manuscript, and revised and approved the submitted version. Mural Al Masri contributed to initial draft and revised and approved the submitted version. Awni al subu contributed to manuscript critical revision and approved the submitted version. Riad Lutfi contributed to manuscript critical revision and approved the submitted version.

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Correspondence to Mohammed Hamzah.

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Hamzah, M., Othman, H.F., Almasri, M. et al. Survival outcomes of in-hospital cardiac arrest in pediatric patients in the USA. Eur J Pediatr 180, 2513–2520 (2021). https://doi.org/10.1007/s00431-021-04082-3

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  • DOI: https://doi.org/10.1007/s00431-021-04082-3

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