Intensive Care Medicine

, Volume 39, Issue 2, pp 309–318 | Cite as

Factors associated with mortality in pediatric in-hospital cardiac arrest: a prospective multicenter multinational observational study

  • Jesús López-Herce
  • Jimena del Castillo
  • Martha Matamoros
  • Sonia Cañadas
  • Ana Rodriguez-Calvo
  • Corrado Cecchetti
  • Antonio Rodriguez-Núñez
  • Angel Carrillo Álvarez
  • Iberoamerican Pediatric Cardiac Arrest Study Network RIBEPCI



To analyze prognostic factors associated with in-hospital cardiac arrest (CA) in children.


A prospective, multicenter, multinational, observational study was performed on pediatric in-hospital CA in 12 countries and included 502 children between 1 month and 18 years. The primary endpoint was survival at hospital discharge. Univariate and multivariate logistic regression analyses were performed to assess the influence of each factor on mortality.


Return of spontaneous circulation was achieved in 69.5 % of patients; 39.2 % survived to hospital discharge and 88.9 % of survivors had good neurological outcome. The pre-arrest factors related to mortality were lower Human Development Index [odds ratio (OR) 2.32, 95 % confidence interval (CI) 1.28–4.21], oncohematologic disease (OR 3.33, 95 % CI 1.60–6.98), and treatment with inotropic drugs at the time of CA (OR 2.35, 95 % CI 1.55–3.56). CA and resuscitation factors related to mortality were CA due to neurological disease (OR 5.19, 95 % CI 1.49–18.73) and duration of cardiopulmonary resuscitation greater than 10 min (OR 4.00, 95 % CI 1.49–18.73). Factors related to survival were CA occurring in the pediatric intensive care unit (PICU) (OR 0.38, 95 % CI 0.16–0.86) and shockable rhythm (OR 0.26, 95 % CI 0.09–0.73).


In-hospital CA in children has a low survival but most of the survivors have a good neurological outcome. Some prognostic risk factors cannot be modified, making it important to focus efforts on improving hospital organization to care for children at risk of CA in the PICU and, in particular, in other hospital areas.


Cardiac arrest Cardiopulmonary resuscitation Resuscitation Prognostic factors 



This study was supported in part by grant RT02377 from the Science and Technology for Development (CYTED) Program and by grant PI081167 from Carlos III Institute of Health, Spain.


  1. 1.
    Slonim AD, Patel KM, Ruttimann UE, Pollack MM (1997) Cardiopulmonary resuscitation in pediatric intensive care units. Crit Care Med 25:1951–1955PubMedCrossRefGoogle Scholar
  2. 2.
    Suominen P, Olkkola KT, Voipio V, Korpela R, Palo R, Räsänan J (2000) Utstein style reporting of-in hospital paediatric cardiopulmonary resuscitation. Resuscitation 45:17–25PubMedCrossRefGoogle Scholar
  3. 3.
    Reis AG, Nadkarni V, Perondi MB, Grisi S, Berg RA (2002) A prospective investigation into the epidemiology of in-hospital pediatric cardiopulmonary resuscitation using the international Utstein reporting style. Pediatrics 109:200–209PubMedCrossRefGoogle Scholar
  4. 4.
    López-Herce J, García C, Domínguez P, Carrillo A, Rodríguez-Núñez A, Calvo C, Delgado MA, The Spanish Study Group of Cardiopulmonary Arrest in Children (2004) Characteristics and outcome of cardiorespiratory arrest in children. Resuscitation 63:311–313PubMedCrossRefGoogle Scholar
  5. 5.
    Guay J, Lortie L (2004) An evaluation of pediatric in-hospital advanced life support interventions using the pediatric Utstein guidelines: a review of 203 cardiorespiratory arrests. Can J Anaesth 51:373–378PubMedCrossRefGoogle Scholar
  6. 6.
    Rodriguez-Núñez A, López-Herce J, García C, Carrillo A, Dominguez P, Calvo C, Delgado MA, The Spanish Study Group of Cardiopulmonary Arrest in Children (2006) Effectiveness and long-term outcome of cardiopulmonary resuscitation in paediatric intensive care units in Spain. Resuscitation 71:301–309PubMedCrossRefGoogle Scholar
  7. 7.
    Tibballs J, Kinney S (2006) A prospective study of outcome of in-patient paediatric cardiopulmonary arrest. Resuscitation 71:310–318PubMedCrossRefGoogle Scholar
  8. 8.
    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. JAMA 295:96–98CrossRefGoogle Scholar
  9. 9.
    De Mos N, van Litsenburg RR, McCrindle B, Bohn DJ, Parshuram CS (2006) Pediatric in-intensive-care-unit cardiac arrest: incidence, survival, and predictive factors. Crit Care Med 34:1209–1215PubMedCrossRefGoogle Scholar
  10. 10.
    Meaney PA, Nadkarni VM, Cook EF, Testa M, Helfaer M, Kaye W, Larkin GL, Berg RA, National Registry of Cardiopulmonary Resuscitation Investigators (2006) Higher survival rates among younger patients after pediatric intensive care unit cardiac arrest. Pediatrics 118:2424–2433PubMedCrossRefGoogle Scholar
  11. 11.
    Wu ET, Li MJ, Huang SC, Wang CC, Liu YP, Lu FL, Ko WJ, Wang MJ, Wang JK, Wu MH (2009) Survey of outcome of CPR in pediatric in-hospital cardiac arrest in a medical center in Taiwan. Resuscitation 80:443–448PubMedCrossRefGoogle Scholar
  12. 12.
    Meert KL, Donaldson A, Nadkarni V, Tieves KS, Schleien CL, Brilli RJ, Clark RS, Shaffner DH, Levy F, Statler K, Dalton HJ, van der Jagt EW, Hackbarth R, Pretzlaff R, Hernan L, Dean JM, Moler FW (2009) Pediatric Emergency Care Applied Research Network. Multicenter cohort study of in-hospital pediatric cardiac arrest. Pediatr Crit Care Med 10:544–553PubMedCrossRefGoogle Scholar
  13. 13.
    Olotu A, Ndiritu M, Ismael M, Mohammed S, Mithwani S, Maitland K, Newton CR (2009) Characteristics and outcome of cardiopulmonary resuscitation in hospitalised African children. Resuscitation 80:69–72PubMedCrossRefGoogle Scholar
  14. 14.
    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 21:834–840PubMedCrossRefGoogle Scholar
  15. 15.
    Cummins R, Chamberlain D, Hazinski MF, Nadkarni V, Kloek W, Kramer E (1997) Recommended guidelines for reviewing, reporting, and conducting research on in hospital resuscitation: the in-hospital “Utstein style”. Resuscitation 34:151–183PubMedCrossRefGoogle Scholar
  16. 16.
    Jacobs I, Nadkarni V, Bahr J, Berg RA, Billi JE, Bossaert L, Cassan P, Coovadia A, D’Este K, Finn J, Halperin H, Handley A, Herlitz J, Hickey R, Idris A, Kloeck W, Larkin GL, Mancini ME, Mason P, Mears G, Monsieurs K, Montgomery W, Morley P, Nichol G, Nolan J, Okada K, Perlman J, Shuster M, Steen PA, Sterz F, Tibballs J, Timerman S, Truitt T, Zideman D; International Liaison Committee on Resuscitation; American Heart Association; European Resuscitation Council; Australian Resuscitation Council; New Zealand Resuscitation Council; Heart and Stroke Foundation of Canada; InterAmerican Heart Foundation; Resuscitation Councils of Southern Africa; ILCOR Task Force on Cardiac Arrest and Cardiopulmonary Resuscitation Outcomes (2004) Cardiac arrest and cardiopulmonary resuscitation outcomes 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, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Councils of Southern Africa). Circulation 110:3385–3397Google Scholar
  17. 17.
    Fiser DH, Long N, Roberson PK, Heffley G, Zolten K, Brodie-Fowler M (2000) Relationship of pediatric overall performance category and pediatric cerebral performance category scores at pediatric intensive care unit discharge with outcome measures collected at hospital discharge and 1- and 6-month follow-up assessments. Crit Care Med 28:2616–2620PubMedCrossRefGoogle Scholar
  18. 18.
  19. 19.
    World Health Organization (2012) Accessed date 10 Apr 2012
  20. 20.
    Human Development Reports (2012) Accessed date 10 Apr 2012
  21. 21.
    Moler FW, Meert K, Donaldson AE, Nadkarni V, Brilli RJ, Dalton HJ, Clark RS, Shaffner DH, Schleien CL, Statler K, Tieves KS, Hackbarth R, Pretzlaff R, van der Jagt EW, Levy F, Hernan L, Silverstein FS, Dean JM, Pediatric Emergency Care Applied Research Network (2009) In-hospital versus out-of-hospital pediatric cardiac arrest: a multicenter cohort study. Crit Care Med 37:2259–2267PubMedCrossRefGoogle Scholar
  22. 22.
    Smith GB (2010) In-hospital cardiac arrest: is it time for an in-hospital ‘chain of prevention’? Resuscitation 81:1209–1211PubMedCrossRefGoogle Scholar
  23. 23.
    Sharek PJ, Parast LM, Leong K, Coombs J, Earnest K, Sullivan J, Frankel LR, Roth SJ (2007) Effect of a rapid response team on hospital-wide mortality and code rates outside the ICU in a children’s hospital. JAMA 298:2267–2274PubMedCrossRefGoogle Scholar
  24. 24.
    Tibballs J, Kinney S (2009) Reduction of hospital mortality and of preventable cardiac arrest and death on introduction of a pediatric medical emergency team. Pediatr Crit Care Med 10:306–312PubMedCrossRefGoogle Scholar
  25. 25.
    Suraseranivongse S, Chawaruechai T, Saengsung P, Komoltri C (2006) Outcome of cardiopulmonary resuscitation in a 2300-bed hospital in a developing country. Resuscitation 71:188–193PubMedCrossRefGoogle Scholar
  26. 26.
    Tian J, Kaufman DA, Zarich S, Chan PS, Ong P, Amoateng-Adjepong Y, Manthous CA, American Heart Association National Registry for Cardiopulmonary Resuscitation Investigators (2010) Outcomes of critically ill patients who received cardiopulmonary resuscitation. Am J Respir Crit Care Med 182:501–506PubMedCrossRefGoogle Scholar
  27. 27.
    Kissoon N, Carcillo JA, Espinosa V, Argent A, Devictor D, Madden M, Singhi S, van der Voort E, Latour J, Global Sepsis Initiative Vanguard Center Contributors. World Federation of Pediatric Intensive Care and Critical Care Societies (2011) Global Sepsis Initiative. Pediatr Crit Care Med 12:494–503PubMedCrossRefGoogle Scholar
  28. 28.
    Donoghue AJ, Nadkarni VM, Elliott M, Durbin D, American Heart Association National Registry of Cardiopulmonary Resuscitation Investigators (2006) Effect of hospital characteristics on outcomes from pediatric cardiopulmonary resuscitation: a report from the national registry of cardiopulmonary resuscitation. Pediatrics 118:995–1001PubMedCrossRefGoogle Scholar
  29. 29.
    Sasson C, Rogers MA, Dahl J, Kellermann AL (2010) Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes 3:63–81PubMedCrossRefGoogle Scholar
  30. 30.
    Wolff H, Chong HG, Auffhammer M (2011) Classification, detection and consequences of data error: evidence from the Human Development Index. Econ J 121:843–870CrossRefGoogle Scholar

Copyright information

© Copyright jointly held by Springer and ESICM 2012

Authors and Affiliations

  • Jesús López-Herce
    • 1
  • Jimena del Castillo
    • 1
  • Martha Matamoros
    • 2
  • Sonia Cañadas
    • 3
  • Ana Rodriguez-Calvo
    • 4
  • Corrado Cecchetti
    • 5
  • Antonio Rodriguez-Núñez
    • 6
  • Angel Carrillo Álvarez
    • 1
  • Iberoamerican Pediatric Cardiac Arrest Study Network RIBEPCI
  1. 1.Pediatric Intensive Care DepartmentHospital General Universitario Gregorio MarañónMadridSpain
  2. 2.Hospital EscuelaTegucigalpaHonduras
  3. 3.Hospital Valle de HebrónBarcelonaSpain
  4. 4.Hospital Niño JesúsTucumánArgentina
  5. 5.Ospedale Bambinu GesuRomeItaly
  6. 6.Hospital Clínico Universitario de Santiago de CompostelaSantiagoSpain

Personalised recommendations