Outcome of In-Hospital Pediatric Cardiopulmonary Arrest from a Single Center in Pakistan

  • Anwarul HaqueEmail author
  • Arjumand Rizvi
  • Surraiya Bano
Original Article



To review the incidence and outcome of in-hospital pediatric cardiopulmonary arrest (CPA).


This retrospective six-year case series was carried out at the PICU and Pediatric Units of Aga Khan University Hospital (AKUH). All children aged 1 month to 14 years who underwent cardiopulmonary resuscitation from January 2001 through December 2006 were included. Data were recorded according to the Utstein style. The outcome variables were sustained return of spontaneous circulation (initial survival) and hospital discharge (final survival). Factors associated with survival were evaluated using logistic regression analysis.


The incidence of CPA was 0.4% of all the admissions. Most of the CPR attempts took place in pediatric intensive care unit (53%) and the most frequent etiology was shock (78%). After initial CPR, the sustained return of spontaneous circulation was achieved in 58 patients (55%). Only 12 patients (11%) were discharged alive from the hospital. The most common initial documented rhythm was bradycardia (78%). Multivariate logistic regression analysis revealed that prolonged duration of CPR (>20 min) was the best predictor of initial and final mortality (p < 0.001).


The survival rate of in-hospital pediatric cardiopulmonary arrest in the present report is low.


In-hospital Survival CPR Pediatric 



The author thanks Muhammad K. Ashraf and Muhhammad A. Anwar for data collection, Arjumund Rizvi for statistical analysis and Dr. Aisha Yousufzai for manuscript proof reading.

Conflict of Interest


Role of Funding Source



  1. 1.
    Gillis JD, Rieder M, Steward D, et al. Results of inpatient pediatric resuscitation. Crit Care Med. 1986;14:469–71.PubMedCrossRefGoogle Scholar
  2. 2.
    Zaritsky A, Nadkarni VM, Getson P, et al. CPR in children. Ann Emerg Med. 1987;16:1107–11.PubMedCrossRefGoogle Scholar
  3. 3.
    Berg MD, Nadkarni VM, Berg RA. Cardiopulmonary resuscitation in children. Curr Opin Crit Care. 2008;14:254–60.PubMedCrossRefGoogle Scholar
  4. 4.
    Nadkarni VM, Larkin GL, Peberdy MA, et al. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA. 2006;295:50–7.PubMedCrossRefGoogle Scholar
  5. 5.
    Tibballs J, Kinney S. A prospective study of outcome of in-patients pediatric cardiopulmonary arrest. Resuscitation. 2006;71:310–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Samson RA, Nadkarni VM, Meaney PA, et al. Outcomes of in-hospital ventricular fibrillation in children. N Engl J Med. 2006;354:2328.PubMedCrossRefGoogle Scholar
  7. 7.
    Suominen P, Olkkola KT, Voipa V, et al. Utstein style reporting of in-hospital pediatric cardiopulmonary resuscitation. Resuscitation. 2000;45:17–25.PubMedCrossRefGoogle Scholar
  8. 8.
    Reis AG, Nadkarni VM, Perondi MB, et al. A prospective investigation into the epidemiology of in-hospital pediatric cardiopulmonary resuscitation using the international utstein reporting style. Pediatrics. 2002;109:200–9.PubMedCrossRefGoogle Scholar
  9. 9.
    Guay J, Lortie L. An evaluation of pediatric in-hospital advanced life support interventions using the pediatric Utstein guidelines: a review of 203 cardiopulmonary arrests. Can J Anesth. 2004;51:373–8.PubMedCrossRefGoogle Scholar
  10. 10.
    American Heart Association (AHA) in Collaboration with the International Liaison Committee on Resuscitation (ILCOR). Guidelines 2005 for cardiopulmonary resuscitation and emergency cardiovascular care, pediatric advanced life support and pediatric basic life support. Circulation. 2005;112:I67–87.CrossRefGoogle Scholar
  11. 11.
    Berg MD, Nadkarni VM, Zuercher M, et al. In-hospital pediatric cardiac arrest. Pediatr Clin N Am. 2008;55:589–604.CrossRefGoogle Scholar
  12. 12.
    Zaritsky A, Nadkarni V, Hazinski MF, et al. Recommended guidelines for uniform reporting of pediatric advance life support: the pediatric Utstein Style. Pediatrics. 1995;96:765–79.PubMedGoogle Scholar
  13. 13.
    Sharek PJ, Parast LM, Leong K, et al. Effect of a rapid response team on hospital-wide mortality and code rates outside the ICU in a children’s hospital. JAMA. 2007;298:2267–74.PubMedCrossRefGoogle Scholar
  14. 14.
    Gallagher EJ, Lombardi G, Gennis P. Effectiveness of bystander cardiopulmonary resuscitation and survival following out-of-hospital cardiac arrest. JAMA. 1995;274:1922–5.PubMedCrossRefGoogle Scholar
  15. 15.
    Haque A, Ali FS, Zaidi S, et al. Experience of pediatric rapid response team in a tertiary care hospital in Pakistan. Indian J Pediatr. 2010;77:273–6.CrossRefGoogle Scholar
  16. 16.
    Adrie C, Adib-Conquy M, Laurent I, et al. Successful cardiopulmonary resuscitation after cardiac arrest as a “Sepsis-like” Syndrome. Circulation. 2002;106:562–8.PubMedCrossRefGoogle Scholar
  17. 17.
    Kleinman ME, Srinivasan V. Post-resuscitation care. Pediatr Clin N Am. 2008;55:943–67.CrossRefGoogle Scholar
  18. 18.
    Sunde K, Pylte M, Jacobsen D, et al. Implementation of a standardized treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation. 2007;73:29–39.PubMedCrossRefGoogle Scholar
  19. 19.
    Peberdy MA, Ornato JP. Post Resuscitation care: is it the missing link in the chain of survival? Resuscitation. 2005;64:135–7.PubMedCrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2011

Authors and Affiliations

  1. 1.Department of Pediatrics and Child HealthAga Khan University HospitalKarachiPakistan
  2. 2.Department of Emergency MedicineAga Khan University HospitalKarachiPakistan
  3. 3.Department: of PediatricsAga Khan University HospitalKarachiPakistan

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