Document Detail


Multicenter cohort study of out-of-hospital pediatric cardiac arrest.
MedLine Citation:
PMID:  20935561     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: To describe a large cohort of children with out-of-hospital cardiac arrest with return of circulation and to identify factors in the early postarrest period associated with survival. These objectives were for planning an interventional trial of therapeutic hypothermia after pediatric cardiac arrest.
METHODS: A retrospective cohort study was conducted at 15 Pediatric Emergency Care Applied Research Network clinical sites over an 18-month study period. All children from 1 day (24 hrs) to 18 yrs of age with out-of-hospital cardiac arrest and a history of at least 1 min of chest compressions with return of circulation for at least 20 mins were eligible.
MEASUREMENTS AND MAIN RESULTS: One hundred thirty-eight cases met study entry criteria; the overall mortality was 62% (85 of 138 cases). The event characteristics associated with increased survival were as follows: weekend arrests, cardiopulmonary resuscitation not ongoing at hospital arrival, arrest rhythm not asystole, no atropine or NaHCO3, fewer epinephrine doses, shorter duration of cardiopulmonary resuscitation, and drowning or asphyxial arrest event. For the 0- to 12-hr postarrest return-of-circulation period, absence of any vasopressor or inotropic agent (dopamine, epinephrine) use, higher lowest temperature recorded, greater lowest pH, lower lactate, lower maximum glucose, and normal pupillary responses were all associated with survival. A multivariate logistic model of variables available at the time of arrest, which controlled for gender, age, race, and asystole or ventricular fibrillation/ventricular tachycardia anytime during the arrest, found the administration of atropine and epinephrine to be associated with mortality. A second model using additional information available up to 12 hrs after return of circulation found 1) preexisting lung or airway disease; 2) an etiology of arrest drowning or asphyxia; 3) higher pH, and 4) bilateral reactive pupils to be associated with lower mortality. Receiving more than three doses of epinephrine was associated with poor outcome in 96% (44 of 46) of cases.
CONCLUSIONS: Multiple factors were identified as associated with survival after out-of-hospital pediatric cardiac arrest with the return of circulation. Additional information available within a few hours after the return of circulation may diminish outcome associations of factors available at earlier times in regression models. These factors should be considered in the design of future interventional trials aimed to improve outcome after pediatric cardiac arrest.
Authors:
Frank W Moler; Amy E Donaldson; Kathleen Meert; Richard J Brilli; Vinay Nadkarni; Donald H Shaffner; Charles L Schleien; Robert S B Clark; Heidi J Dalton; Kimberly Statler; Kelly S Tieves; Richard Hackbarth; Robert Pretzlaff; Elise W van der Jagt; Jose Pineda; Lynn Hernan; J Michael Dean;
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  Critical care medicine     Volume:  39     ISSN:  1530-0293     ISO Abbreviation:  Crit. Care Med.     Publication Date:  2011 Jan 
Date Detail:
Created Date:  2010-12-23     Completed Date:  2011-02-07     Revised Date:  2013-07-03    
Medline Journal Info:
Nlm Unique ID:  0355501     Medline TA:  Crit Care Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  141-9     Citation Subset:  AIM; IM    
Affiliation:
Pediatric Emergency Care Applied Research Network, Salt Lake City, UT, USA. fmoler@umich.edu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Age Factors
Blood Circulation / physiology
Cardiopulmonary Resuscitation / methods*,  mortality
Child
Child, Preschool
Cohort Studies
Emergency Medical Services
Female
Hemodynamics / physiology*
Hospital Mortality*
Humans
Infant
Infant, Newborn
Intensive Care / methods
Intensive Care Units, Pediatric
Male
Out-of-Hospital Cardiac Arrest / diagnosis,  mortality*,  therapy*
Pediatrics
Prognosis
Recovery of Function
Retrospective Studies
Risk Assessment
Sex Factors
Survival Analysis
Treatment Outcome
Grant Support
ID/Acronym/Agency:
HD044955/HD/NICHD NIH HHS; HD050531/HD/NICHD NIH HHS; KL2 TR000450/TR/NCATS NIH HHS; R21 HD044955-01/HD/NICHD NIH HHS; R21 HD044955-02/HD/NICHD NIH HHS; R34 HD050531-01A1/HD/NICHD NIH HHS; U03MC00001//PHS HHS; U03MC00003//PHS HHS; U03MC00006//PHS HHS; U03MC00007//PHS HHS; U03MC00008//PHS HHS
Investigator
Investigator/Affiliation:
N Kuppermann / ; E Alpern / ; J Chamberlain / ; J M Dean / ; M Gerardi / ; J Goepp / ; M Gorelick / ; J Hoyle / ; D Jaffe / ; C Johns / ; N Levick / ; P Mahajan / ; R Maio / ; K Melville / ; S Miller / ; D Monroe / ; R Ruddy / ; R Stanley / ; D Treloar / ; M Tunik / ; A Walker / ; D Kavanaugh / ; H Park / ; M Dean / ; R Holubkov / ; S Knight / ; A Donaldson / ; J Chamberlain / ; M Brown / ; H Corneli / ; J Goepp / ; R Holubkov / ; P Mahajan / ; K Melville / ; E Stremski / ; M Tunik / ; M Gorelick / ; E Alpern / ; J M Dean / ; G Foltin / ; J Joseph / ; S Miller / ; F Moler / ; R Stanley / ; S Teach / ; D Jaffe / ; K Brown / ; A Cooper / ; J M Dean / ; C Johns / ; R Maio / ; N C Mann / ; D Monroe / ; K Shaw / ; D Teitelbaum / ; D Treloar / ; R Stanley / ; D Alexander / ; J Brown / ; M Gerardi / ; M Gregor / ; R Holubkov / ; K Lillis / ; B Nordberg / ; R Ruddy / ; M Shults / ; A Walker / ; N Levick / ; J Brennan / ; J Brown / ; J M Dean / ; J Hoyle / ; R Maio / ; R Ruddy / ; W Schalick / ; T Singh / ; J Wright / ; R Brilli / ; L Hernan / ; K Meert / ; C Schleien / ; V Nadkarni / ; R Clark / ; K Tieves / ; H Dalton / ; F Moler / ; E van der Jagt / ; R Hackbarth / ; K Statler / ; J Pineda / ; H Shaffner / ; R Pretzlaff /
Comments/Corrections
Comment In:
Crit Care Med. 2011 Jan;39(1):218-9   [PMID:  21178547 ]
Crit Care Med. 2011 May;39(5):1237; author reply 1237-8   [PMID:  21610599 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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