Survival Trends in Pediatric In - Hospital Cardiac Arrests

In-hospital cardiac arrest in children occurs in 2% to 6% of all pediatric intensive care unit patients and is associated with poor survival. Over the past decade, various strategies have been promoted by clinical practice guidelines to improve survival after in-hospital cardiac arrests. These include earlier recognition and management of at-risk patients, greater emphasis on quality of resuscitation (eg, high-quality chest compressions with minimal interruptions, use of extracorporeal membrane oxygenation during resuscitation [ECPR]), and postresuscitation care (eg, multidisciplinary care). Despite increased emphasis on these initiatives, no study has yet examined temporal trends in survival for pediatric in-hospital cardiac arrests in part because of the lack of a national pediatric cardiac arrest registry with standardized definitions and uniform data reporting. Although indirect comparisons across single-center studies may suggest that cardiac arrest survival in hospitalized children improved from 9% in the 1980s to 27% in 2005, these comparisons do not account for important differences across centers or in patient characteristics over time (eg, age, comorbid conditions, cause of cardiac arrest, or initial rhythm). For example, advances in the management of children with complex congenital heart diseases may have resulted in a temporal decrease in the proportion of cardiac arrests because of ventricular fibrillation (VF) and pulseless ventricular tachycardia (VT) rhythms, which are associated with better survival than asystole or pulseless electrical activity (PEA). Furthermore, survivors of cardiac arrest are at significant risk of neurological impairment, and it is unknown whether any improvement in