Pediatric cardiopulmonary resuscitation in a cardiology hospital

Background

Numerous reports document the efficacy of pediatric inhospital cardiopulmonary resuscitation (CPR). There are few data about pediatric patients with heart diseases.

Methods

All inhospital CPRs in children during 12 months at a university hospital of cardiology, were described and evaluated using Utstein reporting guidelines. CPR was defined as chest compression and assisted ventilation or defibrillation provided because of cardiac arrest or severe bradycardia with poor perfusion.

Results

A total of 110 attempted resuscitations were performed in 55 children. From these patients 72.2% had returned to spontaneous circulation and 21.4% were discharged alive. Most of the children had congenital heart disease (74.5%). Bradycardia with poor perfusion were present in 55.4% as an initial rhythm of the 110 episodes, asystole in 18.2%, electrical activity without pulse in 15.4% and ventricular fibrillation or tachycardia without pulse in 10.9%. The most common precipitating causes were hypotension (22.8%), arrythmias (17.3%), metabolic disturbance (17.3%) and hypoxemia (14.2%). Univariate predictive factors correlating with hospital discharge were hypoxemia as the precipitating cause of arrest, duration of resuscitation <10 min and single cardiac arrest.

In addition administration of bicarbonate, three or more doses of epinephrine during resuscitation, vasoactive drugs and mechanical ventilation at moment of cardiac arrest were negatively associated with survival. Multivariate stepwise logistic regression analysis identified independent association of survival with duration of resuscitation <10 min (OR 36.5, 95% CI 3.6–366.3) and single arrest (OR 17.1, 95% CI 1.6–181.3).

Conclusion

Survival to hospital discharge and predictors of children with heart diseases and cardiac arrest are similar to patients in general pediatric hospitals.