Epidemiology and outcome of pediatric in-hospital cardiopulmonary resuscitation in Northern India

Abstract

Data regarding in-hospital pediatric cardiopulmonary resuscitation (CPR) are limited because of retrospective study designs and inconsistent definitions. There are no Indian studies on pediatric CPR. Accordingly, we conducted this retrospective study to determine the outcome of in-hospital CPR and assess which variables predict outcome. Consecutive in-hospital CPR events in children aged 1-mo to 14-yr during a 1 yr period were described prospectively using Utstein guidelines. Variables affecting outcome were evaluated by univariate and multivariate analysis. A total of 427 patients were enrolled and received CPR. The indication for CPR was primary respiratory failure in 213 (50%) and clinical cardiac arrest in 191 (44%). The most common underlying etiology was neurological illness (26%). Sustained return of spontaneous circulation was attained in 112 (26%). Fifty-three (12%) patients were alive at 24 h, of which only 8 (1.87%) were alive at discharge. Of those patients who survived to discharge, all were alive after 6 mo. Multivariate logistic regression analysis showed that CPR during night hours (adjusted odds ratio [aOR]: 3.73), CPR of more than 10 min duration (aOR: 27.04) and cardiac arrest as an indication of CPR (aOR: 2.56) were independently associated with poor immediate outcome. Factors associated with death within 24 h were CPR during night hours (aOR: 3.17), age > 1 yr (aOR: 5.52) and cardiac arrest (aOR: 4.93). Good neurological outcome was found in seven out of eight (87.5%) patients at follow up. We conclude that pediatric cardiac arrest in a tertiary hospital in India has a poor outcome even after survival beyond 24 h; however, neurological outcome is generally good among survivors.

Keywords

Cardiopulmonary resuscitation - in hospital - Utstein guidelines