Elsevier

Resuscitation

Volume 63, Issue 3, December 2004, Pages 311-320
Resuscitation

Characteristics and outcome of cardiorespiratory arrest in children

https://doi.org/10.1016/j.resuscitation.2004.06.008Get rights and content

Abstract

Objective: To analyse the present day characteristics and outcome of cardio-respiratory arrest in children in Spain. Design: An 18-month prospective, multicentre study analysing out-of-hospital and in-hospital cardio-respiratory arrest in children. Patients and methods: Two hundred and eighty-three children between 7 days and 17 years of age with cardio-respiratory arrest. Data were recorded according to the Utstein style. The outcome variables were the sustained return of spontaneous circulation (initial survival), and survival at 1 year (final survival). Three hundred and eleven cardio-respiratory arrest episodes, composed of 70 respiratory arrests and 241 cardiac arrests in 283 children were studied. Accidents were the most frequent cause of out-of-hospital arrest (40%), and cardiac disease was the leading cause (31%) of in-hospital arrest. Initial survival was 60.2% and 1 year survival was 33.2%. The final survival was higher in patients with respiratory arrest (70%) than in patients with cardiac arrest (21.1%) (P < 0.0001). Although many individual factors correlated with mortality, multivariate logistic regression revealed that the best indicator of mortality was a duration of cardiopulmonary resuscitation of over 20 min (odds ratio: 10.35; 95% CI 4.59–23.32). Conclusions: In Spain, the present mortality from cardio-respiratory arrest in children remains high. Survival after respiratory arrest is significantly higher than after cardiac arrest. The duration of cardiopulmonary resuscitation attempt is the best indicator of mortality of cardio-respiratory arrest in children.

Resumo

Objectivo: Analisar as características actuais e o prognóstico da paragem cardio-respiratória nas crianças em Espanha. Desenho: Estudo prospectivo multicêntrico durante 18 meses para analisar as paragens cardio-respiratórias extra-hospitalares e intra-hospitalares nas crianças. Doentes e Métodos: Duzentas e oitenta e três crianças com idades compreendidas entre os 7 e os 17 anos vítimas de paragem cardio-respiratória. Os dados foram registados de acordo com o estilo Utstein. As variáveis de outcome foram a recuperação sustentada da circulação espontânea (sobrevivência inicial), e a sobrevivência ao fim de um ano (sobrevivência final). Foram estudados trezentos e onze episódios de paragem cardio-respiratória, compostos de 70 paragens respiratórias e 241 paragens cardíacas em 283 crianças. Os acidentes foram a causa mais frequente de paragem cardíaca extra-hospitalar (40%), e a doença cardíaca foi a principal causa (31%) de paragem intra-hospitalar. A sobrevivência inicial foi de 60.2% e a sobrevivência após um ano foi 33.2%. A sobrevivência final foi mais elevada nos doentes com paragem respiratória (70%) do que nos doentes com paragem cardíaca (21.1%) (p < 0.0001). Embora muitos factores individuais se correlacionem com a mortalidade, uma análise de regressão logística multivariada revelou que o melhor indicador da mortalidade foi a duração da reanimação cardio-pulmonar superior a 20 minutos (odds ratio: 10.35; CI 4.59–23.32). Conclusões:Em Espanha, a mortalidade actual por paragem cardio-respiratória em crianças permanece elevada. A sobrevivência após paragem respiratória é significativamente mais elevada do que após paragem cardíaca. A duração das tentativas de reanimação cardio-pulmonar é o melhor indicador da mortalidade após paragem cardio-respiratória nas crianças.

Resumen

Objetivo: Analizar las características y resultados actuales del paro cardiorrespiratorio en niños en España. Diseño: Estudio multicéntrico, prospectivo de 18 meses de duración, analizando el paro cardiorrespiratorio intra y extrahospitalario en niños. Pacientes y métodos: 283 niños entre 7 días y 17 años de edad con paro cardiorrespiratorio. Los datos fueron registrados de acuerdo con el estilo Utstein. Las variables de resultado fueron el retorno a circulación espontánea sostenida (sobrevida inicial), sobrevida a un año de plazo (sobrevida final). Se estudiaron 311 episodios de paro cardiorrespiratorio, compuestos de 70 paros respiratorios y 241 paros cardíacos en 283 niños. Los accidentes fueron la causa mas frecuente de paro cardíaco extrahospitalario (40%), y la enfermedad cardiaca fue la causa principal (31%) de paro intrahospitalario. La sobrevida inicial fue de 60.2% y a un año fue de 33.2%. La sobrevida final fue mas alta en pacientes con paro respiratorio (70%) que en pacientes con paro cardíaco (21.1%) (P < 0.0001). Aunque muchos factores individuales se correlacionan con la mortalidad, el análisis de regresión logística multivariable reveló que el mejor indicador de mortalidad fue la duración de la resucitación cardiopulmonar por encima de 20 minutos (odds ratio: 10.35; 95% CI 4.59–23.32). Conclusiones: En España, la mortalidad actual del paro cardiorrespiratorio en niños sigue alta. La sobrevida después del paro respiratorio es significativamente más alta que después del paro cardiaco. La duración de las maniobras de reanimación cardiopulmonar es el mejor indicador de mortalidad del paro cardiorrespiratorio en niños.

Introduction

Despite the advances in prevention, training in cardiopulmonary resuscitation, and early treatment, mortality after cardio-respiratory arrest (CRA) remains very high both in adults [1], [2], [3], [4], [5] and children [6], [7], [8], [9]. Until now, there are few prospective studies that analyse the causes, risk factors and outcomes of CRA in children [9]. Some studies showed that survival varies depending on the location of arrest, underlying disease, initial electrocardiographic (ECG) rhythm, the time elapsing between CRA and the initiation of resuscitation, and the duration of cardiopulmonary resuscitation (CPR) [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18]. However, comparison of the different studies is complicated as many are retrospective, with a small number of patients, and different definitions of CRA, methods of description and analysis of the results have been used. The Utstein style provides uniform guidelines for reporting characteristics and outcome for in-hospital and out-of-hospital CRA in children [19], [20]. To date, only one prospective study that analysed the outcome of in-hospital CRA in children in a single centre following the Utstein style guidelines has been reported [9].

The objective of the present study was to provide a prospective, multicentre, Utstein style report of paediatric out-of-hospital and in-hospital CRA to evaluate the factors associated with mortality, and to know the final outcome of survivors.

Section snippets

Patients and methods

An invitation to participate in the study was sent to all the paediatric intensive care units (PICU), paediatric departments and out-of-hospital emergency medical systems in Spain [21]. A protocol was drawn up in accordance with the Utstein style guidelines [19], [20]. Patients aged from 7 days to 18 years were eligible for the study if they had presented in respiratory arrest (RA) defined as the absence of respiration requiring assisted ventilation, or cardiac arrest (CA) defined as the

Results

We collected 311 episodes of cardiorespiratory arrest (CRA) that were either primarily cardiac or primarily respiratory in origin. These occurred from 1 April 1998 to 30 September 1999 in 283 children with a mean age of 48 ± 54.4 months (range 7 days to 17 years) and mean weight of 17.1 ± 16 kg (2.3–80 kg). Subsequent re-arrest (range 2–6) occurred in the PICU in 17 patients. Characteristics of the patients and CRA, and the initial and final mortalities are summarised in Table 1 and Fig. 1.

Discussion

To our knowledge, this is the first prospective, multicentre study that used the Utstein style to report the aetiology and characteristics of out-of-hospital and in-hospital cardiac and respiratory arrest in children, and that analyses the factors relating to prognosis. There is only one previous study, performed in a single hospital, which has analysed in-hospital cardio-respiratory arrest following the Utstein style [9]. Although ours is not an epidemiological study, a large number of

References (32)

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Other members of the Study Group: Jose A. Alonso (Virgen de la Salud Hospital, Toledo), Julio Melendo (Miguel Servet Hospital, Zaragoza), Corsino Rey (Asturias Central Hospital, Oviedo), Teresa Hermana (Cruces Hospital, Baracaldo), Josefina Cano (Virgen del Rocio Hospital, Seville), Francisco Romero (061 Emergency Service, Jaen), Servando Pantoja (Puerta del Mar Hospital, Cadiz), Carlos Lucena (061, Almeria), Pere Plaja (Palamós Hospital, Gerona), Ana Concheiro (San Juan de Dios Hospital, Barcelona), Alvaro Díaz (Tarrasa Hospital, Barcelona), Ricardo Martino (Príncipe de Asturias Hospital, Alcala de Henares), Maria V. Esteban (Princesa de España Hospital, Jaen), Nieves de Lucas (SAMUR, Madrid), Esther Ocete (Granada Clinical Hospital), Juan I Muñoz (Reina Sofía Hospital, Cordoba), Maria A. Rodríguez (Barbanza Provincial Hospital, Coruña), Susana Simó (061 Emergency Service, Barcelona), Eduard Solé (Arnaú de Villanova Hospital, Lerida), Enrio Jiménez (del Mar Hospital, Barcelona), Rosario Alvarez (Jarrio Hospital, Asturias), Víctor Canduela (Laredo Hospital, Cantabria), Antonio Fernández (San Agustin Hospital, Linares), Amelia Sánchez-Galindo (Juan Canalejo Hospital, La Coruña), R. Closa (Juan XXIII Hospital, Barcelona), P. Villalobos (Figueras Hospital, Gerona), Orenci Urraca (Nens Hospital, Barcelona), Federico Pérez (Josep Trueta Hospital, Gerona), Antonio Torres (San Juan de Dios Hospital, Ubeda), Miguel Labay (Obispo Polanco Hospital, Teruel), Ma Luisa Masiques (Mollet Hospital, Barcelona), Fátima Aborto (Juan Ramón Jiménez Hospital, Huelva), Narcisa Palomino (Ciudad de Jaén Hospital, Jaén), Monserrat Miquel (San Celoni Hospital, Barcelona), Antonio Gómez Calzado (Virgen Macarena Hospital, Seville), Jose M Bellón, Maria La Calle (Gregorio Marañón Hospital, statistical data analysis).

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