Prognosis of cardiopulmonary arrests in children

What are the outcomes of pediatric cardiopulmonary arrests? 

The survival rates for children who experienced isolated respiratory arrest ranges from 73% to 97%, and survival rates for children who experienced full cardiopulmonary arrest ranges from 4% to 28%. One recent comprehensive review of 41 articles on pediatric arrest found that of 5363 out-of-hospital pediatric arrests, only 12.1% of patients survived until discharge and only 4% were neurologically intact. Another study on out-of-hospital pediatric cardiac arrests prospectively followed 474 patients and found that only 1.9% survived to discharge. A multicenter registry of 3419 in-hospital arrests found somewhat better outcomes: 27.9% survived until discharge, but only 19% had favorable neurologic outcomes. The overall poor prognosis of full cardiopulmonary arrests probably reflects the terminal nature of asystole, which is often preceded by prolonged respiratory insufficiency and its resultant long-standing tissue hypoxemia and acidosis. This is one reason why initial management is directed toward improvement of oxygenation and ventilation. 

What are some prognostic factors for pediatric cardiopulmonary arrests? 

Some factors that appear to be prognosticators of outcome for arrests include location (in or out of hospital), resuscitation at the scene, presenting rhythm, length of resuscitation, and whether drowning or trauma was involved. For out-of-hospital arrests, bystander or paramedic initiation of resuscitation of witnessed arrest has repeatedly been found to improve survival as much as fourfold compared to initial resuscitation by physicians after patient arrival at the hospital. Survival of patients presenting in ventricular fibrillation (VF) is much higher than among those in asystole, severe bradycardia, or pulseless electrical activity (PEA). Prolonged resuscitation over 20 minutes is often thought to be the strongest indicator of fatality, with chance of survival decreasing by 2.1% per minute in one large study of 3419 pediatric arrests. Overall, trauma- and submersion injury–associated arrests are associated with better survival rates compared with isolated cardiac-origin arrests (21.9% and 22.7% versus 1.1%, respectively). However, those with blunt traumas are about three times less likely to survive compared to those with penetrating traumas. Outcomes can also vary greatly based on region; for instance, even in a relatively homogeneous society such as Japan, the 1-month survival rate ranged from 5.8% to more than double that rate, 12.2%. This variance is likely due to statistically different variations in factors such as patient age, CPR initiation and type, emergency medical services (EMS) responsiveness, and their use of epinephrine and intubation. 


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Matos RI, Watson RS, Nadkarni VM, et al: Duration of cardiopulmonary resuscitation and illness category impact survival and neurologic outcomes for in-hospital pediatric cardiac arrests. Circulation 2013;127(4):442-451. 

Nadkarni VM, Larkin GL, Peberdy MA, et al: First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA 2006;295:50-57.

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Okamoto Y, Kwami T, Kitamura T, et al: Regional variation in survival following pediatric out-of-hospital cardiac arrest. Circ J 2013;77(13):2596-2603. Epub 2013 Jul 4. 

Scribano PV, Baker MD, Ludwig S: Factors influencing termination of resuscitative efforts in children: A comparison of pediatric emergency medicine and adult emergency medicine physicians. Pediatr Emerg Care 1997;13:320-324.


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