A prospective investigation into the epidemiology of in-hospital pediatric cardiopulmonary resuscitation using the international Utstein reporting style
A prospective investigation into the epidemiology of in-hospital pediatric cardiopulmonary resuscitation using the international Utstein reporting style
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DOI：
10.1542/peds.109.2.200
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发表时间：
2002-02-01
期刊：
影响因子：
8
通讯作者：
Berg, RA
中科院分区：
文献类型：
--
作者：
Reis, AG;Nadkarni, V;Berg, RA
目标。由于回顾性研究设计、样本量小以及心脏骤停和心肺复苏的定义不一致，有关儿科住院心肺复苏（CPR）的数据有限。本研究的目的是前瞻性地描述和评估来自Utstein指南的国际共识流行病学定义的儿科院内心肺复苏术。采用Utstein报告指南对巴西圣保罗一家拥有122个床位的大学儿童医院12个月内的129例住院cpr进行了描述和评估。这些指南包括对医院变量、患者变量、骤停/事件变量和结果变量的标准化描述。心肺复苏术的定义是由于心脏骤停或由于灌注不良的严重心动过缓而进行胸部按压和辅助通气。结果变量包括持续的自然循环恢复、24小时生存、30天生存、1年生存和幸存者的神经系统状态。在入院的6024名儿童中，176名（3%）的发作符合提供心肺复苏术的标准，129名（2%）接受了心肺复苏术，86名因临床心脏骤停，43名因灌注不良的心动过缓。大多数儿童（71%）先前存在慢性疾病。最常见的诱发原因是呼吸衰竭（61%）和休克（29%）。71例（55%）患儿的初始心律停止，12例（9%）患儿无脉性电活动，1例（9%）患儿心室颤动，43例（33%）患儿心动过缓伴脉搏和灌注不良。83例患儿（64%）达到持续的自然循环恢复（>20分钟），43例（33%）在24小时存活，24例（19%）在30天存活，19例（15%）在1年存活。虽然有许多因素与24小时生存率相关，但多因素logistic回归分析显示，24小时生存率与呼吸衰竭作为诱发原因（比值比[OR]: 4.92； 95%可信区间[CI]: 1.73-14.0）、脉搏性心动缓作为初始事件（OR: 2.68; 95% CI: 1.01-7.1）和较短的CPR持续时间（OR: 0.92; 95% CI: 0.89-0.96）存在独立关联。同样，30天生存率与呼吸衰竭作为诱发原因和较短的心肺复苏术时间独立相关。心肺复苏术每延长一分钟，30天生存率降低5%。21名幸存者中有19名（91%）出院，19名1年幸存者中有16名（83%）的神经功能与心肺复苏术前状态相比没有明显的长期变化。在这项研究中，心肺复苏术不常见，但并不罕见。呼吸衰竭是最常见的诱发因素，其次是休克。先前存在的慢性病在这些儿童中普遍存在。无搏停止是最常见的初始心律，其次是心动过缓伴搏动和灌注不良。心室颤动是罕见的，但儿童急性心脏疾病，如心脏手术和急性心肌病，没有被收住在这个儿童医院。心肺复苏术是有效的：这些儿童中有近三分之二最初成功复苏，三分之一在24小时内存活，而没有心肺复苏术和高级生命支持的儿童即将死亡。然而，随着时间的推移，生存率逐渐下降，通常是由于潜在的疾病过程。一年生存率为15%。重要的是，大多数幸存者在心肺复苏术前的总体神经功能方面没有明显的变化。
Objective. Data regarding pediatric in-hospital cardiopulmonary resuscitation (CPR) have been limited because of retrospective study designs, small sample sizes, and inconsistent definitions of cardiac arrest and CPR. The purpose of this study was to prospectively describe and evaluate pediatric in-hospital CPR with the international consensus-derived epidemiologic definitions from the Utstein guidelines.Methods. All 129 in-hospital CPRs during 12 months at a 122-bed university children's hospital in Sao Paulo, Brazil, were described and evaluated using Utstein reporting guidelines. These guidelines include standardized descriptions of hospital variables, patient variables, arrest/event variables, and outcome variables. CPR was defined as chest compressions and assisted ventilation provided because of cardiac arrest or because of severe bradycardia with poor perfusion. Outcome variables included sustained return of spontaneous circulation, 24-hour survival, 30-day survival, 1-year survival, and neurologic status of survivors by the Pediatric Cerebral Performance Category Scale.Results. Of the 6024 children admitted to the hospital, 176 (3%) had an episode that met the criteria for provision of CPR and 129 (2%) received CPR, 86 for clinical cardiac arrest and 43 for bradycardia with poor perfusion. Most of the children (71%) had preexisting chronic diseases. The most common precipitating causes were respiratory failure (61%) and shock (29%). The initial cardiac rhythm was asystole in 71 children (55%), pulseless electrical activity in 12 (9%), ventricular fibrillation in 1, and bradycardia with pulses and poor perfusion in 43 (33%). Eighty-three children (64%) attained sustained return of spontaneous circulation (>20 minutes), 43 (33%) were alive at 24 hours, 24 (19%) were alive at 30 days, and 19 (15%) were alive at 1 year. Although many factors correlated with 24-hour survival, multivariate logistic regression analysis revealed independent association of 24-hour survival with respiratory failure as the precipitating cause (odds ratio [OR]: 4.92; 95% confidence interval [CI]: 1.73-14.0), bradycardia with pulses as the initial event (OR: 2.68; 95% CI: 1.01-7.1), and shorter duration of CPR (OR: 0.92; 95% CI: 0.89-0.96 for each elapsed minute). Similarly, 30-day survival was independently associated with respiratory failure as the precipitating cause and shorter duration of CPR. Thirty-day survival decreased by 5% with each elapsed minute of CPR. Nineteen (91%) of the 21 survivors to hospital discharge and 16 (83%) of the 19 1-year survivors had no demonstrable long-term change in neurologic function from their pre-CPR status.Conclusions. During this study, CPR was uncommon but not rare. Respiratory failure was the most common precipitating cause, followed by shock. Preexisting chronic diseases were prevalent among these children. Asystole was the most common initial cardiac rhythm, and bradycardia with pulses and poor perfusion was the second most common. Ventricular fibrillation was rare, but children with acute cardiac diseases, such as cardiac surgery and acute cardiomyopathies, were not admitted to this children's hospital. CPR was effective: nearly two thirds of these children were initially successfully resuscitated, and one third were alive at 24 hours compared with imminent death without CPR and advanced life support. Nevertheless, survival progressively decreased over time, generally as a result of the underlying disease process. One-year survival was 15%. Importantly, most of these survivors had no demonstrable change in gross neurologic function from their pre-CPR status.