Multicenter cohort study of in-hospital pediatric cardiac arrest.
Multicenter cohort study of in-hospital pediatric cardiac arrest.
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DOI：
10.1097/pcc.0b013e3181a7045c
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发表时间：
2009-09
期刊：
影响因子：
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通讯作者：
Pediatric Emergency Care Applied Research Network
中科院分区：
文献类型：
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作者：
Meert KL;Donaldson A;Nadkarni V;Tieves KS;Schleien CL;Brilli RJ;Clark RS;Shaffner DH;Levy F;Statler K;Dalton HJ;van der Jagt EW;Hackbarth R;Pretzlaff R;Hernan L;Dean JM;Moler FW;Pediatric Emergency Care Applied Research Network
(1)描述2003年7月1日至2004年12月31日期间在儿科急诊应用研究网络（PECARN）内接受治疗的一组儿童的临床特征、住院过程和结局，这些儿童在医院内发生心脏骤停并持续恢复循环，（2）确定与该人群住院死亡率相关的因素。这些数据需要准备一个随机试验的治疗性低温对神经行为的结果在儿童在医院心脏骤停后。回顾性队列研究。与PECARN有联系的15家儿童医院。年龄在1天至18岁之间的患者，他们接受了心肺复苏术（CPR）并接受了>1分钟的胸外按压，并恢复了>20分钟的循环。没有。共有353例患者符合入选标准; 172例（48.7%）存活至出院。在幸存者中，132例（76.7%）有良好的神经功能结局记录的小儿脑功能分类评分。校正年龄、性别和首次记录的心脏骤停心律后，与死亡率增加独立相关的心脏骤停前和心脏骤停期间可用的变量包括预先存在的血液学、肿瘤学或免疫学疾病、遗传或代谢疾病、心脏骤停前存在气管内插管以及心脏骤停期间使用碳酸氢钠。与死亡率降低相关的变量包括术后CPR。将时间范围扩展到包括在心脏骤停之前、期间和之后12小时内可用的变量，与死亡率增加独立相关的变量包括心脏骤停期间钙的使用。与死亡率降低相关的变量包括较高的最低血液pH值和瞳孔反应性。许多因素与院内心脏骤停和循环恢复后儿童的院内死亡率有关。在设计儿科患者心脏骤停后低温治疗试验时，必须考虑这些因素。
(1) Describe the clinical characteristics, hospital courses and outcomes of a cohort of children cared for within the Pediatric Emergency Care Applied Research Network (PECARN) who experienced in-hospital cardiac arrest with sustained return of circulation between July 1, 2003 and December 31, 2004, and (2) identify factors associated with hospital mortality in this population. These data are required to prepare a randomized trial of therapeutic hypothermia on neurobehavioral outcomes in children after in-hospital cardiac arrest. Retrospective cohort study. Fifteen children’s hospitals associated with PECARN. Patients between one day and 18 years of age who had cardiopulmonary resuscitation (CPR) and received chest compressions for >1 minute, and had a return of circulation for >20 minutes. None. A total of 353 patients met entry criteria; 172 (48.7%) survived to hospital discharge. Among survivors, 132 (76.7%) had good neurological outcome documented by Pediatric Cerebral Performance Category scores. After adjustment for age, gender and first documented cardiac arrest rhythm, variables available prior to and during the arrest that were independently associated with increased mortality included pre-existing hematologic, oncologic, or immunologic disorders, genetic or metabolic disorders, presence of an endotracheal tube prior to the arrest, and the use of sodium bicarbonate during the arrest. Variables associated with decreased mortality included post-operative CPR. Extending the time frame to include variables available prior to, during, and within 12 hours following arrest, variables independently associated with increased mortality included the use of calcium during the arrest. Variables associated with decreased mortality included higher minimum blood pH and pupillary responsiveness. Many factors are associated with hospital mortality among children after in-hospital cardiac arrest and return of circulation. Such factors must be considered when designing a trial of therapeutic hypothermia after cardiac arrest in pediatric patients.