Factors associated with mortality in pediatric in-hospital cardiac arrest: A prospective multicenter multinational observational study

Purpose: To analyze prognostic factors associated with in-hospital cardiac arrest (CA) in children. Methods: A prospective, multicenter, multinational, observational study was performed on pediatric in-hospital CA in 12 countries and included 502 children between 1 month and 18 years. The primary endpoint was survival at hospital discharge. Univariate and multivariate logistic regression analyses were performed to assess the influence of each factor on mortality. Results: Return of spontaneous circulation was achieved in 69.5 % of patients; 39.2 % survived to hospital discharge and 88.9 % of survivors had good neurological outcome. The pre-arrest factors related to mortality were lower Human Development Index [odds ratio (OR) 2.32, 95 % confidence interval (CI) 1.28-4.21], oncohematologic disease (OR 3.33, 95 % CI 1.60-6.98), and treatment with inotropic drugs at the time of CA (OR 2.35, 95 % CI 1.55-3.56). CA and resuscitation factors related to mortality were CA due to neurological disease (OR 5.19, 95 % CI 1.49-18.73) and duration of cardiopulmonary resuscitation greater than 10 min (OR 4.00, 95 % CI 1.49-18.73). Factors related to survival were CA occurring in the pediatric intensive care unit (PICU) (OR 0.38, 95 % CI 0.16-0.86) and shockable rhythm (OR 0.26, 95 % CI 0.09-0.73). Conclusions: In-hospital CA in children has a low survival but most of the survivors have a good neurological outcome. Some prognostic risk factors cannot be modified, making it important to focus efforts on improving hospital organization to care for children at risk of CA in the PICU and, in particular, in other hospital areas.