Post return of spontaneous circulation factors associated with mortality in pediatric in-hospital cardiac arrest: A prospective multicenter multinational observational study

Jesús López-Herce, Jimena Del Castillo, Martha Matamoros, Sonia Canadas, Ana Rodriguez-Calvo, Corrado Cecchetti, Antonio Rodríguez-Núnez, Ángel Carrillo, Javier Urbano, Jose Maria Bellon, Sarah Fernández, Roger Rodríguez, Allison Callejas, Douglas Carranza, Hilda Zerón, Pedro Dominguez, Ana Rodriguez Calvo, Lorenzo Marcos, Corrado Cechetti, Marta SilvaRegina Grigolli Cesar, Javier Pilar Orive, Ana Maria Nieva, Antonio Rodriguez-Nunez, Marta Parada, Maria Angeles Garcia Teresa, Di Prietro Pasquale, Miguel Angel Delgado, Mauricio Fernandez, Roxana Flavia Jaen, Juan Garbayo Solana, Raul Borrego Dominguez, Victor Monreal, Cristina Molinos, Iolster Thomas, Ricardo Iramain, Juan Carlos de Carlos, Corsino Rey Galán, Custodio Calvo Macías, Q. P Olivia Pérez Quevedo, Adriana Koliski, Santiago Campos, Alfredo Reparaz, Sivia Sanchez Perez, Deolinda Matos, Claudia Carolina, Jessica Ortiz Rodríguez, Pedro Pablo Oyagüez, Mario José Sánchez Fernández, Concepción Goñi Orayen, Asunción Pino Vázquez, M. Elena May Llanas, Abián Montesdeoca Melián, Isabel Lucía Benítez Gómez, Antonio de Francisco, Santiago Hermógenes Esquivel, Cecilia Andrea Chede, Gabriel Cassaletti Bustillo, Lourdes Marroquin Yanez, Pediatric Cardiac Arrest Study Network RIBEPCI Iberoamerican Pediatric Cardiac Arrest Study Network RIBEPCI

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Abstract

Introduction: Most studies have analyzed pre-arrest and resuscitation factors associated with mortality after cardiac arrest (CA) in children, but many patients that reach return of spontaneous circulation die within the next days or weeks. The objective of our study was to analyze post-return of spontaneous circulation factors associated with in-hospital mortality after cardiac arrest in children.Methods: A prospective multicenter, multinational, observational study in 48 hospitals from 12 countries was performed. A total of 502 children aged between 1 month and 18 years with in-hospital cardiac arrest were analyzed. The primary endpoint was survival to hospital discharge. Univariate and multivariate logistic regression analyses were performed to assess the influence of each post-return of spontaneous circulation 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. In the univariate analysis, post- return of spontaneous circulation factors related with mortality were pH, base deficit, lactic acid, bicarbonate, FiO2, need for inotropic support, inotropic index, dose of dopamine and dobutamine at 1 hour and at 24 hours after return of spontaneous circulation as well as Pediatric Intensive Care Unit and total hospital length of stay. In the multivariate analysis factors associated with mortality at 1 hour after return of spontaneous circulation were PaCO2 <30 mmHg and >50 mmHg, inotropic index >14 and lactic acid >5 mmol/L. Factors associated with mortality at 24 hours after return of spontaneous circulation were PaCO2 > 50 mmHg, inotropic index >14 and FiO2≥ 0.80. Conclusions: Secondary in-hospital mortality among the initial survivors of CA is high. Hypoventilation, hyperventilation, FiO2 ≥ 0.80, the need for high doses of inotropic support, and high levels of lactic acid were the most important post-return of spontaneous circulation factors associated with in-hospital mortality in children in our population.

Original languageEnglish
Article number607
JournalCritical Care
Volume18
Issue number6
DOIs
Publication statusPublished - Nov 3 2014

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ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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López-Herce, J., Del Castillo, J., Matamoros, M., Canadas, S., Rodriguez-Calvo, A., Cecchetti, C., Rodríguez-Núnez, A., Carrillo, Á., Urbano, J., Bellon, J. M., Fernández, S., Rodríguez, R., Callejas, A., Carranza, D., Zerón, H., Dominguez, P., Calvo, A. R., Marcos, L., Cechetti, C., ... Iberoamerican Pediatric Cardiac Arrest Study Network RIBEPCI, P. C. A. S. N. RIBEPCI. (2014). Post return of spontaneous circulation factors associated with mortality in pediatric in-hospital cardiac arrest: A prospective multicenter multinational observational study. Critical Care, 18(6), [607]. https://doi.org/10.1186/s13054-014-0607-9