Independent Prognosis Predictor for In-hospital Pediatric Cardiopulmonary Resuscitation

Park, Jung Geun; Lim, Kyoung Soo; Ryu, Seung; Kim, Won Young; Kim, Won

Abstract

PURPOSE
Investigations of in-hospital pediatric cardiopulmonary resuscitation (CPR) have been of limited value because of the retrospective nature of the studies, the small sample sizes, and inconsistent definitions of cardiac arrest and CPR. The purpose of this study was to prospectively describe in-hospital pediatric CPR by using the Utstein guidelines and to confirm prognosis predictors.
METHODS
All 168 in-hospital pediatric CPRs involving 115 patients, at Asan Medical Center from January 1, 2002, to December 31, 2003 were prospectively described and evaluated by using Utstein reporting guidelines. Uniform reports were made out after the CPRs and were supplemented with chart reviews. The outcome variables included sustained return of spontaneous circulation (ROSC), the survival rate at 24 hrs, the survival discharge rate, and the pediatric overall performance category scale (POPC) after CPR.
RESULTS
All of the 115 patients who received CPRs, 65 (56.5%) patients had sustained ROSC, 54 (47.0%) patients were alive at 24 hrs, and 33 (28.7%) patients were discharged alive. The most common underlying disease was cardiovascular disease (45.2%), and the most common precipitating cause of CPR was shock (48.7%). The most common initial cardiac rhythm was bradycardia with poor perfusion (41.7%). A multiple logistic regression analysis revealed that death at discharge was independently associated with a higher POPC score before CPR, a longer duration of CPR, and repeated CPR.
CONCLUSION
Independent prognosis predictors of in-hospital pediatric CPR were the POPC score before CPR, the duration of CPR, and repeated CPR.