Rodríguez-Núñez Antonio, López-Herce Jesús, García Cristina, Carrillo Angel, Domínguez Pedro, Calvo Custodio, Delgado Miguel Angel
Paediatric Emergency and Critical Care Division, Hospital Clinico Universitario de Santiago de Compostela, Santiago de Compostela, Spain.
Resuscitation. 2006 Dec;71(3):301-9. doi: 10.1016/j.resuscitation.2005.11.020. Epub 2006 Sep 20.
To analyse the immediate effectiveness of resuscitation and long-term outcome of children who suffered a cardiorespiratory arrest when admitted to paediatric intensive care units (PICU).
Secondary analysis of data from an 18-month prospective, multicentre study analysing cardiorespiratory arrest in children in 16 paediatric intensive care units in Spain.
We studied 116 children between 7 days and 17 years of age. Data were recorded according to the Utstein style. Analysed outcome variables were sustained return of spontaneous circulation (ROSC), survival to hospital discharge and survival at 1 year. Neurological and general performance outcome was assessed by means of the Paediatric Cerebral Performance Category (PCPC) and the Paediatric Overall Performance Category (POPC) scales.
None.
In 80 patients (69%) ROSC was achieved and it was sustained > 20 min in 69 (59.5%). At one-year follow-up, 40 children (34.5%) were alive. Survival was not associated with sex, age or weight of patients. Mortality from cardiac arrest was higher than respiratory arrest (69.8% versus 40%, p = 0.01). Patients with sepsis had a higher mortality than other diagnostic groups. Mechanically ventilated children and those treated with vasoactive drugs had a higher mortality. Initial mortality was slightly higher in patients with slow ECG rhythms (35.7%) compared to those with ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) (27.2%). Duration of resuscitation effort was correlated with mortality (p < 0.0001). Patients who required one or more doses of adrenaline had also a higher mortality (77.8% versus 20.7%, p < 0.0001) and survivors needed less doses of adrenaline (0.85 +/- 1.14 versus 4.4+/-2.9, p < 0.0001). At hospital discharge 86.8 and 84.6% of patients had scores 1 or 2 (normal or near-normal) in the PCPC and POPC scales. At 1-year follow-up these figures were 90.8 and 86.3%, respectively.
One-third of children who suffer a cardiac or respiratory arrest when admitted to PICU survive, and most of them had a good long-term neurological and functional outcome. The duration of cardiopulmonary resuscitation attempts is the best indicator of mortality.
分析入住儿科重症监护病房（PICU）时发生心肺骤停儿童的复苏即时效果及长期预后。
对一项为期18个月的前瞻性多中心研究数据进行二次分析，该研究分析了西班牙16家儿科重症监护病房儿童的心肺骤停情况。
我们研究了116名年龄在7天至17岁之间的儿童。数据按照乌斯坦风格记录。分析的结局变量为自主循环持续恢复（ROSC）、出院存活及1年存活情况。通过儿科脑功能表现分类（PCPC）和儿科总体表现分类（POPC）量表评估神经和总体功能结局。
无。
80例患者（69%）实现了ROSC，其中69例（59.5%）自主循环持续恢复超过20分钟。在1年随访时，40名儿童（34.5%）存活。存活与患者的性别、年龄或体重无关。心脏骤停导致的死亡率高于呼吸骤停（69.8%对40%，p = 0.01）。脓毒症患者的死亡率高于其他诊断组。机械通气儿童和接受血管活性药物治疗的儿童死亡率更高。心电图节律缓慢的患者初始死亡率（35.7%）略高于心室颤动（VF）或无脉性室性心动过速（VT）患者（27.2%）。复苏持续时间与死亡率相关（p < 0.0001）。需要一剂或多剂肾上腺素的患者死亡率也更高（77.8%对20.7%，p < 0.0001），且存活者所需肾上腺素剂量更少（0.85±1.14对4.4±2.9，p < 0.0001）。出院时，86.8%和84.6%的患者在PCPC和POPC量表上的得分分别为1或2分（正常或接近正常）。在1年随访时，这些数字分别为90.8%和86.3%。
入住PICU时发生心脏或呼吸骤停的儿童中有三分之一存活，且大多数患者长期神经和功能预后良好。心肺复苏尝试的持续时间是死亡率的最佳指标。
