Rathore Vinay, Bansal Arun, Singhi Sunit C, Singhi Pratibha, Muralidharan Jayashree
a Department of Pediatrics, Advanced Pediatrics Center , Post-Graduate Institute of Medical Education and Research , Chandigarh , India.
Paediatr Int Child Health. 2016 May;36(2):141-7. doi: 10.1179/2046905515Y.0000000016. Epub 2016 Feb 10.
Data on outcome of children undergoing in-hospital cardiopulmonary resuscitation (CPR) in low- and middle-income countries are scarce.
To describe the clinical profile and outcome of children undergoing in-hospital CPR.
This prospective observational study was undertaken in the Advanced Pediatric Center, PGIMER, Chandigarh. All patients aged 1 month to 12 years who underwent in-hospital CPR between July 2010 and March 2011 were included. Data were recorded using the 'Utstein style'. Outcome variables included 'sustained return of spontaneous circulation' (ROSC), survival at discharge and neurological outcome at 1 year.
The incidence of in-hospital CPR in all hospital admissions (n = 4654) was 6.7% (n = 314). 64.6% (n = 203) achieved ROSC, 14% (n = 44) survived to hospital discharge and 11.1% (n = 35) survived at 1 year. Three-quarters of survivors had a good neurological outcome at 1-year follow-up. Sixty per cent of patients were malnourished. The Median Pediatric Risk of Mortality-III (PRISM-III) score was 16 (IQR 9-25). Sepsis (71%), respiratory (39.5%) and neurological (31.5%) illness were the most common diagnoses. The most common initial arrhythmia was bradycardia (52.2%). On multivariate logistic regression, duration of CPR, diagnosis of sepsis and requirement for vasoactive support prior to arrest were independent predictors of decreased hospital survival.
The requirement for in-hospital CPR is common in PGIMER. ROSC was achieved in two-thirds of children, but mortality was higher than in high-income countries because of delayed presentation, malnutrition and severity of illness. CPR >15 min was associated with death. Survivors had good long-term neurological outcome, demonstrating the value of timely CPR.
低收入和中等收入国家儿童住院期间心肺复苏（CPR）结局的数据稀缺。
描述接受住院CPR儿童的临床特征和结局。
本前瞻性观察性研究在昌迪加尔PGIMER的高级儿科中心进行。纳入2010年7月至2011年3月期间在住院期间接受CPR的所有1个月至12岁患者。使用“乌斯坦风格”记录数据。结局变量包括“自主循环持续恢复”（ROSC）、出院时存活情况以及1年时的神经学结局。
在所有住院患者（n = 4654）中，住院CPR的发生率为6.7%（n = 314）。64.6%（n = 203）实现了ROSC，14%（n = 44）存活至出院，11.1%（n = 35）在1年时存活。四分之三的幸存者在1年随访时神经学结局良好。60%的患者营养不良。儿童死亡率风险评估Ⅲ（PRISM-Ⅲ）评分中位数为16（四分位间距9 - 25）。脓毒症（71%）、呼吸系统疾病（39.5%）和神经系统疾病（31.5%）是最常见的诊断。最常见的初始心律失常是心动过缓（52.2%）。多因素逻辑回归分析显示，CPR持续时间、脓毒症诊断以及心脏骤停前对血管活性支持的需求是住院生存率降低的独立预测因素。
在PGIMER，住院CPR的需求很常见。三分之二的儿童实现了ROSC，但由于就诊延迟、营养不良和疾病严重程度，死亡率高于高收入国家。CPR持续时间>15分钟与死亡相关。幸存者长期神经学结局良好，表明及时进行CPR的价值。
