Alten Jeffrey A, Klugman Darren, Raymond Tia T, Cooper David S, Donohue Janet E, Zhang Wenying, Pasquali Sara K, Gaies Michael G
1Department of Pediatric Cardiology, Section of Cardiac Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL. 2Departments of Pediatric Critical Care Medicine and Pediatric Cardiology, Children's National Health System, Washington, D.C. 3Department of Pediatric Cardiology, Medical City Children's Hospital, Dallas, TX. 4Department of Pediatric Cardiology, Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH. 5Department of Pediatrics and Communicable Diseases, Division of Cardiology, C. S. Mott Children's Hospital and University of Michigan Medical School, Ann Arbor, MI.
Pediatr Crit Care Med. 2017 Oct;18(10):935-943. doi: 10.1097/PCC.0000000000001273.
In-hospital cardiac arrest occurs in 2.6-6% of children with cardiac disease and is associated with significant morbidity and mortality. Much remains unknown about cardiac arrest in pediatric cardiac ICUs; therefore, we aimed to describe cardiac arrest epidemiology in a contemporary multicenter cardiac ICU cohort.
Retrospective analysis within the Pediatric Cardiac Critical Care Consortium clinical registry.
Cardiac ICUs within 23 North American hospitals.
All cardiac medical and surgical patients admitted from August 2014 to July 2016.
None.
There were 15,908 cardiac ICU encounters (6,498 medical, 9,410 surgical). 3.1% had cardiac arrest; rate was 4.8 cardiac arrest per 1,000 cardiac ICU days. Medical encounters had 50% higher rate of cardiac arrest compared with surgical encounters. Observed (unadjusted) cardiac ICU cardiac arrest prevalence varied from 1% to 5.5% among the 23 centers; cardiac arrest per 1,000 cardiac ICU days varied from 1.1 to 10.4. Over half cardiac arrest occur within 48 hours of admission. On multivariable analysis, prematurity, neonatal age, any Society of Thoracic Surgeons preoperative risk factor, and Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery mortality category 4, 5 had strongest association with surgical encounter cardiac arrest. In medical encounters, independent cardiac arrest risk factors were acute heart failure, prematurity, lactic acidosis greater than 3 mmol/dL, and invasive ventilation 1 hour after admission. Median cardiopulmonary resuscitation duration was 10 minutes, return of spontaneous circulation occurred in 64.5%, extracorporeal cardiopulmonary resuscitation in 27.2%. Unadjusted survival was 53.2% in encounters with cardiac arrest versus 98.2% without. Medical encounters had lower survival after cardiac arrest (37.7%) versus surgical encounters (62.5%); Norwood patients had less than half the survival after cardiac arrest (35.6%) compared with all others. Unadjusted survival after cardiac arrest varied greatly among 23 centers.
We provide contemporary epidemiologic and outcome data for cardiac arrest occurring in the cardiac ICU from a multicenter clinical registry. As detailed above, we highlight high-risk patient cohorts and periods of time that may serve as targets for research and quality improvement initiatives aimed at cardiac arrest prevention.
患有心脏病的儿童中，2.6%-6%会发生院内心脏骤停，且与显著的发病率和死亡率相关。关于儿科心脏重症监护病房（ICU）中的心脏骤停，仍有许多未知之处；因此，我们旨在描述当代多中心心脏ICU队列中的心脏骤停流行病学情况。
在儿科心脏重症监护联盟临床登记处进行回顾性分析。
北美23家医院的心脏ICU。
2014年8月至2016年7月收治的所有心脏内科和外科患者。
无。
共15908例心脏ICU病例（内科6498例，外科9410例）。3.1%发生了心脏骤停；发生率为每1000个心脏ICU日有4.8次心脏骤停。内科病例的心脏骤停发生率比外科病例高50%。在23个中心中，观察到的（未调整的）心脏ICU心脏骤停患病率在1%至5.5%之间；每1000个心脏ICU日的心脏骤停发生率在1.1至10.4之间。超过一半的心脏骤停发生在入院后48小时内。多变量分析显示，早产、新生儿期、任何胸外科医师协会术前危险因素以及胸外科医师协会-欧洲心胸外科协会死亡率分类4、5与外科病例心脏骤停的关联性最强。在内科病例中，心脏骤停的独立危险因素为急性心力衰竭、早产、乳酸酸中毒大于3 mmol/dL以及入院后1小时进行有创通气。心肺复苏的中位持续时间为10分钟，自主循环恢复率为64.5%，体外膜肺氧合心肺复苏率为27.2%。发生心脏骤停的病例未调整生存率为53.2%，未发生心脏骤停的病例为98.2%。内科病例心脏骤停后的生存率（37.7%）低于外科病例（62.5%）；诺伍德手术患者心脏骤停后的生存率（35.6%）不到所有其他患者的一半。心脏骤停后的未调整生存率在23个中心之间差异很大。
我们从多中心临床登记处提供了当代心脏ICU中发生心脏骤停的流行病学和结局数据。如上所述，我们强调了高危患者队列和时间段，这些可作为旨在预防心脏骤停的研究和质量改进举措的目标。
