Riley Hospital for Children, Indianapolis, IN, USA.
University of Iowa Stead Family Children's Hospital, Iowa City, IA, USA; Lucile Packard Children's Hospital, Palo Alto, CA, USA.
Resuscitation. 2021 Dec;169:60-66. doi: 10.1016/j.resuscitation.2021.10.015. Epub 2021 Oct 18.
Recurrent in-hospital cardiac arrest (IHCA) is associated with morbidity and mortality in adults. We aimed to describe the risk factors and outcomes for paediatric recurrent IHCA.
Retrospective cohort study of patients ≤18 years old with single or recurrent IHCA. Recurrent IHCA was defined as ≥2 IHCA within the same hospitalization. Categorical variables expressed as percentages and compared via Chi square test. Continuous variables expressed as medians with interquartile ranges and compared via rank sum test. Outcomes assessed in a propensity match cohort.
From July 1, 2015 to January 26, 2021, 139/894 (15.5%) patients experienced recurrent IHCA. Compared to patients with a single IHCA, recurrent IHCA patients were more likely to be trauma and less likely to be surgical cardiac patients. Median duration of cardiopulmonary resuscitation (CPR) was shorter in the recurrent IHCA (5 vs. 11 min; p < 0.001) with no difference in IHCA location or immediate cause of CPR. Patients with recurrent IHCA had worse survival to intensive care unit (ICU) discharge (31% vs. 52%; p < 0.001), and worse survival to hospital discharge (30% vs. 48%; p < 0.001) in unadjusted analyses and after propensity matching, patients with recurrent IHCA still had worse survival to ICU (34% vs. 67%; p < 0.001) and hospital (31% vs. 64%; p < 0.001) discharge.
When examining those with a single vs. a recurrent IHCA, event and patient factors including more pre-existing conditions and shorter duration of CPR were associated with risk for recurrent IHCA. Recurrent IHCA is associated with worse survival outcomes following propensity matching.
院内复发性心脏骤停（IHCA）与成人的发病率和死亡率相关。本研究旨在描述儿科复发性 IHCA 的危险因素和结局。
对≤18 岁单次或复发性 IHCA 患者进行回顾性队列研究。复发性 IHCA 定义为同一次住院期间发生≥2 次 IHCA。分类变量用百分比表示，并通过卡方检验进行比较。连续变量用中位数表示，四分位距表示，并通过秩和检验进行比较。采用倾向匹配队列评估结局。
2015 年 7 月 1 日至 2021 年 1 月 26 日，共 139/894（15.5%）例患者发生复发性 IHCA。与单次 IHCA 患者相比，复发性 IHCA 患者更可能为创伤患者，而手术心脏患者比例较低。复发性 IHCA 患者心肺复苏（CPR）的中位时间更短（5 分钟 vs. 11 分钟；p < 0.001），但 IHCA 部位或 CPR 即刻原因无差异。复发性 IHCA 患者 ICU 出院生存率（31% vs. 52%；p < 0.001）和住院出院生存率（30% vs. 48%；p < 0.001）更差，未校正分析和倾向匹配后，复发性 IHCA 患者 ICU 出院生存率（34% vs. 67%；p < 0.001）和住院出院生存率（31% vs. 64%；p < 0.001）仍较差。
在比较单次 IHCA 与复发性 IHCA 时，事件和患者因素，包括更多的基础疾病和 CPR 持续时间更短，与复发性 IHCA 的风险相关。复发性 IHCA 与倾向匹配后生存率更差相关。
