Liu G, Chu J P, Chen J L, Qian S Y, Jin D Q, Lu X L, Xu M X, Cheng Y B, Sun Z Y, Miao H J, Li J, Dong S Y, Ding X, Wang Y, Chen Q, Duan Y Y, Huang J T, Guo Y M, Shi X N, Su J, Yin Y, Xin X W, Zhao S D, Lou Z X, Jiang J H, Zeng J S
Pediatric Intensive Care Unit,Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
Pediatric Intensive Care Unit, Xian Children's Hospital, Xi'an 710003, China.
Zhonghua Er Ke Za Zhi. 2022 Mar 2;60(3):197-202. doi: 10.3760/cma.j.cn112140-20211116-00962.
To investigate the prognostic factors of children with congenital heart disease (CHD) who had undergone cardiopulmonary resuscitation (CPR) in pediatric intensive care unit (PICU) in China. From November 2017 to October 2018, this retrospective multi-center study was conducted in 11 hospitals in China. It contained data from 281 cases who had undergone CPR and all of the subjects were divided into CHD group and non-CHD group. The general condition, duration of CPR, epinephrine doses during resuscitation, recovery of spontaneous circulation (ROSC), discharge survival rate and pediatric cerebral performance category in viable children at discharge were compared. According to whether malignant arrhythmia is the direct cause of cardiopulmonary arrest or not, children in CHD and non-CHD groups were divided into 2 subgroups: arrhythmia and non-arrhythmia, and the ROSC and survival rate to discharge were compared. Data in both groups were analyzed by -test, chi-square analysis or ANOVA, and logistic regression were used to analyze the prognostic factors for ROSC and survival to discharge after cardiac arrest (CA). The incidence of CA in PICU was 3.2% (372/11 588), and the implementation rate of CPR was 75.5% (281/372). There were 144 males and 137 females with median age of 32.8 (5.6, 42.7) months in all 281 CPA cases who received CPR. CHD group had 56 cases while non-CHD had 225 cases, with the percentage of 19.9% (56/281) and 80.1% (225/281) respectively. The proportion of female in CHD group was 60.7% (34/56) which was higher than that in non-CHD group (45.8%, 103/225) (χ=4.00, =0.045). There were no differences in ROSC and rate of survival to discharge between the two groups (0.05). The ROSC rate of children with arthythmid in CHD group was 70.0% (28/40), higher than 6/16 for non-arrhythmic children (χ5.06, 0.024). At discharge, the pediatric cerebral performance category scores (1-3 scores) of CHD and non-CHD child were 50.9% (26/51) and 44.9% (92/205) respectively. Logistic regression analysis indicated that the independent prognostic factors of ROSC and survival to discharge in children with CHD were CPR duration (odds ratio ()=0.95, 0.97; 95%: 0.920.97, 0.950.99; both <0.05) and epinephrine dosage (=0.87 and 0.79, 95%: 0.76-1.00 and 0.69-0.89, respectively; both 0.05). There is no difference between CHD and non-CHD children in ROSC and survival rate of survival to discharge was low. The epinephrine dosage and the duration of CPR are related to the ROSC and survival to discharge of children with CHD.
探讨我国儿科重症监护病房（PICU）中接受心肺复苏（CPR）的先天性心脏病（CHD）患儿的预后因素。2017年11月至2018年10月，在中国11家医院开展了这项回顾性多中心研究。研究纳入了281例接受CPR的数据，所有受试者被分为CHD组和非CHD组。比较了两组患儿的一般情况、CPR持续时间、复苏期间肾上腺素剂量、自主循环恢复（ROSC）情况、出院生存率以及出院时存活患儿的小儿脑功能分类。根据恶性心律失常是否为心肺骤停的直接原因，将CHD组和非CHD组患儿分为2个亚组：心律失常组和非心律失常组，比较两组的ROSC情况和出院生存率。两组数据采用t检验、卡方分析或方差分析进行分析，并采用逻辑回归分析心脏骤停（CA）后ROSC和出院生存的预后因素。PICU中CA的发生率为3.2%（372/11588），CPR实施率为75.5%（281/372）。在接受CPR的281例CA患儿中，男性144例，女性137例，中位年龄为32.8（5.6，42.7）个月。CHD组56例，非CHD组225例，分别占19.9%（56/281）和80.1%（225/281）。CHD组女性比例为60.7%（34/56），高于非CHD组（45.8%，103/225）（χ²=4.00，P=0.045）。两组间ROSC情况和出院生存率无差异（P>0.05）。CHD组心律失常患儿的ROSC率为70.0%（28/40），高于非心律失常患儿的6/16（χ²=5.06，P=0.024）。出院时，CHD患儿和非CHD患儿的小儿脑功能分类评分（1 - 3分）分别为50.9%（26/51）和44.9%（92/205）。逻辑回归分析表明，CHD患儿ROSC和出院生存的独立预后因素为CPR持续时间（比值比（OR）=0.95，95%置信区间（CI）：0.920.97；OR=0.97，95%CI：0.950.99；P均<0.05）和肾上腺素剂量（OR分别为0.87和0.79，95%CI分别为0.761.00和0.690.89；P均<0.05）。CHD患儿和非CHD患儿在ROSC方面无差异，且出院生存率较低。肾上腺素剂量和CPR持续时间与CHD患儿的ROSC和出院生存相关。
