Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
Pediatric Intensive Care Unit, Department of Women's and Children's Health, University of Padova, Padova, Italy.
JAMA Netw Open. 2023 Feb 1;6(2):e2256178. doi: 10.1001/jamanetworkopen.2022.56178.
Data on trends in incidence and mortality for in-hospital cardiac arrest (IHCA) in children with cardiac disease in the intensive care unit (ICU) are lacking. Additionally, there is limited information on factors associated with IHCA and mortality in this population.
To investigate incidence, trends, and factors associated with IHCA and mortality in children with cardiac disease in the ICU.
A systematic review was conducted using PubMed, Web of Science, EMBASE, and CINAHL, from inception to September 2021.
Observational studies on IHCA in pediatric ICU patients with cardiac disease were selected (age cutoffs in studies varied from age ≤18 y to age ≤21 y).
Quality of studies was assessed using the National Institutes of Health Quality Assessment Tools. Data on incidence, mortality, and factors associated with IHCA or mortality were extracted by 2 independent observers. Random-effects meta-analysis was used to compute pooled proportions and pooled ORs. Metaregression, adjusted for type of study and diagnostic category, was used to evaluate trends in incidence and mortality.
Primary outcomes were incidence of IHCA and in-hospital mortality. Secondary outcomes were proportions of patients who underwent extracorporeal membrane oxygenation (ECMO) cardiopulmonary resuscitation (ECPR) and those who did not achieve return of spontaneous circulation (ROSC).
Of the 2574 studies identified, 25 were included in the systematic review (131 724 patients) and 18 in the meta-analysis. Five percent (95% CI, 4%-6%) of children with cardiac disease in the ICU experienced IHCA. The pooled in-hospital mortality among children who experienced IHCA was 51% (95% CI, 42%-59%). Thirty-nine percent (95% CI, 29%-51%) did not achieve ROSC; in centers with ECMO, 22% (95% CI, 14%-33%) underwent ECPR, whereas 22% (95% CI, 12%-38%) were unable to be resuscitated. Both incidence of IHCA and associated in-hospital mortality decreased significantly in the last 20 years (both P for trend < .001), whereas the proportion of patients not achieving ROSC did not significantly change (P for trend = .90). Neonatal age, prematurity, comorbidities, univentricular physiology, arrhythmias, prearrest mechanical ventilation or ECMO, and higher surgical complexity were associated with increased incidence of IHCA and mortality odds.
This systematic review and meta-analysis found that 5% of children with cardiac disease in the ICU experienced IHCA. Decreasing trends in IHCA incidence and mortality suggest that education on preventive interventions, use of ECMO, and post-arrest care may have been effective; however, there remains a crucial need for developing resuscitation strategies specific to children with cardiac disease.
关于重症监护病房（ICU）中患有心脏病的儿童院内心搏骤停（IHCA）发病率和死亡率的趋势的数据是缺乏的。此外，关于该人群中与 IHCA 和死亡率相关的因素的信息有限。
调查 ICU 中患有心脏病的儿童中 IHCA 和死亡率的发病率、趋势和相关因素。
通过 PubMed、Web of Science、EMBASE 和 CINAHL 进行了系统评价，检索时间从建库至 2021 年 9 月。
选择了 ICU 中患有心脏病的儿科患者 IHCA 的观察性研究（研究中的年龄截止点从年龄≤18 岁到年龄≤21 岁不等）。
使用美国国立卫生研究院质量评估工具评估研究质量。由 2 名独立观察员提取与 IHCA 或死亡率相关的发病率、死亡率和相关因素的数据。使用随机效应荟萃分析计算汇总比例和汇总 OR。使用元回归，根据研究类型和诊断类别进行调整，评估发病率和死亡率的趋势。
主要结局是 IHCA 和院内死亡率的发病率。次要结局是接受体外膜肺氧合（ECMO）心肺复苏（ECPR）和未达到自主循环恢复（ROSC）的患者比例。
在确定的 2574 项研究中，有 25 项研究被纳入系统评价（131724 名患者），18 项研究被纳入荟萃分析。5%（95%CI，4%-6%）的 ICU 中患有心脏病的儿童经历 IHCA。经历 IHCA 的儿童的院内死亡率为 51%（95%CI，42%-59%）。39%（95%CI，29%-51%）未达到 ROSC；在有 ECMO 的中心，22%（95%CI，14%-33%）接受了 ECPR，而 22%（95%CI，12%-38%）无法复苏。IHCA 的发病率和相关的院内死亡率在过去 20 年中均显著下降（趋势 P 值均<0.001），而未达到 ROSC 的患者比例没有显著变化（趋势 P 值=0.90）。新生儿年龄、早产、合并症、单心室生理学、心律失常、术前机械通气或 ECMO 以及更高的手术复杂性与 IHCA 发生率和死亡率的增加相关。
本系统评价和荟萃分析发现，5%的 ICU 中患有心脏病的儿童经历 IHCA。IHCA 发病率和死亡率呈下降趋势表明，关于预防干预措施、ECMO 使用和复苏后护理的教育可能已经有效；然而，仍然需要制定针对患有心脏病的儿童的复苏策略。
Zotero 插件
