Department of Pediatrics, Division of Cardiology, Emory University School of Medicine, Children's Healthcare of Atlanta, 2835 Brandywine Road, suite 400, Atlanta, GA, 30341, USA.
Emory University School of Medicine, Atlanta, GA, USA.
Pediatr Cardiol. 2023 Dec;44(8):1674-1683. doi: 10.1007/s00246-023-03251-5. Epub 2023 Aug 16.
Children with cardiac disease are at significantly higher risk for in-hospital cardiac arrest (CA) compared with those admitted without cardiac disease. CA occurs in 2-6% of patients admitted to a pediatric intensive care unit (ICU) and 4-6% of children admitted to the pediatric cardiac-ICU. Treatment of in-hospital CA with cardiopulmonary resuscitation (CPR) results in return of spontaneous circulation in 43-64% of patients and survival rate that varies from 20 to 51%. We aimed to investigate the change in functional status of survivors who experienced an in-hospital CA using the functional status scale (FSS) in our heart center by conducting a retrospective study of all patients 0-18 years who experienced CA between June 2015 and December 2020 in a free-standing university-affiliated quaternary children's hospital. Of the 165 CA patients, 61% (n = 100) survived to hospital discharge. The non-survivors had longer length from admission to CA, higher serum lactate levels peri-CA, and received higher number of epinephrine doses. Using FSS, of the survivors, 26% developed new morbidity, and 9% developed unfavorable outcomes. There was an association of unfavorable outcomes with longer CICU-LOS and number of epinephrine doses given. Sixty-one-percent of CA patients survived to hospital discharge. Of the survivors, 26% developed new morbidity and 91% had favorable outcomes. Future multicenter studies are needed to help better identify modifiable risk factors for development of poor outcomes and help improve outcomes of this fragile patient population.
患有心脏病的儿童在院内发生心搏骤停 (CA) 的风险明显高于无心脏病的儿童。在儿科重症监护病房 (PICU) 住院的患者中，CA 发生率为 2-6%，在儿科心脏重症监护病房 (PCICU) 住院的儿童中，CA 发生率为 4-6%。心肺复苏 (CPR) 治疗院内 CA 可使 43-64%的患者恢复自主循环，存活率从 20%到 51%不等。我们旨在通过对我们心脏中心的所有 0-18 岁经历过 CA 的患者进行回顾性研究，使用功能状态量表 (FSS) 来研究经历过 CA 的幸存者的功能状态变化。在一家独立的大学附属四级儿童医院，2015 年 6 月至 2020 年 12 月期间，共有 165 例 CA 患者，其中 61%（n=100）存活至出院。非幸存者从入院到 CA 的时间较长，peri-CA 血清乳酸水平较高，接受的肾上腺素剂量较高。使用 FSS，在幸存者中，26%出现新发病，9%出现不良结局。不良结局与较长的 CICU 住院时间和肾上腺素剂量有关。61%的 CA 患者存活至出院。在幸存者中，26%出现新发病，91%出现良好结局。未来需要进行多中心研究，以帮助更好地识别不良结局发展的可改变危险因素，并帮助改善这一脆弱患者群体的结局。
