Al-Eyadhy Ayman, Almazyad Mohammed, Hasan Gamal, AlKhudhayri Nawaf, AlSaeed Abdullah F, Habib Mohammed, Alhaboob Ali A N, AlAyed Mohammed, AlSehibani Yazeed, Alsohime Fahad, Alabdulhafid Majed, Temsah Mohamad-Hani
Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Department of Pediatrics, Pediatric Intensive Care Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
J Pediatr Intensive Care. 2021 Jul 30;12(4):303-311. doi: 10.1055/s-0041-1733855. eCollection 2023 Dec.
Understanding the factors affecting survival and modifying the preventable factors may improve patient outcomes following cardiopulmonary resuscitation (CPR). The aim of this study was to assess the prevalence and outcomes of cardiac arrest and CPR events in a tertiary pediatric intensive care unit (PICU). Outcomes of interest were the return of spontaneous circulation (ROSC) lasting more than 20 minutes, survival for 24 hours post-CPR, and survival to hospital discharge. We analyzed data from the PICU CPR registry from January 1, 2011 to January 1, 2018. All patients who underwent at least 2 minutes of CPR in the PICU were included. CPR was administered in 65 PICU instances, with a prevalence of 1.85%. The mean patient age was 32.7 months. ROSC occurred in 38 (58.5%) patients, 30 (46.2%) achieved 24-hour survival, and 21 (32.3%) survived to hospital discharge. Younger age ( < 0.018), respiratory cause ( < 0.001), bradycardia ( < 0.018), and short duration of CPR ( < 0.001) were associated with better outcomes, while sodium bicarbonate, norepinephrine, and vasopressin were associated with worse outcome ( < 0.009). The off-hour CPR had no impact on the outcome. The patients' cumulative predicted survival declined by an average of 8.7% for an additional 1 minute duration of CPR ( = 0.001). The study concludes that the duration of CPR, therefore, remains one of the crucial factors determining CPR outcomes and needs to be considered in parallel with the guideline emphasis on CPR quality. The lower survival rate post-ROSC needs careful consideration during parental counseling. Better anticipation and prevention of CPR remain ongoing challenges.
了解影响生存的因素并改变可预防因素，可能会改善心肺复苏（CPR）后的患者预后。本研究的目的是评估三级儿科重症监护病房（PICU）中心脏骤停和CPR事件的发生率及预后。感兴趣的预后指标包括自主循环恢复（ROSC）持续超过20分钟、CPR后存活24小时以及存活至出院。我们分析了2011年1月1日至2018年1月1日期间PICU CPR登记处的数据。纳入了所有在PICU接受至少2分钟CPR的患者。在65例PICU病例中实施了CPR，发生率为1.85%。患者平均年龄为32.7个月。38例（58.5%）患者出现ROSC，30例（46.2%）存活24小时，21例（32.3%）存活至出院。年龄较小（P<0.018）、呼吸原因（P<0.001）、心动过缓（P<0.018）和CPR持续时间较短（P<0.001）与较好的预后相关，而碳酸氢钠、去甲肾上腺素和血管加压素与较差的预后相关（P<0.009）。非工作时间CPR对预后无影响。CPR每增加1分钟，患者的累积预测生存率平均下降8.7%（P=0.001）。研究得出结论，因此，CPR持续时间仍然是决定CPR预后的关键因素之一，需要与指南对CPR质量的强调一并考虑。ROSC后的较低生存率在向家长咨询时需要仔细考虑。更好地预测和预防CPR仍然是持续存在的挑战。
