Epidemiology of pediatric cardiopulmonary resuscitation

Shimoda-Sakano, Tania Miyuki; Schvartsman, Cláudio; Reis, Amélia Gorete

doi:10.1016/j.jped.2019.08.004

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Sumário

Review articles • J. Pediatr. (Rio J.) 96 (4) • Jul-Aug 2020 • https://doi.org/10.1016/j.jped.2019.08.004 copy

Epidemiology of pediatric cardiopulmonary resuscitation

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To analyze the main epidemiological aspects of prehospital and hospital pediatric cardiopulmonary resuscitation and the impact of scientific evidence on survival.

Source of data:

This was a narrative review of the literature published at PubMed/MEDLINE until January 2019 including original and review articles, systematic reviews, meta-analyses, annals of congresses, and manual search of selected articles.

Synthesis of data:

The prehospital and hospital settings have different characteristics and prognoses. Pediatric prehospital cardiopulmonary arrest has a three-fold lower survival rate than cardiopulmonary arrest in the hospital setting, occurring mostly at home and in children under 1 year. Higher survival appears to be associated with age progression, shockable rhythm, emergency medical care, use of automatic external defibrillator, high-quality early life support, telephone dispatcher-assisted cardiopulmonary resuscitation, and is strongly associated with witnessed cardiopulmonary arrest. In the hospital setting, a higher incidence was observed in children under 1 year of age, and mortality increased with age. Higher survival was observed with shorter cardiopulmonary resuscitation duration, occurrence on weekdays and during daytime, initial shockable rhythm, and previous monitoring. Despite the poor prognosis of pediatric cardiopulmonary resuscitation, an increase in survival has been observed in recent years, with good neurological prognosis in the hospital setting.

Conclusions:

A great progress in the science of pediatric cardiopulmonary resuscitation has been observed, especially in developed countries. The recognition of the epidemiological aspects that influence cardiopulmonary resuscitation survival may direct efforts towards more effective actions; thus, studies in emerging and less favored countries remains a priority regarding the knowledge of local factors.

KEYWORDS
Cardiopulmonary resuscitation; Cardiopulmonary arrest; Ventricular fibrillation; Pulseless ventricular tachycardia; Asystole; Pulseless electrical activity

	Overall	Infants	Children	Adolescents	Adults
Incidence (100,000 cases/year)	3.3-8.0	65.5-72	3.7	6.3	50-64.7
30-day survival (%)	8.1	1.4-2.6	7.8-16.1	7.7-9.3	9.3
Survival-hospital discharge (%)	1.1-20	3.3	9.1	8.9	1.1-10.6
Favorable neurological prognosis^a a Studies evaluated 1 to 18 months after CPA.2,10,11,15,19,21 (%)	1-12	1-2	4	11-16	2-10.7
Public place (%)	7-12	4	14	22-45	16
CPR in the community (%)	6-48.8	37	40	28	19
Initial rhythm asystole (%)	82-95	84	83	77	60
Initial rhythm VF (%)	5-11.7	4	5-22	15-51.2	23-33.7

Author	Country	Year	Study type	Number of patients	Place	ROSC (%)	High survival (%)	Survival with good neurological prognosis (%)	One-year survival (%)
Slonin⁶²62 Slonim AD, Patel KM, Ruttimann UE, Pollack MM. Cardiopulmonary resuscitation in pediatric intensive care units. Crit Care Med. 1997;25:1951-5.	United States	1997	Prospective	205	ICU	NA	13,7	NA	NA
Suominen⁷¹71 Suominen P, Olkkola KT, Voipio V, Korpela R, Palo R, Räsänen J. Utstein style reporting of in-hospital paediatric cardiopulmonary resuscitation. Resuscitation. 2000;45:17-25.	Finland	2000	Retrospective	118	Hospital	62.7	19.5	12.7	17.8
Reis⁵⁹59 Reis AG, Nadkarni V, Perondi MB, Grisi S, Berg RA. A prospective investigation into the epidemiology of in-hospital pediatric cardiopulmonary resuscitation using the international Utstein reporting style. Pediatrics. 2002;109:200-9.	Brazil	2002	Prospective	129	Hospital	64	16.2	15	14.7
Guay⁷²72 Guay J, Lortie L. An evaluation of pediatric in-hospital advanced life support interventions using the pediatric Utstein guidelines: a review of 203 cardiorespiratory arrests. Can J Anaesth J Can Anesth. 2004;51:373-8.	Canada	2004	Retrospective	203^a a Includes apnea patients, 55 CPA patients.	Hospital	73.8	40.8	23.4	26
Rodríguez-Nuñes³⁷37 Rodríguez-Núñez A, López-Herce J, García C, Domínguez P, Carrillo A, Bellón JM, et al. Pediatric defibrillation after cardiac arrest: initial response and outcome. Crit Care Lond Engl. 2006;10:R113.	Spain	²⁰⁰⁶	Prospective	116	ICU	59.5	35.3	31	34.5
Tibballs⁷³73 Tibballs J, Kinney S. A prospective study of outcome of in-patient paediatric cardiopulmonary arrest. Resuscitation. 2006;71:310-8.	Australia	2006	Prospective	111	Hospital	76	36	NA	34
Nadkarni⁶⁰60 Nadkarni VM, Larkin GL, Peberdy MA, Carey SM, Kaye W, Mancini ME, et al. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA. 2006;295:50-7.	United States and Canada	2006	Prospective	880	Hospital	52	27	18	NA
de Mos⁷⁵75 de Mos N, van Litsenburg RRL, McCrindle B, Bohn DJ, Parshuram CS. Pediatric in-intensive-care-unit cardiac arrest: incidence, survival, and predictive factors. Crit Care Med. 2006;34:1209-15.	Canada	2006	Retrospective	91	ICU	82	25	18	NA
Meaney⁶³63 Meaney PA, Nadkarni VM, Cook EF, Testa M, Helfaer M, Kaye W, et al. Higher survival rates among younger patients after pediatric intensive care unit cardiac arrests. Pediatrics. 2006;118:2424-33.	United States	2006	Prospective	411	ICU	48.9	21.4	14	NA
Wu⁷⁶76 Wu ET, Li MJ, Huang SC, Wang CC, Liu YP, Lu FL, et al. Survey of outcome of CPR in pediatric in-hospital cardiac arrest in a medical center in Taiwan. Resuscitation. 2009;80:443-8.	Taiwan	2009	Retrospective	316	Hospital	72.2	20.9	15.5	NA
Meert⁷⁷77 Meert KL, Donaldson A, Nadkarni V, Tieves KS, Schleien CL, Brilli RJ, et al. Multicenter cohort study of in-hospital pediatric cardiac arrest. Pediatr Crit Care Med. 2009;10:544-53.	United States	2009	Retrospective	353^b b Not including all CPA patients, only those with sustained ROSC.	Hospital	ND	48ª	46^a a Includes apnea patients, 55 CPA patients.	NA
Olotu⁷⁸78 Olotu A, Ndiritu M, Ismael M, Mohammed S, Mithwani S, Maitland K, et al. Characteristics and outcome of cardiopulmonary resuscitation in hospitalised African children. Resuscitation. 2009;80:69-72.	Kenya	2009	Prospective	114^c c Includes newborns and children with apnea and CPA.	Hospital	ND	15.7% PCR	ND	NA
Berens⁷⁹79 Berens RJ, Cassidy LD, Matchey J, Campbell D, Colpaert KD, Welch T, et al. Probability of survival based on etiology of cardiopulmonary arrest in pediatric patients. Paediatr Anaesth. 2011;21:834-40.	United States	2011	Retrospective	257	Hospital	56.8	31.1	19.8	NA
Girotra²⁹29 Girotra S, Spertus JA, Li Y, Berg RA, Nadkarni VM, Chan PS, et al. Survival trends in pediatric in-hospital cardiac arrests: an analysis from Get With the Guidelines-Resuscitation. Circ Cardiovasc Qual Outcomes. 2013;6:42-9.	United States	2013	Retrospective	1031	Hospital		34.8	61	NA
López-Herce⁸⁰80 López-Herce J, del Castillo J, Cañadas S, Rodríguez-Núñez A, Carrillo A. In-hospital pediatric cardiac arrest in Spain. Rev Espanola Cardiol Engl Ed. 2014;67:189-95.	Spain	2014	Prospective	200	Hospital	74	41	77.9	NA
Berg⁸¹81 Berg RA, Sutton RM, Holubkov R, Nicholson CE, Dean JM, Harrison R, et al. Ratio of PICU versus ward cardiopulmonary resuscitation events is increasing. Crit Care Med. 2013;41:2292-7.	United States	2013	Prospective	5870 events	Hospital	72	39	95	NA
Zeng⁷⁴74 Zeng J, Qian S, Zheng M, Wang Y, Zhou G, Wang H. The epidemiology and resuscitation effects of cardiopulmonary arrest among hospitalized children and adolescents in Beijing: an observational study. Resuscitation. 2013;84:1685-90.	China	2013	Prospective	174	Hospital	62.1	28.2	86	12.1
RIBEPCI⁸²82 López-Herce J, Del Castillo J, Matamoros M, Cañadas S, Rodriguez-Calvo A, Cecchetti C, et al. Factors associated with mortality in pediatric in-hospital cardiac arrest: a prospective multicenter multinational observational study. Intensive Care Med. 2013;39:309-18.	Multinational	2013	Prospective	502	Hospital	69.5	39.2	34.8	NA
Straney⁸³83 Straney LD, Schlapbach LJ, Yong G, Bray JE, Millar J, Slater A, et al. Trends in PICU admission and survival rates in children in Australia and New Zealand following cardiac arrest. Pediatr Intensive Crit Care Soc. 2015;16:613-20.	Australia, NewZealand	2015	Prospective	677	ICU	NA	63.7	NA	NA
Rathore⁶⁸68 Rathore V, Bansal A, Singhi SC, Singhi P, Muralidharan J. Survival and neurological outcome following in-hospital paediatric cardiopulmonary resuscitation in North India. Paediatr Int Child Health. 2016;36:141-7.	India	2016	Prospective	314	Hospital	64.6	14	77	11.1
Berg⁸⁴84 Berg RA, Nadkarni VM, Clark AE, Moler F, Meert K, Harrison RE, et al. Incidence and outcomes of cardiopulmonary resuscitation in PICUs. Crit Care Med. 2016;44:798-808.	United States	2016	Prospective	139	ICU	65	45	89	NA
Gupta⁸⁵85 Gupta P, Wilcox A, Noel TR, Gossett JM, Rockett SR, Eble BK, et al. Characterizing cardiac arrest in children undergoing cardiac surgery: asingle-center study. J Thorac Cardiovasc Surg. 2017;153, 450-8.e1.	United States	2017	Retrospective	154	ICU	100	66,6	94,3	NA
Andersen⁸⁶86 Andersen LW, Vognsen M, Topjian A, Brown L, Berg RA, Nadkarni VM, et al. Pediatric in-hospital acute respiratory compromise: a report from the American Heart Association tm)s get with the Guidelines-Resuscitation Registry. Pediatr Intensive Crit Care Soc. 2017;18:838-49.	United States	2017	Prospective	182	Hospital	ND	53,8	NA	NA
Sutton⁶⁴64 Sutton RM, Reeder RW, Landis W, Meert KL, Yates AR, Berger JT, et al. Chest compression rates and pediatric in-hospital cardiac arrest survival outcomes. Resuscitation. 2018;130:159-66.	United States	2018	Prospective	164	ICU	90	47	75,7	NA
Shimoda-Sakano, Annals⁶⁹69 Shimoda-Sakano TM, Paiva EF, Bello FPS, Schvartsman C, Reis AG. Análise descritiva da ressuscitação cardiopulmonar pediátrica em hospital terciário: estudo piloto.; 2018.	Brazil	2018	Prospective	220	Hospital	70,1	28,7	NA	NA
Edward-Jackson⁷⁰70 Edwards-Jackson N, North K, Chiume M, Nakanga W, Schubert C, Hathcock A, et al. Outcomes of in-hospital paediatric cardiac arrest from a tertiary hospital in a low-income African country. Paediatr Int Child Health. 2019;:1-5.	Malawi (Africa)	2019	Prospective	135	Hospital	6	0	0	0

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[1] * Corresponding author. E-mail: sakano@hotmail.com (T.M. Shimoda-Sakano).