More children surviving in-hospital cardiac arrest
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University of Iowa researchers and colleagues recently reported that adults were almost two times more likely to survive in-hospital cardiac arrest in 2009 than they were in 2000. In a new study, the team now shows that the results for children are even better.
The study, published Dec. 18 in the journal Circulation: Cardiovascular Quality & Outcomes, finds that children who had in-hospital cardiac arrest in 2009, were three times more likely to survive than children who had cardiac arrests in 2000—43.4 percent survival in 2009 compared to 14.3 percent in 2000. In addition, among surviving children, the risk of severe brain damage appears to have remained unchanged during this period.
Saket Girotra, M.D.
"The reason for the study was to learn how we are doing in terms of our performance in delivering resuscitation care," says lead study author Saket Girotra, M.D., associate in internal medicine with UI Health Care. "We found a dramatic three-fold increase in survival in children who experience a cardiac arrest during hospitalization over the past decade. That suggests there has been improvement in the quality of resuscitation care."
Cardiac arrest is relatively uncommon in children and most children who have an in-hospital cardiac arrest are already critically ill. These children typically have respiratory illnesses such as pneumonia, widespread infections, or are receiving care for heart problems including heart failure.
Researchers analyzed cases of 1,031 children who experienced cardiac arrest at 12 urban U.S. teaching hospitals over the decade ending in 2009. The hospitals all participate in the American Heart Association’s Get With the Guidelines-Resuscitation program, a quality-improvement effort that promotes consistent application of the latest scientific guidance for resuscitation.
The team found that the increased survival appeared to be due to both a greater success in reviving patients from the initial cardiac arrest, as well as an improvement in survival following successful resuscitation until discharge. However, the biggest improvement was during the acute resuscitation phase when the heart is restarted following the cardiac arrest, where survival rates increased from 42.9 percent to 81.2 percent over the 10-year period of the study.
Although the new study was not able to pinpoint which specific factors are responsible for the improvement in survival, Girotra says the findings suggest that there has been an overall improvement in quality of resuscitation care.
"I think we're learning how to treat patients in both phases of resuscitation care much better," he says. "Although it is hard to pinpoint the specifics, response times may have improved because of better identification and monitoring of at-risk patients. It's also possible the treatments during the cardiac arrest, including the quality of chest compressions and coordination of running the resuscitation effort, have improved. In addition, improvements in how we care for these patients in the post-resuscitation period may have also occurred."
Girotra notes that a greater understanding of the factors behind these increased survival rates will allow the benefits to be consolidated and expanded to all hospitals.
In addition to showing a three-fold increase in survival, the study also suggests that rates of brain damage have not worsened over the 10-year study period. However, despite being the largest study of its kind to date, the number of children in the study who survive was too small to provide statistical certainty regarding rates of neurological impairment. In an earlier much larger study of in-hospital cardiac arrest survival in adults, however, the team showed that increased survival was accompanied by reduction in rates of neurological damage.
"Ultimately, the most important thing is the sooner resuscitative measures can be initiated, the greater the chance of survival and the greater the chance of preserving brain function," Girotra concludes.
In addition to Girotra, the study authors include John Spertus, M.D., M.P.H., and Yan Li, Ph.D., at Saint Luke's Mid America Heart Institute, Kansas City, Mo.; Paul Chan, M.D., M.Sc., at University of Missouri-Kansas City and Saint Luke’s Mid America Heart Institute; and Robert Berg, M.D., and Vinay Nadkarni, M.D., at Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa.