Published online December 1, 2006
PEDIATRICS Vol. 118 No. 6 December 2006, pp. 2424-2433 (doi:10.1542/10.1542/peds.2006-1724)
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ARTICLE

Higher Survival Rates Among Younger Patients After Pediatric Intensive Care Unit Cardiac Arrests

Peter A. Meaney, MD, MPHa, Vinay M. Nadkarni, MDa, E. Francis Cook, ScDb, Marcia Testa, PhD, MPhil, MPHb, Mark Helfaer, MDa, William Kaye, MDc, G. Luke Larkin, MDd, Robert A. Berg, MDe for the American Heart Association National Registry of Cardiopulmonary Resuscitation Investigators

a Department of Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
b Departments of Epidemiology and Biostatistics, Harvard School of Public Health, Boston, Massachusetts
c Department of Surgery, Brown University, Providence, Rhode Island
d Department of Emergency Medicine, Yale University, New Haven, Connecticut
e Steele Children’s Research Center and Department of Pediatrics, University of Arizona, Tucson, Arizona

BACKGROUND. Age is an important determinant of outcome from adult cardiac arrests but has not been identified previously as an important factor in pediatric cardiac arrests except among premature infants. Chest compressions can result in more effective blood flow during cardiac arrest in an infant than an older child or adult because of increased chest wall compliance. We, therefore, hypothesized that survival from cardiac arrest would be better among infants than older children.

METHODS. We evaluated 464 pediatric ICU arrests from the National Registry of Cardiopulmonary Resuscitation from 2000 to 2002. NICU cardiac arrests were excluded. Data from each arrest include >200 variables describing facility, patient, prearrest, arrest intervention, outcome, and quality improvement data. Age was categorized as newborn (<1 month; N = 62), infant (1 month to <1 year; N = 105), younger child (1 year to <8 years; N = 90), and older child (8 years to <21 years; N = 207). Multivariable logistic regression was performed to examine the association between age and survival.

RESULTS. Overall survival was 22%, with 27% of newborns, 36% of infants, 19% of younger children and 16% of older children surviving to hospital discharge. Newborns and infants demonstrated double and triple the odds of surviving to hospital discharge from a cardiac arrest in an intensive care setting when compared with older children. When potential confounders were controlled, newborns increased their advantage to almost fivefold, while infants maintained their survival advantage to older children.

CONCLUSIONS. Survival from pediatric ICU cardiac arrest is age dependent. Newborns and infants have better survival rates even after adjusting for potential confounding variables.

Key Words: cardiac arrest • resuscitation • CPR • cardiopulmonary resuscitation • heart arrest • age • intensive care • pediatric • survival

Abbreviations: CPR—cardiopulmonary resuscitation • NRCPR—National Registry of Cardiopulmonary Resuscitation • ROSC—return of sustained circulation • CPC—cerebral performance category • PCPC—pediatric cerebral performance category • OR—odds ratio • CI—confidence interval

Accepted Aug 8, 2006.


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