Elsevier

Resuscitation

Volume 45, Issue 1, June 2000, Pages 17-25
Resuscitation

Utstein style reporting of in-hospital paediatric cardiopulmonary resuscitation

https://doi.org/10.1016/S0300-9572(00)00167-2Get rights and content

Abstract

Study objective: To report paediatric in-hospital cardiac arrest data according to Utstein style and to determine the effectiveness of cardiopulmonary resuscitation (CPR) in hospitalized children. Design: Retrospective 5-year case series. Setting: Urban, tertiary-care children's hospital. Participants: All patients who sustained cardiopulmonary arrest. Results: Altogether 227 patients experienced a cardiopulmonary arrest during the study period, 109 (48.0%) were declared dead without attempted resuscitation, and CPR was initiated in 118 (52.0%). The incidence of cardiac arrest was 0.7% of all hospital admissions and 5.5% of PICU admissions; the incidence of CPR attempts was 0.4 and 2.5%, respectively. Most of the CPR attempts (64.4%) took place in the PICU and the most frequent aetiology was cardiovascular (71.2%). The 1-year survival rate was 17.8%. Short duration of external CPR was the best prognostic factor associated with survival. With few exceptions, the Paediatric Utstein Style was found to be applicable for reporting retrospective data from in-hospital cardiac arrests in children. Conclusions: In-hospital cardiopulmonary resuscitation was shown to be an uncommon event in children; the survival rate was similar to earlier studies.

Introduction

Interpretation of outcome from paediatric resuscitation studies is complicated by the diverse aetiologies of cardiac arrest, the definition of cardiac arrest and CPR, age limits, and the level of prehospital and hospital care. Due to the low incidence of cardiac arrest in children, published studies are mainly retrospective and small.

The Utstein Style provides uniform guidelines for reporting advanced life support (ALS) research, and thus may improve patient care and outcome [1]. While several Utstein Style reports of adult cardiac arrest data are available, only one [2] focuses on paediatric cardiac arrest patients.

The purpose of the present study was to provide an Utstein style report of paediatric in-hospital cardiac arrest data and to evaluate factors associated with survival from cardiac arrest in hospitalized paediatric patients.

Section snippets

Patients and methods

The Hospital for Children and Adolescents (HCA) at Helsinki University Central Hospital is a 165-bed tertiary care teaching hospital in the capital of Finland. It has an eight-bed paediatric intensive care unit (PICU) which admits all critically ill children under 16 years of age in the area of southern Finland with roughly 1 310 000 inhabitants, except neurosurgical patients and children with severe trauma. The HCA is also nationally responsible for the care of paediatric patients requiring

Results

During the 5-year study period, 32 407 patients were admitted to the HCA (neonatal units excluded) for 163 648 hospital days. Of these patients, 3011 required PICU admission for 12 131 days. We identified 227 patients, who had sustained a cardiopulmonary arrest or received CPR for life-threatening hypotension or bradycardia. CPR was initiated in 118 (52.0%) of these patients, while 109 (48.0%) patients were declared dead without attempted resuscitation. In the non-CPR group 19 patients (17.4%)

Discussion

The Paediatric Utstein Style [1] enables comparison of survival rates from different institutions because it standardizes the reporting of patient data. To our knowledge, this study is the first Utstein-style report of in-hospital resuscitation data in children. Therefore, it is currently not possible to compare the incidence of CPR attempts and outcomes in the present study to earlier results, because the definitions of cardiac arrest and resuscitation vary. The incidence and outcome of CPR

Conclusions

The outcome of cardiopulmonary resuscitation in the Hospital for Children and Adolescents is in line with that in previous studies. Most CPR attempts took place in PICU and the most frequent etiology was cardiovascular. Short duration of external CPR was the best prognostic factor associated with survival of pediatric patients from in-hospital cardiac arrest. The Paediatric Utstein Style of reporting was easily applicable to pediatric arrest data, but compete data sets as suggested by the task

Acknowledgements

The authors would like to thank the staff from the archives of the Hospital for Adolescents and Children for their valuable assistance in obtaining the patients’ records. The authors are grateful to MD, PhD Olli Meretoja for his valuable comments on the manuscript.

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