Survival rate after in-hospital cardiac arrest improving for children
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CHICAGO — Survival rates have almost doubled for children who experienced in-hospital cardiac arrest during the last 20 years, with the greatest gains in children who experienced cardiac arrest after cardiac surgery, researchers reported.
The data were presented at the American Heart Association Scientific Sessions.
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“Survival rates after cardiac arrest have gone up over the past 20 years — almost doubling — which is reflective of advances in the field and a commitment from the medical community to focus on high-quality resuscitation and post-arrest care in children,” Monique M. Gardner MD, assistant professor of anesthesiology and critical care and pediatrics at the Perelman School of Medicine, University of Pennsylvania, and attending physician in cardiac critical care medicine at the Children’s Hospital of Philadelphia, told Healio. “Notably, however, patients with cardiac disease that have not recently undergone surgery (the medical-cardiac group) have lower rates of survival and have not had as substantial of an increase in improved survival as noncardiac and surgical-cardiac groups.”
Gardner and colleagues analyzed pediatric in-hospital cardiac arrest data from the AHA Get With The Guidelines-Resuscitation database from 2000 through 2021. Researchers defined cardiac arrests as surgical-cardiac, or in-hospital cardiac arrest after cardiac surgery; medical-cardiac, or in-hospital cardiac arrest in nonsurgical cardiac disease; and noncardiac, in-hospital cardiac arrest in patients without cardiac disease. The primary outcome was survival to hospital discharge. Researchers compared rates from 2000-2004, 2005-2009, 2010-2014 and 2015-2021.
Of 17,696 index in-hospital cardiac arrest events, 18% were surgical-cardiac, 18% were medical-cardiac and 64% were noncardiac.
The surgical-cardiac category had the highest rate of survival to discharge compared with the medical-cardiac and non-cardiac categories (56.1% vs. 43.4% vs. 46.3%; P < .001). After adjusting for age, location of event and hospital size, the odds of survival were higher for the surgical-cardiac category (adjusted OR = 1.28; 95% CI, 1.16-1.4) and lower for the medical-cardiac category (aOR = 0.87; 95% CI, 0.8-0.95), compared with the noncardiac category.
Survival odds increased for all illness categories across eras. Between the 2000-2004 and 2015-2021 eras, survival among surgical-cardiac children increased from 45.6% to 62.3% with odds of survival increasing by 24% per era, for an OR of 1.24 (95% CI, 1.15-1.35). Survival for medical-cardiac children increased from 36.6% to 47%, with 14% increased odds per era (OR = 1.14; 95% CI, 1.06-1.23).
“Children have higher rates of survival after in-hospital cardiac arrest than previously reported, which is an amazing feat in the resuscitation science and quality field,” Gardner told Healio. “Children with cardiac arrest after recent cardiac surgery have the highest rates of survival to hospital discharge, reflecting dedicated efforts to care for these patients. However, we need to continue to focus on improving survival rates, particularly for medical-cardiac patients.”
Gardner said researchers and clinicians must focus on physiology that is unique to cardiac patients, specifically those with medical disease, as they lag behind in outcomes to surgical-cardiac and non-cardiac patients.
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Gardner MM, et al. Abstract 287. Presented at: American Heart Association Scientific Sessions; Nov. 5-7, 2022; Chicago (hybrid meeting).
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