Incidence and Outcomes of Cardiopulmonary Resuscitation in PICUs

Robert A. Berg*, Vinay M. Nadkarni, Amy E. Clark, Frank Moler, Kathleen Meert, Rick E. Harrison, Christopher J L Newth, Robert M. Sutton, David L. Wessel, John T. Berger, Joseph Carcillo, Heidi Dalton, Sabrina Heidemann, Thomas P. Shanley, Athena F. Zuppa, Allan Doctor, Robert F. Tamburro, Tammara L. Jenkins, J. Michael Dean, Richard HolubkovMurray M. Pollack

*Corresponding author for this work

Research output: Contribution to journalArticle

46 Citations (Scopus)

Abstract

Objectives: To determine the incidence of cardiopulmonary resuscitation in PICUs and subsequent outcomes. Design, Setting, and Patients: Multicenter prospective observational study of children younger than 18 years old randomly selected and intensively followed from PICU admission to hospital discharge in the Collaborative Pediatric Critical Care Research Network December 2011 to April 2013. Results: Among 10,078 children enrolled, 139 (1.4%) received cardiopulmonary resuscitation for more than or equal to 1 minute and/or defibrillation. Of these children, 78% attained return of circulation, 45% survived to hospital discharge, and 89% of survivors had favorable neurologic outcomes. The relative incidence of cardiopulmonary resuscitation events was higher for cardiac patients compared with non-cardiac patients (3.4% vs 0.8%, p <0.001), but survival rate to hospital discharge with favorable neurologic outcome was not statistically different (41% vs 39%, respectively). Shorter duration of cardiopulmonary resuscitation was associated with higher survival rates: 66% (29/44) survived to hospital discharge after 1-3 minutes of cardiopulmonary resuscitation versus 28% (9/32) after more than 30 minutes (p < 0.001). Among survivors, 90% (26/29) had a favorable neurologic outcome after 1-3 minutes versus 89% (8/9) after more than 30 minutes of cardiopulmonary resuscitation. Conclusions: These data establish that contemporary PICU cardiopulmonary resuscitation, including long durations of cardiopulmonary resuscitation, results in high rates of survival-to-hospital discharge (45%) and favorable neurologic outcomes among survivors (89%). Rates of survival with favorable neurologic outcomes were similar among cardiac and noncardiac patients. The rigorous prospective, observational study design avoided the limitations of missing data and potential selection biases inherent in registry and administrative data.

Original languageEnglish (US)
Pages (from-to)798-808
Number of pages11
JournalCritical Care Medicine
Volume44
Issue number4
DOIs
StatePublished - Apr 1 2016

Fingerprint

Cardiopulmonary Resuscitation
Nervous System
Incidence
Survival Rate
Survivors
Observational Studies
Prospective Studies
Selection Bias
Critical Care
Registries
Pediatrics
Research

Keywords

  • cardiac arrest
  • cardiopulmonary resuscitation
  • children
  • incidence
  • intensive care
  • survival

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

Berg, R. A., Nadkarni, V. M., Clark, A. E., Moler, F., Meert, K., Harrison, R. E., ... Pollack, M. M. (2016). Incidence and Outcomes of Cardiopulmonary Resuscitation in PICUs. Critical Care Medicine, 44(4), 798-808. https://doi.org/10.1097/CCM.0000000000001484
Berg, Robert A. ; Nadkarni, Vinay M. ; Clark, Amy E. ; Moler, Frank ; Meert, Kathleen ; Harrison, Rick E. ; Newth, Christopher J L ; Sutton, Robert M. ; Wessel, David L. ; Berger, John T. ; Carcillo, Joseph ; Dalton, Heidi ; Heidemann, Sabrina ; Shanley, Thomas P. ; Zuppa, Athena F. ; Doctor, Allan ; Tamburro, Robert F. ; Jenkins, Tammara L. ; Dean, J. Michael ; Holubkov, Richard ; Pollack, Murray M. / Incidence and Outcomes of Cardiopulmonary Resuscitation in PICUs. In: Critical Care Medicine. 2016 ; Vol. 44, No. 4. pp. 798-808.
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abstract = "Objectives: To determine the incidence of cardiopulmonary resuscitation in PICUs and subsequent outcomes. Design, Setting, and Patients: Multicenter prospective observational study of children younger than 18 years old randomly selected and intensively followed from PICU admission to hospital discharge in the Collaborative Pediatric Critical Care Research Network December 2011 to April 2013. Results: Among 10,078 children enrolled, 139 (1.4{\%}) received cardiopulmonary resuscitation for more than or equal to 1 minute and/or defibrillation. Of these children, 78{\%} attained return of circulation, 45{\%} survived to hospital discharge, and 89{\%} of survivors had favorable neurologic outcomes. The relative incidence of cardiopulmonary resuscitation events was higher for cardiac patients compared with non-cardiac patients (3.4{\%} vs 0.8{\%}, p <0.001), but survival rate to hospital discharge with favorable neurologic outcome was not statistically different (41{\%} vs 39{\%}, respectively). Shorter duration of cardiopulmonary resuscitation was associated with higher survival rates: 66{\%} (29/44) survived to hospital discharge after 1-3 minutes of cardiopulmonary resuscitation versus 28{\%} (9/32) after more than 30 minutes (p < 0.001). Among survivors, 90{\%} (26/29) had a favorable neurologic outcome after 1-3 minutes versus 89{\%} (8/9) after more than 30 minutes of cardiopulmonary resuscitation. Conclusions: These data establish that contemporary PICU cardiopulmonary resuscitation, including long durations of cardiopulmonary resuscitation, results in high rates of survival-to-hospital discharge (45{\%}) and favorable neurologic outcomes among survivors (89{\%}). Rates of survival with favorable neurologic outcomes were similar among cardiac and noncardiac patients. The rigorous prospective, observational study design avoided the limitations of missing data and potential selection biases inherent in registry and administrative data.",
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Berg, RA, Nadkarni, VM, Clark, AE, Moler, F, Meert, K, Harrison, RE, Newth, CJL, Sutton, RM, Wessel, DL, Berger, JT, Carcillo, J, Dalton, H, Heidemann, S, Shanley, TP, Zuppa, AF, Doctor, A, Tamburro, RF, Jenkins, TL, Dean, JM, Holubkov, R & Pollack, MM 2016, 'Incidence and Outcomes of Cardiopulmonary Resuscitation in PICUs', Critical Care Medicine, vol. 44, no. 4, pp. 798-808. https://doi.org/10.1097/CCM.0000000000001484

Incidence and Outcomes of Cardiopulmonary Resuscitation in PICUs. / Berg, Robert A.; Nadkarni, Vinay M.; Clark, Amy E.; Moler, Frank; Meert, Kathleen; Harrison, Rick E.; Newth, Christopher J L; Sutton, Robert M.; Wessel, David L.; Berger, John T.; Carcillo, Joseph; Dalton, Heidi; Heidemann, Sabrina; Shanley, Thomas P.; Zuppa, Athena F.; Doctor, Allan; Tamburro, Robert F.; Jenkins, Tammara L.; Dean, J. Michael; Holubkov, Richard; Pollack, Murray M.

In: Critical Care Medicine, Vol. 44, No. 4, 01.04.2016, p. 798-808.

Research output: Contribution to journalArticle

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AU - Nadkarni, Vinay M.

AU - Clark, Amy E.

AU - Moler, Frank

AU - Meert, Kathleen

AU - Harrison, Rick E.

AU - Newth, Christopher J L

AU - Sutton, Robert M.

AU - Wessel, David L.

AU - Berger, John T.

AU - Carcillo, Joseph

AU - Dalton, Heidi

AU - Heidemann, Sabrina

AU - Shanley, Thomas P.

AU - Zuppa, Athena F.

AU - Doctor, Allan

AU - Tamburro, Robert F.

AU - Jenkins, Tammara L.

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KW - cardiac arrest

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KW - children

KW - incidence

KW - intensive care

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Berg RA, Nadkarni VM, Clark AE, Moler F, Meert K, Harrison RE et al. Incidence and Outcomes of Cardiopulmonary Resuscitation in PICUs. Critical Care Medicine. 2016 Apr 1;44(4):798-808. https://doi.org/10.1097/CCM.0000000000001484