Characteristics, course and outcomes of children admitted to a paediatric intensive care unit after cardiac arrest

摘要

BACKGROUND: Cardiac arrest is a potentially devastating event, associated with death or severe neurological complications in survivors. There is little evidence on paediatric cardiac arrest prevalence, characteristics and outcomes in South Africa (SA OBJECTIVE: To describe the characteristics, course and outcomes of children admitted to an SA paediatric intensive care unit (PICU) following cardiac arrest METHODS: Retrospective descriptive study of routinely collected data (January 2010 - December 2011 RESULTS: Of 2 501 PICU admissions, 110 (4.4%) had preceding cardiac arrest. The median (interquartile range (IQR)) age of children was 7.2 (2.5 - 21.6) months. In-hospital arrests accounted for 80.6% of the events. The most common primary diagnostic categories were respiratory (29.1%), cardiovascular (21.4%) and gastrointestinal (21.4%). Twenty-four patients (23.3%) arrested during endotracheal intubation. Cardiopulmonary resuscitation (CPR) was applied for a median (IQR) of 10 (5 - 20) minutes. Duration of CPR for non-survivors and survivors was 17.5 (10 - 30) v. 10 (5 - 15) minutes (p=0.006). PICU mortality was 38.8%, with half of the deaths occurring within 24 hours of admission. The standardised mortality ratio was 0.7. The median (IQR) length of stay in the PICU and hospital was 3 (1 - 8) and 27 (9 -52) days, respectively. No independent predictors of mortality were identified. Thirty-nine surviving patients (76.5%) had normal neurological function or mild disability at follow-up after hospital discharge. Six (11.8%) survived with severe disability CONCLUSION: Mortality was lower than predicted in children admitted to the PICU following cardiac arrest. The majority of survivors had good neurological outcomes.