Characteristics, course and outcomes of children admitted to a paediatric intensive care unit after cardiac arrest
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.
Keywords. Pediatric, cardiac arrest, cardiopulmonary resuscitation, pulseless electrical activity, ventricular tachycardia, pediatric intensive care unit, in-hospital cardiac arrest, out-of-hospital cardiac arrest