Risk and Outcomes Following Cardiac Arrest in Children: a Single-Centre Thai Study

Abstract

Cardiac arrest (CA) is a life-threatening event which requires immediate and effective resuscitation. CA results from respiratory failure, shock, or both. Immediate diagnosis of cardiac arrest will provide a better outcome. The objective of this study was to determine the incidence, risks, and outcomes of in-hospital cardiac arrest in Queen Sirikit National Institute of Child Health (QSNICH). It was conducted as a retrospective descriptive study of patients between 1- 15 years of age who were diagnosed of in-hospital cardiac arrest and resuscitated with Pediatric Advanced Life Support from AHA guidelines 2010 in QSNICH from 1 January 2012 to 31 December 2016. It was found that 86,003 children (between 1 - 15 years of age) who were admitted from 2012 to 2016 and 214 children (0.25%) received cardiopulmonary resuscitation (CPR). Among them, 112 (52%) were male, and 102 (48%) were female. Most common cause of in-hospital cardiac arrest was hypoxia: 170 children (79%); and 43% of non-survived patients were under 5 years of age. For non-survived patients 74% had underlying diseases which were cardiovascular disease. Electrocardiography mainly showed asystole in 136 children (63%), and ventricular tachycardia (VT) or ventricular fibrillation (VF) in 36 children (17%). However, all patients with ventricular arrhythmia died. We found that the rate of return of spontaneous circulation was 46% but the survival to discharge was 9.8%. Risk factors lead to in-hospital cardiac arrest were cardiovascular disease and ventricular arrhythmias. In conclusion: The rate of survival to hospital discharge was lower than others. Mortality rate was higher in under 4 years old, with underlying cardiac diseases, and related to location (outside ICU). Expanding bed in PICU and set up rapid response team might be useful.