Elsevier

Resuscitation

Volume 81, Issue 4, April 2010, Pages 410-417
Resuscitation

Clinical paper
Post-resuscitative clinical features in the first hour after achieving sustained ROSC predict the duration of survival in children with non-traumatic out-of-hospital cardiac arrest

https://doi.org/10.1016/j.resuscitation.2010.01.006Get rights and content

Abstract

Aim of the study

Although sustained return of spontaneous circulation (ROSC) can be initially established after resuscitation from non-traumatic out-of-hospital cardiac arrest (OHCA) in some children, many of the children lose spontaneous circulation during hospital stay and do not survive to discharge. The aim of this study was to determine the clinical features during the first hour after ROSC that may predict survival to hospital discharge.

Methods

We retrospectively evaluated the medical records of 228 children who presented to the emergency department without spontaneous circulation following non-traumatic OHCA during the period January 1996 to December 2008. Among these children, 80 achieved sustained ROSC for at least 20 min. The post-resuscitative clinical features during the first hour after achieving sustained ROSC that correlated with survival, median duration of survival, and death were analyzed.

Results

Among the 80 children who achieved sustained ROSC for at least 20 min, 28 survived to hospital discharge and 6 had good neurologic outcomes (PCPC scale = 1 or 2). Post-resuscitative clinical features associated with survival included sinus cardiac rhythm (p = 0.012), normal heart rate (p = 0.008), normal blood pressure (p < 0.001), urine output > 1 ml/kg/h (p = 0.002), normal skin color (p = 0.016), lack of cardiopulmonary resuscitation (CPR)-induced rib fracture (p = 0.044), initial Glasgow Coma Scale score > 7 (p < 0.001), and duration of in-hospital CPR  10 min (p < 0.001). Furthermore, these variables were also significantly associated with the duration of survival (all p < 0.05).

Conclusions

The most important predictors of survival to hospital discharge in children with OHCA who achieve sustained ROSC are a normal heart rate, normal blood pressure, and an initial urine output > 1 ml/kg/h.

Introduction

Pediatric out-of-hospital cardiac arrest (OHCA) is rare and the rate of survival is very low.1, 2, 3, 4, 5, 6 Although sustained return of spontaneous circulation (ROSC) can be initially established after resuscitation from non-traumatic OHCA in up to 35% of children, the rate of survival to hospital discharge is only 6–12%, and only 2–4% of those children have good neurologic outcome.1, 2 Some studies have shown that survival of children with OHCA is associated with factors in the pre-hospital resuscitation period, such as whether the arrest was witnessed, initial cardiac rhythm, and bystander resuscitation.7, 8, 9 The post-resuscitative clinical features that may be predictive of survival and duration of survival in children, however, have not been well addressed.

The aim of this study was to determine the clinical features during the first hour after ROSC that may predict survival in children with non-traumatic OHCA.

Section snippets

Study design

Children aged  18 years who presented to the emergency department (ED) of either the Chang Gung Memorial Hospital or the Changhua Christian Hospital with OHCA of non-traumatic origin during the period January 1996–December 2008 were included in this study. Patient characteristics and post-resuscitative clinical features that may be associated with the outcomes of children with OHCA were analyzed retrospectively. The study protocol was approved by the Institutional Review Boards of both hospitals.

Patient characteristics and factors related to sustained ROSC

Data on 228 children with OHCA of non-traumatic origin were analyzed. Patient characteristics are presented in Table 1. Among the 228 patients, sustained ROSC was achieved in 80 children. The overall mortality rate was 87.8%. A total of 28 patients survived to discharge. Among them, 6 had good neurologic outcomes and 17 had poor neurologic outcomes (Fig. 1). The factors that were positively associated with achieving sustained ROSC in the ED are also shown in Table 1.

Clinical features during the first hour after achieving sustained ROSC

Among the 80 children who

Discussion

Although sustained ROSC can be initially established after resuscitation from non-traumatic OHCA in some children, many of the children lose spontaneous circulation during hospital stay and do not survive to discharge.2 It remains challenging for ED physicians to predict the survival after OHCA in children, especially in children with unstable signs in the post-resuscitative period. In this study, we have analyzed the post-resuscitative clinical features that may predict the chances of survival

Conclusions

The post-resuscitative clinical features of non-traumatic OHCA children in the first hour after achieving sustained ROSC that can predict survival include sinus rhythm, a normal heart rate, normal blood pressure, and an initial urine output > 1 ml/kg/h.

Conflict of interest statement

There is no conflict of interest related to this study.

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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2010.01.006.

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