Predictors of Pediatric In-Hospital Recurrent Cardiac Arrest

In-hospital pediatric cardiac arrest is an important cause of morbidity and mortality. Approximately 16,000 children receive cardiopulmonary resuscitation (CPR) in the United States each year. Patients who suffer more than one cardiac arrest event are at a particularly increased risk of mortality, with survival to hospital discharge estimated to be 41-50%. Identification of patients who are likely to suffer a recurrent cardiac arrest has important implications for the clinician at the bedside. These high risk patients may benefit from more aggressive post-arrest therapies, including Extracorporeal Life Support. We performed a retrospective cohort study of pediatric patients (age < 18 years) who survived a cardiac arrest while in the Emergency Department or during inpatient admission at Seattle Children’s Hospital from February 1, 2012 to September 18, 2019. Data were extracted from the Electronic Data Warehouse, Code Blue Database, and from individual patient charts. There were 259 patients identified who suffered at least one cardiac arrest and met all inclusion and exclusion criteria, 55 of these patients (21 percent) experienced a recurrent arrest. Prolonged duration of CPR was associated with an increased risk of recurrent arrest, with a RR of RR 2.2 (95% CI 0.9 – 5.5) for 21-50 minutes and RR 5.1 (95% CI 3.6 – 7.1) for >50 minutes. There was little or no association between recurrent arrest and unit of admission, primary diagnosis, organ dysfunction or the presence of acidosis preceding the initial arrest. Further work is required to determine whether there are other factors that can be used to identify patients in whom recurrent arrest is likely to occur.