Survival after In-hospital Cardiac Arrest among Paediatric Patients-A Descriptive Study
Dr. Sarthak Das,
Flat No. D4, Jawaharlal Institute of Postgaduate Medical Education and Research,
Hostel Complex, Velatheeru, Karaikal, Puducherry-609602, India.
Introduction: Cardiac arrest in children is a fatal incident usually ending in death or very poor neurological results. Western countries that have reliable data have put in place, mechanisms to anticipate cardiac arrest due to common condition and also effective response for a cardiac arrest in vulnerable children. The prevalence and survival of paediatric cardiopulmonary arrest are not well-studied in a developing country like India. Moreover, data regarding the effectiveness of CardioPulmonary Resuscitation (CPR) and the survival of children after suffering cardiac arrest in the hospital is also scarce from developing countries. Data on the precipitating events, survival and predictors of adverse outcome of cardiac arrest in our patient population can potentially help us in planning for the delivery of better care to our patients. The differences in data from India and rest of the world are highlighted.
Aim: To identify underlying aetiology, precipitating factors, the outcome in terms of survival, and the predictors of survival among hospitalised paediatric patients developing cardiac arrest.
Materials and Methods: This prospective descriptive study was conducted from October 2012 to June 2014 in JIPMER, a tertiary care teaching institute in Puducherry, India. A total of 137 cases were included in the study. There clinical baseline, pre-arrest, arrest, post-arrest parameters were recorded. Final outcome of the patient as survival or death was also recorded. For the survivors Paediatric Cerebral Performance Category (PCPC) measure of cognitive function was recorded. The result obtained from the study was analysed using SPSS 20.0.
Results: Total 137 patients included in the study after qualified the inclusion criteria and majority 77 (56.2%) patients were infants. Infections was major 103 (75.18%) underlying aetiology. 126 cases (92%) of the observed cardiac arrest occurred in Paediatric Intensive Care Unit (PICU). Return of Spontaneous Circulation (ROSC) was achieved in 82 children (59.8%) and 27 children (19.7%) survived to hospital discharge. A 77.8% of the survivors had normal to mild disability and one patient (<1%) had severe disability at discharge. Most common observed rhythm at the time of cardiac arrest was bradycardia 100 (72.9%) cases. At the time of arrest, prolonged CPR, multiple doses of adrenaline, venous blood gas disturbances were predictors of poor outcome. In the post-arrest period, presence of hypotension, prolonged capillary refilling time, low SpO2, hypothermia and lab parameters like thrombocytopenia and liver dysfunction were associated with poor outcome.
Conclusion: In paediatric CPR prevalence of survival is absolutely excellent. Independent association between many parameters and hospital mortality is established. Subsequent research should focus on whether each of these association establish as cause and effect in future. In paediatric cardiac arrest clinical epidemiologist determining the efficiency of present day interventions like therapeutic hypothermia is crucial to recognise these associations in their research methodology.