Abstract 15880

Prevalence and Outcome of Pediatric In-Hospital Cardiopulmonary Resuscitation in the United States An analysis of the Kids' Inpatient Database

Knudson, Jarrod D
Neish, Steven R
Cabrera, Antonio G
Morales, David L
Zafar, Farhan
Graves, Daniel E
Williams, Eric A
Rossano, Joseph W

Baylor College of Medicine / Texas Children's Hosp, Houston, TX

Author Disclosures: J.D. Knudson , None; S.R. Neish , None; A.G. Cabrera , None; D.L. Morales , None; F. Zafar , None; D.E. Graves , None; E.A. Williams , None; J.W. Rossano , None.

Circulation 122(21_MeetingAbstracts), November 23, 2010.

Introduction: Population-based data on in-hospital cardiopulmonary resuscitation (CPR) in children in the United States are scarce. Studies from single centers and voluntary registries may skew the prevalence and outcomes of CPR.

Hypothesis: CPR is not a rare occurrence in hospitalized pediatric patients in the United States and that many patients would survive to hospital discharge. Risk factors for CPR and death after CPR were determined.

Methods: A retrospective analysis of the Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database was performed for children receiving inpatient CPR in 2006. The database is a nationwide sampling of pediatric hospital discharges and is weighted to provide national estimates (analyses were performed using weighted values).

Results: CPR was performed in 5807 (95% CI 5,259 to 6,355) hospitalized children with a prevalence of 0.77 per 1,000 admissions. Most patients (68%) were < 1 year old and 44% were female. Extracorporeal membrane oxygenation (ECMO) was uncommon (3%). On multivariable analysis, patients receiving CPR were more likely to have heart failure (OR 4.8, 95% CI 3.8 to 6.0), cardiomyopathy (OR 4.9, 95% CI 4.1 to 6.0), acute renal failure (OR 23.2, 95% CI 19.3 to 27.9), respiratory failure (OR 31.7, 95% CI 27.6 to 36.5) and acute cerebrovascular disease (OR 3.9, 95% CI 3.1 to 5.0). Overall in-hospital mortality was 51.8% and greater among patients ≥ 1 year (68%) versus < 1 year (44%) (OR 2.7 95% CI 2.3 to 3.2). On multivariable analysis, factors associated with an increased risk of death among patients receiving CPR included acute renal failure (OR 1.5, 95% CI 1.1 to 1.9), age ≥ 1 year (OR 2.9, 95% CI 2.4 to 3.5), cancer (OR 1.8, 95% CI 1.1 to 2.9) and sepsis (OR 1.5, 95% CI 1.2 to 1.7).

Conclusions: In this largest population-based study of pediatric inpatient CPR, CPR occurred in approximately 1 in every 1,300 pediatric hospital admissions. Just over half of the patients who received CPR did not survive to hospital discharge. ECMO was not frequently utilized. Risk factors for hospital mortality among patients receiving CPR include older age, acute renal failure, cancer and sepsis. Further studies are needed to confirm these findings and develop strategies to improve outcomes.