Favourable outcomes for children following in-hospital cardiac arrest

An article published in JAMA has found that following in-hospital cardiac arrest, children survive to hospital discharge more frequently than adults.Cardiac arrests in children and adults differ in both aetiology and pathophysiology. Adults typically have sudden, unexpected ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), both of which are associated with better outcomes than pulseless electrical activity (PEA). In contrast, cardiac arrests in children usually progress through bradyarrhythmias to asystole or PEA rather than to VF, and the outcomes from pulseless cardiac arrests in children are usually poor. Nadkarni et al. hypothesised that children who have in-hospital cardiac arrests would have worse survival outcomes than adults because they have fewer hospital cardiac arrests associated with VF or pulseless VT.Nadkarni et al. analysed 37,782 paediatric and adult sequential index cardiac arrest events reported to the National Registry of Cardiopulmonary Resuscitation in order to characterise and compare the paediatric and adult outcomes following confirmed in-hospital pulseless cardiac arrests.Data was defined based on Utstein style definitions and only the first in-hospital index cardiac arrest and resuscitation were described and analysed for patients with multiple arrests. The outcome measure was survival to hospital discharge.The results revealed that children had a higher rate of survival to hospital discharge following pulseless cardiac arrest than adults (27% versus 18%, adjusted odds ratio [OR] 2.29. The prevalence of VF or pulseless VT as the first documented pulseless rhythm was 14% in children and 23% in adults (OR, 0.54; pp=0.006) whereas the prevalence of PEA was 24% in children and 32% in adults (OR, 0.67; pThus these results suggest that contrary to the authors' hypothesis, children survive to hospital discharge more frequently following in-hospital cardiac arrest than adults. The authors suggest that this is predominantly as a result of better outcomes following asystole and PEA. The authors pointed out, "although asystole and PEA are often considered futile cardiac arrest rhythms, substantial numbers of children and adults with these rhythms survived to hospital discharge.""These data suggest that resuscitation training and treatment protocols can be better tailored for in-hospital cardiac arrest", the authors concluded.In an accompanying editorial, Dr Linda Quan from the University of Washington School of Medicine, Seattle, remarks that the results of Nadkarni et al raise the issue of whether approaches for paediatric and adult resuscitation should differ."Although the underlying diseases and the degrees of illness are very different for adult and pediatric patients with cardiac arrest, the tenets of care appear the same. By recognizing the need for prevention of cardiac arrest, recognition of respiratory deterioration, early CPR, and early defibrillation, the chain of survival and its treatment implications appear applicable to all patients," she concludes. Reference...