Elsevier

Resuscitation

Volume 97, December 2015, Pages 122-128
Resuscitation

Clinical paper
Observational study of children admitted to United Kingdom and Republic of Ireland Paediatric Intensive Care Units after out-of-hospital cardiac arrest

https://doi.org/10.1016/j.resuscitation.2015.07.011Get rights and content

Abstract

Aims

To estimate the prevalence of children admitted after out-of-hospital cardiac arrest (OHCA) to UK and Republic of Ireland (RoI) Paediatric Intensive Care Units (PICUs) and factors associated with mortality to inform future clinical trial feasibility.

Method

Observational study using a prospectively collected dataset of the Paediatric Intensive Care Audit Network (PICANet) of 33 UK and RoI PICUs (January 2003 to June 2010). Cases (0 to <16 years), with documented OHCA surviving to PICU admission and requiring mechanical ventilation were included. Main outcomes were prevalence for admission and death within PICU. Factors associated with mortality were examined with multiple logistic regression analysis.

Results

827 of 111,170 admissions (0.73%; 95% CI [0.48 to 0.98%]) were identified as children admitted following OHCA. PICU mortality for OHCA was 50.5% (418/827). Recruitment into an adequately sized clinical trial would not be feasible with the current prevalence rate. Characteristics at PICU admission associated with increased risk of death included; bilateral unreactive pupils, genetically inherited condition, inter-hospital transfer to PICU, requirement for vasoactive drugs and greater base deficit. Factors associated with reduced risk of death were submersion or a respiratory aetiology and pre-existing respiratory or cardiac conditions.

Conclusions

Less than 120 children a year are admitted to PICUs in the UK and RoI after OHCA, limiting options for conducting UK intervention trials. The risk factors associated with mortality identified in this study will allow risk stratification in future studies.

Introduction

Out-of-hospital cardiac arrest (OHCA) has a high mortality rate,1, 2, 3 accounting for one-quarter of all paediatric sudden deaths. International consensus guidelines,4 dispatcher-assisted cardiopulmonary resuscitation (CPR),5 bystander CPR6 and better quality CPR7 during resuscitation may have improved mortality over the last ten years. However, post cardiac arrest therapies, including induced hypothermia, have not consistently been shown to improve survival or neurological recovery.8, 9, 10, 11, 12. Further epidemiological data is required to allow risk stratification of this heterogeneous population and to improve research of post-OHCA management on the paediatric intensive care unit (PICU).

The aims of this study were to quantify the prevalence of PICU admission following OHCA, quantify PICU mortality, and to examine factors associated with mortality. We consider whether the prevalence of OHCA admitted to PICUs would be adequate to enable recruitment into a UK and RoI post-OHCA intervention trial.

Section snippets

Design

The Paediatric Intensive Care Audit Network (PICANet) dataset contains patient demographics, diagnoses, and interventions along with PICU outcomes for patients admitted to PICUs in the UK and RoI. This has been prospectively collected since 2002 (PICUs in England and Wales), 2006 (Scotland and Northern Ireland) and 2008 (RoI).13 The data set includes severity of illness variables (Paediatric Index of Mortality (PIM)14 (2003–2005) and PIM2 (2006 onwards) risk-adjustment models).15 Quality

Results

Eight hundred and twenty seven OHCA patients requiring mechanical ventilation and surviving to PICU admission were identified over the 7.5 year period (Fig. 1). A mean prevalence rate of 0.73% (95% CI [0.48 to 0.98]), the denominator included all PICU admissions (Fig. 2 and Supplemental Table 1). Data from all 33 PICUs in the UK and RoI were available from 2007 to 2009; mean number of OHCA admissions during this period was 146 [range 144–151] cases per year. Population incidence rates were

Discussion

The principal finding in this study of cases admitted to UK and RoI PICUs after OHCA and requiring ongoing mechanical ventilations is the estimated prevalence rate of 0.73% (95%CI [0.48 to 0.98%) of all PICU admissions. This study did not include the population (approximately 60–80% of all OHCA cases)3 who fail to achieve a return of spontaneous circulation. The focus was subjects in whom intensive care interventions may be applicable. Unfortunately, the low prevalence and number of potentially

Conclusion

Paediatric OHCA patients represent less than one percent of all admission to PICU in the UK with half aged less than one year. UK incidence of OHCA is too low to undertake definitive intervention studies but the importance of the condition necessitates international collaborative research or other novel trial designs. Identified multiple event characteristics (including bilateral unreactive pupils, aetiology of arrest, co-morbidities, inter-hospital transfer to PICU, requirement for vasoactive

Author contributions

Dr Scholefield had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Scholefield, Morris, Duncan, Gao. Acquisition of data: Scholefield, Draper, Parslow, McShane. Analysis and interpretation of data: Scholefield, Tasker, Morris, Duncan, Gao, Parslow. Drafting of the manuscript: Scholefield, Morris, Gao, Tasker, Parslow. Critical revision of the manuscript for important intellectual

Financial disclosures

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

PICANet is funded by the National Clinical Audit and Patient Outcomes Programme through Healthcare Quality Improvement Partnership, Health Commission Wales Specialised Services, National Health Service (NHS) Lothian and National Service Division NHS Scotland, the Royal Belfast Hospital for Sick Children, and the Pan Thames PICU Commissioning Consortium. We thank all the staff in

Competing interests

None.

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    A Spanish translated version of the summary of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2015.07.011.

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