Post-resuscitative clinical features in the first hour after achieving sustained ROSC predict the duration of survival in children with non-traumatic out-of-hospital cardiac arrest

• Published in: Resuscitation 2010-04, Vol.81 (4), p.410-417
• Main Authors: Lin, Yan-Ren, Li, Chao-Jui, Wu, Tung-Kung, Chang, Yu-Jun, Lai, Shih-Chang, Liu, Tzu-An, Hsiao, Ming-Hau, Chou, Chu-Chung, Chang, Chin-Fu
• Format: Article
• Language: English
• Subjects: Adolescent; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Blood Circulation - physiology; Blood Pressure - physiology; Cardiac output; Child; Child, Preschool; Children; Emergency; Emergency and intensive cardiocirculatory care. Cardiogenic shock. Coronary intensive care; Female; Glasgow Coma Scale; Heart Arrest - mortality; Heart Arrest - therapy; Heart Rate - physiology; Humans; Infant; Infant, Newborn; Intensive care medicine; Male; Medical sciences; Out-of-hospital cardiac arrest; Post-resuscitative; Resuscitation; Retrospective Studies; Return of spontaneous circulation; Time Factors; Urine
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2010.01.006

Abstract Aim of the study Although sustained return of spontaneous circulation (ROSC) can be initially established after resuscitation from non-traumatic out-of-hospital cardiac arrest (OHCA) in some children, many of the children lose spontaneous circulation during hospital stay and do not survive to discharge. The aim of this study was to determine the clinical features during the first hour after ROSC that may predict survival to hospital discharge. Methods We retrospectively evaluated the medical records of 228 children who presented to the emergency department without spontaneous circulation following non-traumatic OHCA during the period January 1996 to December 2008. Among these children, 80 achieved sustained ROSC for at least 20 min. The post-resuscitative clinical features during the first hour after achieving sustained ROSC that correlated with survival, median duration of survival, and death were analyzed. Results Among the 80 children who achieved sustained ROSC for at least 20 min, 28 survived to hospital discharge and 6 had good neurologic outcomes (PCPC scale = 1 or 2). Post-resuscitative clinical features associated with survival included sinus cardiac rhythm ( p = 0.012), normal heart rate ( p = 0.008), normal blood pressure ( p < 0.001), urine output > 1 ml/kg/h ( p = 0.002), normal skin color ( p = 0.016), lack of cardiopulmonary resuscitation (CPR)-induced rib fracture ( p = 0.044), initial Glasgow Coma Scale score > 7 ( p < 0.001), and duration of in-hospital CPR ≤ 10 min ( p < 0.001). Furthermore, these variables were also significantly associated with the duration of survival (all p < 0.05). Conclusions The most important predictors of survival to hospital discharge in children with OHCA who achieve sustained ROSC are a normal heart rate, normal blood pressure, and an initial urine output > 1 ml/kg/h.