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Original Contribution
January 4, 2006

First Documented Rhythm and Clinical Outcome From In-Hospital Cardiac Arrest Among Children and Adults

Author Affiliations

Author Affiliations: Departments of Anesthesia, Critical Care, and Pediatrics, University of Pennsylvania School of Medicine, Philadelphia (Dr Nadkarni); Departments of Surgery, Emergency Medicine, and Public Health, University of Texas Southwestern Medical Center, Dallas (Dr Larkin); Departments of Emergency and Internal Medicine, Virginia Commonwealth University Health Systems, Richmond (Drs Peberdy and Ornato); Digital Innovation Inc, Forest Hill, Md (Mr Carey); Departments of Surgery and Medicine, Brown University School of Medicine, Providence, RI (Dr Kaye); Undergraduate Nursing Programs (Dr Mancini) and Department of Nursing Education (Ms Lane-Truitt), University of Texas at Arlington, Arlington; University of Washington Harborview Prehospital Research and Training Center, Seattle (Dr Nichol); Emergency Cardiovascular Care, American Heart Association, Dallas, Tex (Dr Potts); and University of Arizona School of Medicine, Tucson (Dr Berg).

JAMA. 2006;295(1):50-57. doi:10.1001/jama.295.1.50

Context Cardiac arrests in adults are often due to ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), which are associated with better outcomes than asystole or pulseless electrical activity (PEA). Cardiac arrests in children are typically asystole or PEA.

Objective To test the hypothesis that children have relatively fewer in-hospital cardiac arrests associated with VF or pulseless VT compared with adults and, therefore, worse survival outcomes.

Design, Setting, and Patients A prospective observational study from a multicenter registry (National Registry of Cardiopulmonary Resuscitation) of cardiac arrests in 253 US and Canadian hospitals between January 1, 2000, and March 30, 2004. A total of 36 902 adults (≥18 years) and 880 children (<18 years) with pulseless cardiac arrests requiring chest compressions, defibrillation, or both were assessed. Cardiac arrests occurring in the delivery department, neonatal intensive care unit, and in the out-of-hospital setting were excluded.

Main Outcome Measure Survival to hospital discharge.

Results The rate of survival to hospital discharge following pulseless cardiac arrest was higher in children than adults (27% [236/880] vs 18% [6485/36 902]; adjusted odds ratio [OR], 2.29; 95% confidence interval [CI], 1.95-2.68). Of these survivors, 65% (154/236) of children and 73% (4737/6485) of adults had good neurological outcome. The prevalence of VF or pulseless VT as the first documented pulseless rhythm was 14% (120/880) in children and 23% (8361/36 902) in adults (OR, 0.54; 95% CI, 0.44-0.65; P<.001). The prevalence of asystole was 40% (350) in children and 35% (13 024) in adults (OR, 1.20; 95% CI, 1.10-1.40; P = .006), whereas the prevalence of PEA was 24% (213) in children and 32% (11 963) in adults (OR, 0.67; 95% CI, 0.57-0.78; P<.001). After adjustment for differences in preexisting conditions, interventions in place at time of arrest, witnessed and/or monitored status, time to defibrillation of VF or pulseless VT, intensive care unit location of arrest, and duration of cardiopulmonary resuscitation, only first documented pulseless arrest rhythm remained significantly associated with differential survival to discharge (24% [135/563] in children vs 11% [2719/24 987] in adults with asystole and PEA; adjusted OR, 2.73; 95% CI, 2.23-3.32).

Conclusions In this multicenter registry of in-hospital cardiac arrest, the first documented pulseless arrest rhythm was typically asystole or PEA in both children and adults. Because of better survival after asystole and PEA, children had better outcomes than adults despite fewer cardiac arrests due to VF or pulseless VT.