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Original Investigation
January 2017

Survival Rates Following Pediatric In-Hospital Cardiac Arrests During Nights and Weekends

Author Affiliations
  • 1Centre for Medical Education and Department of Pediatrics, McGill University, Montreal, Quebec, Canada
  • 2Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada
  • 3Departments of Anesthesia and Critical Care Medicine and of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
  • 4University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 5Departments of Anesthesiology and Critical Care Medicine and of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 6Department of Pediatrics, Alberta Children’s Hospital, Calgary, Alberta, Canada
JAMA Pediatr. 2017;171(1):39-45. doi:10.1001/jamapediatrics.2016.2535
Key Points

Question  Do survival rates after pediatric in-hospital cardiac arrests differ during nights and weekends compared with days/evenings and weekdays?

Findings  In this national registry-based cohort study of hospitalized children younger than 18 years of age receiving cardiopulmonary resuscitation (CPR), the rate of survival to hospital discharge was 36.2% (4488 of 12 404 children) overall. After adjusting for important potential confounders, we found that the rate of survival to hospital discharge was significantly lower during nights than during days/evenings, but there was no difference between weekends and weekdays.

Meaning  The rate of survival to hospital discharge was lower for pediatric CPR events occurring at night than for CPR events occurring during daytime and evening hours.

Abstract

Importance  Nearly 6000 hospitalized children in the United States receive cardiopulmonary resuscitation (CPR) annually. Little is known about whether the survival of these children is influenced by the time of the event (eg, nighttime or weekends). Differences in survival could have important implications for hospital staffing, training, and resource allocation.

Objective  To determine whether outcomes after pediatric in-hospital cardiac arrests differ during nights and weekends compared with days/evenings and weekdays.

Design, Setting, and Participants  This study included a total of 354 hospitals participating in the American Heart Association’s Get With the Guidelines–Resuscitation registry from January 1, 2000, to December 12, 2012. Index cases (12 404 children) from all children younger than 18 years of age receiving CPR for at least 2 minutes were included. Data analysis was performed in December 2014 and June 2016. We aggregated hourly blocks of time, using previously defined time intervals of day/evening and night, as well as weekend. Multivariable logistic regression models were used to examine the effect of independent variables on survival to hospital discharge. We used a combination of a priori variables based on previous literature (including age, first documented rhythm, location of event in hospital, extracorporeal CPR, and hypotension as the cause of arrest), as well as variables that were identified in bivariate generalized estimating equation models, and maintained significance of P ≤ .15 in the final multivariable models.

Main Outcomes and Measures  The primary outcome measure was survival to hospital discharge, and secondary outcomes included return of circulation lasting more than 20 minutes and 24-hour survival.

Results  Of 12 404 children (56.0% were male), 8731 (70.4%) experienced a return of circulation lasting more than 20 minutes, 7248 (58.4%) survived for 24 hours, and 4488 (36.2%) survived to hospital discharge. After adjusting for potential confounders, we found that the rate of survival to hospital discharge was lower during nights than during days/evenings (adjusted odds ratio, 0.88 [95% CI, 0.80-0.97]; P = .007) but was not different between weekends and weekdays (adjusted odds ratio, 0.92 [95% CI, 0.84-1.01]; P = .09).

Conclusions and Relevance  The rate of survival to hospital discharge was lower for pediatric CPR events occurring at night than for CPR events occurring during daytime and evening hours, even after adjusting for many potentially confounding patient-, event-, and hospital-related factors.

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