Title: Study of Clinical Outcomes of Cardiopulmonary Resuscitation in Children
Authors: Atul Tukaram Rane, Shakuntala S Prabhu, Sumitra Venkatesh
DOI: https://dx.doi.org/10.18535/jmscr/v7i11.03
Abstract
Introduction: It was a prospective observational cross sectional study conducted in tertiary care center.
Objective: To study the hemodynamics within 24 hours of initiation of cardiopulmonary resuscitation (CPR) and to compare the clinical & resuscitative parameters with the outcome post CPR.
Method: Forty children aged 1 month to15 years who required CPR in hospital were included in the study. Neurological status was classified as neurologically intact, impaired or dependent. The cohort was divided into long-term survivors, short-term survivors and non-survivors.
Results: Twenty four children required CPR for less than 15 minutes (60%) and 23/40 (57.5%) required resuscitation only once. Return of spontaneous circulation was seen in 35 patients (87.5%). Shorter duration and few attempts at CPR gave better chances of survival. Oliguria prior to CPR led to significantly poor outcomes. Prolonged ventilation (>7days) was directly related to worse neurological impairment and dependency (p=0.00054). Out of 40, 7 patients (17.5%) were non-survivors, 8 (20%) were short-term survivors and 25 (62.5%) were labeled as long-term survivors. Of 25 patients who survived till discharged 17 (68%) were neurologically normal, 3 (12%) had some functional neurological impairment.
Conclusions: Eighty two percent children survived post CPR with 68% having a normal neurological status on discharge. Shorter duration and fewer attempts of CPR, higher motor response post CPR and early institution of enteral feeds had a favorable impact on survival outcome. Oliguria, increased fluid requirement, hyponatremia, hyperglycemia, hypoxia and hypocarbia in the peri-resuscitation period were unfavorable factors for survival. Prolonged ventilator support correlated with poorer neurological outcome.
Keywords: Paediatric, Cardiopulmonary resuscitation, Outcomes, Survival.
References
- J Herlitz et al: Characteristics of cardiac arrest and resuscitation by age group: an analysis from the Swedish Cardiac Arrest Registry. Am J Emerg Med. 2007;25:1025–1031
- Recognition and management of cardiac arrest. PALS provider’s manual (Professional) 2010
- Sahu S et al: Better outcome after pediatric resuscitation is still a dilemma: J Emerg Trauma Shock. 2010 Jul-Sep; 3(3): 243–250.
- M Chakravarthy, S Mitra, L Nonis, N Yellappa. Outcome of in-hospital, out of intensive care and operation room cardiac arrests in a tertiary referral hospital in India: Comparison of outcomes of two audits. Indian J Anaesth 2014;58:479-81
- E F Wijdicks et al. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006;67:203–210.
- Wu-En Fing, Li Meng-Ju, Huangshu-chien, Wang ching-chia Liu, Yuch-Ping, Lufrank Leigh et al; Survey of outcome of CPR in pediatric in-hospital cardiac arrest in a medical centre in Taiwan. Resuscitation 2009; 80(4) ; 443-448.
- H K Lee, H Lee, J M No, Y T Jeon, J W Hwang, Y J Lim, H P Park. Factors influencing outcome in patients with cardiac arrest in the ICU. Acta Anaesthisol Scand.2013 Jul;57(6):784-92.