Acute cardiac care & resuscitation
Pediatric in-hospital cardiac arrest: Respiratory failure characteristics and association with outcomes
Authors' conclusion
There was substantial heterogeneity in respiratory failure characteristics and ventilatory requirements pre-arrest. Higher pre-arrest oxygen requirement and greater degree of oxygenation failure were associated with worse survival outcomes.
Study context
- Population
- Children <18 years in intensive care units (ICUs) receiving invasive mechanical ventilation in the hour before in-hospital cardiac arrest with cardiopulmonary resuscitation (CPR) ≥1 minute, 2017–2021187 events
- Participants
- 154 children
- Exposure
- Return of spontaneous circulation (ROSC) vs no ROSC
- Outcome
- ROSC
Methodological detailssingle-centre, prospectively identified cohort
- Single-centre
- Prospectively identified cohort
Main finding
As reported in the abstract
Pre-arrest respiratory failure characteristics and ROSC · Immediately pre-arrest
ROSC
0.30
Without ROSC
0.99
P < 0.001
- Greater severity of pre-arrest oxygenation failure (oxygenation index, oxygen saturation index, P/F or S/F ratio) without ROSC
- P < 0.001
Observational data: associations, not effects.
Further findings
Cohort characteristics
- Age, median [IQR] (years)
- 0.9 [0.2, 2.4]
- CPR duration, median [IQR] (minutes)
- 7.5 [3, 29]
- Acute respiratory failure before arrest
- 106/187 (56.7%)
- Respiratory primary indication for invasive mechanical ventilation (IMV)
- 107/187 (57.2%)
Ventilatory support immediately pre-arrest (median [IQR])
- PEEP (cmH2O)
- 8 [5, 10]
- Mean airway pressure (cmH2O)
- 13 [10,18]
- Peak inspiratory pressure (cmH2O)
- 28 [24, 35]
- Fraction of inhaled oxygen (FiO2)
- 0.40 [0.25, 0.80]
Original publication
Pediatric in-hospital cardiac arrest: Respiratory failure characteristics and association with outcomes. Resuscitation. Published 29 May 2023. doi:10.
Summarised from the published abstract; every number is checked against it