Characteristics, Outcomes and Mortality Risk Factors of Pediatric In-Hospital Cardiac Arrest in Western China: A Retrospective Study Using Utstein Style
<b>Background</b>: Pediatric in-hospital cardiac arrest (IHCA) remains a critical health challenge with high mortality rates. Limited data from Western China prompted this study to investigate the characteristics of IHCA using the Utstein style. <b>Methods</b>: A retrospectiv...
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2025-04-01
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| author | Jiaoyang Cao Jing Song Baoju Shan Changxin Zhu Liping Tan |
| author_facet | Jiaoyang Cao Jing Song Baoju Shan Changxin Zhu Liping Tan |
| author_sort | Jiaoyang Cao |
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| description | <b>Background</b>: Pediatric in-hospital cardiac arrest (IHCA) remains a critical health challenge with high mortality rates. Limited data from Western China prompted this study to investigate the characteristics of IHCA using the Utstein style. <b>Methods</b>: A retrospective analysis of 456 pediatric patients with IHCA (2018–2022) at the Children’s Hospital of Chongqing Medical University assessed demographics, arrest characteristics, outcomes and mortality risk factors. The primary outcome was survival to discharge; the secondary outcomes included return of spontaneous circulation (ROSC) > 20 min, 24 h survival, and favorable neurological outcomes. Logistic regression was used to identify the mortality risk factors. <b>Results:</b> ROSC > 20 min was achieved in 78.07% of cases, with 37.94% surviving to discharge (86.13% of survivors had favorable neurological outcomes). Etiological stratification identified general medical conditions (52.63%) as the predominant diagnoses, with surgical cardiac patients demonstrating superior resuscitation outcomes (ROSC > 20 min: 86.84%, discharge survival: 64.04%). Initial arrest rhythms predominantly featured non-shockable patterns, specifically bradycardia with poor perfusion (79.39%), whereas shockable rhythms (ventricular fibrillation/pulseless ventricular tachycardia) constituted only 4.17% of cases. Multivariable regression analysis identified five independent risk factors: vasoactive infusion before arrest (OR = 7.69), CPR > 35 min (OR = 13.92), emergency intubation (OR = 5.17), administration of >2 epinephrine doses (OR = 3.12), and rearrest (OR = 8.48). Notably, prolonged CPR (>35 min) correlated with higher mortality (8.96% survival vs. 48.54% for 1–15 min), yet all six survivors with CPR > 35 min had favorable neurological outcomes. <b>Conclusions</b>: These findings underscore the persistent challenges in pediatric IHCA management while challenging the conventional CPR duration thresholds for futility. The identified mortality risk factors inform resuscitation decision making and future studies. |
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| language | English |
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| spelling | doaj-art-c00da1b4fc0e4f5b931dfc33d9ee27352025-08-20T02:33:42ZengMDPI AGChildren2227-90672025-04-0112557910.3390/children12050579Characteristics, Outcomes and Mortality Risk Factors of Pediatric In-Hospital Cardiac Arrest in Western China: A Retrospective Study Using Utstein StyleJiaoyang Cao0Jing Song1Baoju Shan2Changxin Zhu3Liping Tan4Department of Emergency, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing 401123, ChinaCollege of Pediatrics, Chongqing Medical University, Chongqing 400016, ChinaDepartment of Emergency, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing 401123, ChinaCollege of Pediatrics, Chongqing Medical University, Chongqing 400016, ChinaDepartment of Emergency, Children’s Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Child Rare Diseases in Infection and Immunity, Chongqing 401123, China<b>Background</b>: Pediatric in-hospital cardiac arrest (IHCA) remains a critical health challenge with high mortality rates. Limited data from Western China prompted this study to investigate the characteristics of IHCA using the Utstein style. <b>Methods</b>: A retrospective analysis of 456 pediatric patients with IHCA (2018–2022) at the Children’s Hospital of Chongqing Medical University assessed demographics, arrest characteristics, outcomes and mortality risk factors. The primary outcome was survival to discharge; the secondary outcomes included return of spontaneous circulation (ROSC) > 20 min, 24 h survival, and favorable neurological outcomes. Logistic regression was used to identify the mortality risk factors. <b>Results:</b> ROSC > 20 min was achieved in 78.07% of cases, with 37.94% surviving to discharge (86.13% of survivors had favorable neurological outcomes). Etiological stratification identified general medical conditions (52.63%) as the predominant diagnoses, with surgical cardiac patients demonstrating superior resuscitation outcomes (ROSC > 20 min: 86.84%, discharge survival: 64.04%). Initial arrest rhythms predominantly featured non-shockable patterns, specifically bradycardia with poor perfusion (79.39%), whereas shockable rhythms (ventricular fibrillation/pulseless ventricular tachycardia) constituted only 4.17% of cases. Multivariable regression analysis identified five independent risk factors: vasoactive infusion before arrest (OR = 7.69), CPR > 35 min (OR = 13.92), emergency intubation (OR = 5.17), administration of >2 epinephrine doses (OR = 3.12), and rearrest (OR = 8.48). Notably, prolonged CPR (>35 min) correlated with higher mortality (8.96% survival vs. 48.54% for 1–15 min), yet all six survivors with CPR > 35 min had favorable neurological outcomes. <b>Conclusions</b>: These findings underscore the persistent challenges in pediatric IHCA management while challenging the conventional CPR duration thresholds for futility. The identified mortality risk factors inform resuscitation decision making and future studies.https://www.mdpi.com/2227-9067/12/5/579pediatricin-hospital cardiac arrestUtstein stylemortality risk factorsCPR outcomes |
| spellingShingle | Jiaoyang Cao Jing Song Baoju Shan Changxin Zhu Liping Tan Characteristics, Outcomes and Mortality Risk Factors of Pediatric In-Hospital Cardiac Arrest in Western China: A Retrospective Study Using Utstein Style Children pediatric in-hospital cardiac arrest Utstein style mortality risk factors CPR outcomes |
| title | Characteristics, Outcomes and Mortality Risk Factors of Pediatric In-Hospital Cardiac Arrest in Western China: A Retrospective Study Using Utstein Style |
| title_full | Characteristics, Outcomes and Mortality Risk Factors of Pediatric In-Hospital Cardiac Arrest in Western China: A Retrospective Study Using Utstein Style |
| title_fullStr | Characteristics, Outcomes and Mortality Risk Factors of Pediatric In-Hospital Cardiac Arrest in Western China: A Retrospective Study Using Utstein Style |
| title_full_unstemmed | Characteristics, Outcomes and Mortality Risk Factors of Pediatric In-Hospital Cardiac Arrest in Western China: A Retrospective Study Using Utstein Style |
| title_short | Characteristics, Outcomes and Mortality Risk Factors of Pediatric In-Hospital Cardiac Arrest in Western China: A Retrospective Study Using Utstein Style |
| title_sort | characteristics outcomes and mortality risk factors of pediatric in hospital cardiac arrest in western china a retrospective study using utstein style |
| topic | pediatric in-hospital cardiac arrest Utstein style mortality risk factors CPR outcomes |
| url | https://www.mdpi.com/2227-9067/12/5/579 |
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