Aim of study

Recurrent in-hospital cardiac arrest (IHCA) is associated with morbidity and mortality in adults. We aimed to describe the risk factors and outcomes for paediatric recurrent IHCA.

Methods

Retrospective cohort study of patients ≤18 years old with single or recurrent IHCA. Recurrent IHCA was defined as ≥2 IHCA within the same hospitalization. Categorical variables expressed as percentages and compared via Chi square test. Continuous variables expressed as medians with interquartile ranges and compared via rank sum test. Outcomes assessed in a propensity match cohort.

Results

From July 1, 2015 to January 26, 2021, 139/894 (15.5%) patients experienced recurrent IHCA. Compared to patients with a single IHCA, recurrent IHCA patients were more likely to be trauma and less likely to be surgical cardiac patients. Median duration of cardiopulmonary resuscitation (CPR) was shorter in the recurrent IHCA (5 vs. 11 min; p < 0.001) with no difference in IHCA location or immediate cause of CPR. Patients with recurrent IHCA had worse survival to intensive care unit (ICU) discharge (31% vs. 52%; p < 0.001), and worse survival to hospital discharge (30% vs. 48%; p < 0.001) in unadjusted analyses and after propensity matching, patients with recurrent IHCA still had worse survival to ICU (34% vs. 67%; p < 0.001) and hospital (31% vs. 64%; p < 0.001) discharge.

Conclusion

When examining those with a single vs. a recurrent IHCA, event and patient factors including more pre-existing conditions and shorter duration of CPR were associated with risk for recurrent IHCA. Recurrent IHCA is associated with worse survival outcomes following propensity matching.

中文翻译：

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复发性儿科院内心脏骤停的危险因素和结果：回顾性多中心队列研究

学习目的

复发性院内心脏骤停 (IHCA) 与成人的发病率和死亡率有关。我们旨在描述儿科复发性 IHCA 的危险因素和结果。

方法

≤18 岁单发或复发 IHCA 患者的回顾性队列研究。复发性 IHCA 定义为同一住院期间 ≥ 2 次 IHCA。分类变量以百分比表示并通过卡方检验进行比较。连续变量表示为具有四分位距的中位数，并通过秩和检验进行比较。在倾向匹配队列中评估的结果。

结果

从 2015 年 7 月 1 日到 2021 年 1 月 26 日，139/894 (15.5%) 名患者经历了复发性 IHCA。与单次 IHCA 患者相比，复发性 IHCA 患者更可能是外伤，而不太可能是外科心脏病患者。复发性 IHCA 的心肺复苏 (CPR) 的中位持续时间较短（5 分钟 vs. 11 分钟；p < 0.001），在 IHCA 位置或 CPR 的直接原因方面没有差异。在未经调整的分析中，复发性 IHCA 患者的重症监护病房 (ICU) 出院生存率更差（31% 对 52%；p < 0.001），出院生存率更差（30% 对 48%；p < 0.001）和倾向匹配后，复发性 IHCA 患者到 ICU（34% 对 67%；p < 0.001）和出院（31% 对 64%；p < 0.001）的存活率仍然较差。

结论

在检查那些患有单次与复发性 IHCA 的患者时，事件和患者因素（包括更多的既往病症和更短的 CPR 持续时间）与复发性 IHCA 的风险相关。倾向匹配后，复发性 IHCA 与较差的生存结果相关。