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Ratio of PICU Versus Ward Cardiopulmonary Resuscitation Events Is Increasing*

Berg, Robert A. MD, FCCM1; Sutton, Robert M. MD, FCCM1; Holubkov, Richard PhD2; Nicholson, Carol E. MD3; Dean, J. Michael MD, FCCM2; Harrison, Rick MD, FCCM4; Heidemann, Sabrina MD5; Meert, Kathleen MD5; Newth, Christopher MD, ChB6; Moler, Frank MD7; Pollack, Murray MD, FCCM8; Dalton, Heidi MD, FCCM8; Doctor, Allan MD, FCCM9; Wessel, David MD10; Berger, John MD10; Shanley, Thomas MD7; Carcillo, Joseph MD, FCCM11; Nadkarni, Vinay M. MD, FCCM1; for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network and for the American Heart Association’s Get With the Guidelines-Resuscitation (formerly the National Registry of Cardiopulmonary Resuscitation) Investigators

Critical Care Medicine:
doi: 10.1097/CCM.0b013e31828cf0c0
Feature Articles
Abstract

Objectives: The aim of this study was to evaluate the relative frequency of pediatric in-hospital cardiopulmonary resuscitation events occurring in ICUs compared to general wards. We hypothesized that the proportion of pediatric cardiopulmonary resuscitation provided in ICUs versus general wards has increased over the past decade, and this shift is associated with improved resuscitation outcomes.

Design: Prospective and observational study.

Setting: Total of 315 hospitals in the American Heart Association’s Get With The Guidelines-Resuscitation database.

Patients: Total of 5,870 pediatric cardiopulmonary resuscitation events between January 1, 2000 and September 14, 2010. Cardiopulmonary resuscitation events were defined as external chest compressions longer than 1 minute.

Interventions: None.

Measurements and Main Results: The primary outcome was proportion of total ICU versus general ward cardiopulmonary resuscitation events over time evaluated by chi-square test for trend. Secondary outcome included return of spontaneous circulation following the cardiopulmonary resuscitation event. Among 5,870 pediatric cardiopulmonary resuscitation events, 5,477 (93.3%) occurred in ICUs compared to 393 (6.7%) in inpatient wards. Over time, significantly more of these cardiopulmonary resuscitation events occurred in the ICU compared to the wards (test for trend: p < 0.01), with a prominent shift noted between 2003 and 2004 (2000–2003: 87–91% vs 2004–2010: 94–96%). In a multivariable model controlling for within center variability and other potential confounders, return of spontaneous circulation increased in 2004–2010 compared with 2000–2003 (relative risk, 1.08; 95% CI, 1.03–1.13).

Conclusions: In-hospital pediatric cardiopulmonary resuscitation is much more commonly provided in ICUs than in wards, and the proportion has increased significantly over the past decade, with concomitant increases in return of spontaneous circulation.

Author Information

1Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, The Children’s Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

2Department of Pediatrics, University of Utah, Salt Lake City, UT.

3Division of Critical Care Medicine, Department of Pediatrics, National Institute of Child Health and Human Development, Bethesda, MD.

4Division of Critical Care Medicine, Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA.

5Division of Critical Care Medicine, Department of Pediatrics, Children’s Hospital of Michigan, Detroit, MI.

6Division of Critical Care Medicine, Department of Anesthesiology and Critical Care, Children’s Hospital Los Angeles, Los Angeles, CA.

7Division of Critical Care Medicine, Department of Pediatrics, University of Michigan and Mott Children’s Hospital, Ann Arbor, MI.

8Division of Critical Care Medicine, Department of Pediatrics, Phoenix Children’s Hospital, Phoenix, AZ.

9Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO.

10Division of Critical Care Medicine, Department of Pediatrics, Children’s National Medical Center, Washington, DC.

11Department of Critical Care Medicine, Children’s Hospital of Pittsburgh of UPMC, Pittsburgh, PA.

* See also p. 2438.

Get With The Guidelines-Resuscitation Investigators: Besides the authors Robert A. Berg, MD, Heidi Dalton, MD, Frank Moler, MD, and Vinay Nadkarni, MD, members of the Get With The Guidelines-Resuscitation Clinical Work Group and Pediatrics Task Force include: Paul S. Chan, MD, MSc, Mid America Heart Institute and the University of Missouri; Mary Mancini, RN, PhD, University of Texas at Arlington; Emilie Allen, MSN, RN, Parkland Health and Hospital System; Robert Clark, MD, University of Pittsburgh Medical Center; Michael W. Donnino, MD, Beth Israel Deaconess Medical Center; Brian Eigel, PhD and Lana Gent, PhD, American Heart Association; Robert T. Faillace, MD, St. Joseph’s Regional Center; Elizabeth A. Hunt, MD, MPH, PhD, Johns Hopkins Medicine Simulation Center; Lynda Knight, RN, Lucile Packard Children’s Hospital at Stanford; Kenneth LaBresh, RTI International; Peter C. Laussen, MBBS, Children’s Hospital Boston; Marilyn Morris, MD, Children’s Hospital of New York; Graham Nichol, MD, MPH, University of Washington-Harborview Medical Center; Joseph P. Ornato, MD and Mary Ann Peberdy, MD, Virginia Commonwealth University Medical Center; Chris Parshuram, MD, The Hospital for Sick Children; Comilla Sasson, MD, MS, University of Colorado; Mindy Smyth, MSN, RN; and Arno L. Zaritsky, MD, Children’s Hospital of the King’s Daughters.

This work was performed at all of the authors’ institutions and all of the Get With The Guidelines-Resuscitation hospitals.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/ccmjournal).

Supported, in part, by the following cooperative agreements from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Department of Health and Human Services (DHHS): U10-HD050012, U10-HD050096, U10-HD063108, U10-HD049983, U10-HD049981, U10-HD063114, and U10-HD063106.

Drs. Berg, Holubkov, Nicholson, Dean, Harrison, Meert, Newth, Moler, Pollack, Dalton, Doctor, Wessel, Berger, and Carcillo received funding from the National Institutes of Health (NIH). Dr. Sutton received grant support from NIH NICHD (K3 Career Development Award). Dr. Sabrina Heidemann received grant support from the Collaborative Pediatric Critical Care Research Network and funding from NIH. Dr. Shanley received grant support from NIH, served as a board member for the Society of Pediatric Research (Secretary/Treasurer), received textbook royalties from Springer, and received support for travel from the University of Cincinnati and Case Western Reserve (external advisory boards). Dr. Nadkarni disclosed that he does not have any potential conflicts of interest.

For information regarding this article, E-mail: bergra@email.chop.edu

© 2013 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins