Critical Care Medicine

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Critical Care Medicine:
doi: 10.1097/CCM.0b013e31828cf0c0
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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

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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.

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

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