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Cardiopulmonary Resuscitation in Hospitalized Children With Cardiovascular Disease: Estimated Prevalence and Outcomes From the Kids’ Inpatient Database

Lowry, Adam W. MD1; Knudson, Jarrod D. MD, PhD1; Cabrera, Antonio G. MD1; Graves, Daniel E. PhD2; Morales, David L. S. MD3; Rossano, Joseph W. MD4

Pediatric Critical Care Medicine: March 2013 - Volume 14 - Issue 3 - p 248–255
doi: 10.1097/PCC.0b013e3182713329
Feature Article

Objective: Hospitalized children with cardiovascular disease may be at increased risk of cardiac arrest; however, little data exist regarding prevalence, risk factors, or outcomes of cardiopulmonary resuscitation in these patients. We sought to characterize national estimates of cardiopulmonary resuscitation and death after cardiopulmonary resuscitation for hospitalized children with cardiovascular disease.

Setting: A total of 3,739 hospitals in 38 states participating in Kids’ Inpatient Database.

Design: Retrospective analysis of the 2000, 2003, and 2006 Healthcare Cost and Utilization Project Kids’ Inpatient Database was performed. Sample weighting was employed to produce national estimates.

Measurements and Main Results: Cardiovascular disease was identified in 2.2% of the estimated 22,175,468 (95% confidence interval 21,391,343–22,959,592) hospitalizations. Cardiopulmonary resuscitation occurred in 0.74% (3,698; 95% confidence interval 3,205–4,191) of hospitalizations of children with cardiovascular disease, compared with 0.05% (11,726; 95% confidence interval 10,647–12,805) without cardiovascular disease (odds ratio 13.8, 95% confidence interval 12.8–15.0). The highest frequency of cardiopulmonary resuscitation occurred with myocarditis (3.0% of admissions), heart failure (2.0%), and coronary pathology (2.0%). Compared with other forms of cardiovascular disease identified in this study, single-ventricle patients were the only subgroup who exhibited a higher mortality after cardiopulmonary resuscitation (mortality 65% vs. 55%; odds ratio 1.7 [95% confidence interval 1.2–2.6]), while those who had undergone cardiac surgery exhibited a lower mortality rate (mortality 48% vs. 57%; odds ratio 0.6 [95% confidence interval 0.5–0.8]).

Conclusions: Cardiopulmonary resuscitation occurs in approximately 7 per 1,000 hospitalizations of children with cardiovascular disease, a rate greater than ten-fold that observed in hospitalizations of children without cardiovascular disease. Single-ventricle patients demonstrated increased mortality after cardiopulmonary resuscitation, while recent cardiac surgery was associated with a reduced odds of death after cardiopulmonary resuscitation. Further studies are needed to confirm these findings and develop techniques to prevent cardiac arrest in this high-risk population.

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1Department of Pediatrics, Lillie Frank Abercrombie Section of Pediatric Cardiology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX.

2Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX.

3Michael E. DeBakey Department of Surgery, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX.

4Department of Pediatrics, The Perelman School of Medicine at the University of Pennsylvania and the Cardiac Center, Children’s Hospital of Philadelphia, Philadelphia, PA.

This work was performed at Baylor College of Medicine/Texas Children’s Hospital.

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The authors have not disclosed any potential conflicts of interest.

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©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies