Children more likely to survive in-hospital cardiac arrests than adults

Children are more likely to survive in-hospital cardiac arrests than adults and with appropriate cardiopulmonary resuscitation (CPR), the survival rates for both children and adults are higher than previously thought.

These are some of the findings of the largest-ever study of cardiac arrests occurring in hospitals. The study was supervised by Robert A. Berg, MD, professor of pediatrics and associate dean at The University of Arizona College of Medicine.

"This is a landmark study that will change our understanding of the causes for cardiac arrests in hospitals and how to treat them," said Dr. Berg, a member of UA's Sarver Heart Center and UA's Steele Children's Research Center. "Many physicians assume that the vast majority of adult cardiac arrests in hospitals are from sudden arrhythmias. Our findings show that respiratory failure and shock are much more common causes of in-hospital cardiac arrests than arrhythmias in both adults and children."

In contrast to previous studies, which compiled data from a single or relatively few hospitals, the new research is based on data from the National Registry of CPR including 37,000 adults and 880 children who had pulseless cardiac arrests in the hospital. The National Registry of CPR was developed by the American Heart Association to compile comprehensive and accurate information about in-hospital cardiac arrests. The investigators collected data from 253 hospitals in the United States and Canada between 2000 and 2004.

"For the first time, we have data representing all of the United States instead of a snapshot focusing on a particular region or patient group," said Dr. Berg.

The study results, published in the Jan. 4 issue of the Journal of the American Medical Association, send a hopeful message. With appropriate interventions, more than 27 percent of the children and more than 18 percent of the adults who had pulseless cardiac arrest survived to hospital discharge, mostly with good neurological outcomes.

"Nobody ever imagined that such a high percentage of lifeless children could be successfully resuscitated and leave the hospital alive," Dr. Berg said.

"These survival rates are much better than those occurring in cardiac arrests outside of hospitals," said Vinay Nadkarni, MD, a critical care specialist at the Children's Hospital of Philadelphia, and the lead author of the study. "This suggests that CPR currently may succeed more often than physicians commonly believe."

The American Heart Association recently issued new guidelines for CPR and emergency cardiovascular care. Broad-based comprehensive studies through the National Registry of CPR will provide important information for future guidelines, especially with regard to in-hospital cardiac arrests. The Emergency Cardiovascular Care Committee of the American Heart Association and the Endowed Chair of Pediatric Critical Care at The Children's Hospital of Philadelphia funded this study.

The 11 co-authors, writing for the National Registry of CPR Investigators, were from nine hospitals and research institutions and represented the research committee of the Scientific Advisory Board of the registry.

"The National Registry of CPR will allow us to track possible improvements in patient outcomes stemming from the new guidelines, and should help us to refine future revisions to AHA guidelines," said Dr. Berg, who chairs the research committee.

By better understanding ways in which children with in-hospital cardiac arrest may sometimes resemble and sometimes differ from adults, practitioners may be able to better refine emergency cardiovascular care and develop treatment procedures that improve outcomes for all patients.