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Deviations from AHA guidelines during pediatric cardiopulmonary resuscitation are associated with decreased event survival
Journal article   Peer reviewed

Deviations from AHA guidelines during pediatric cardiopulmonary resuscitation are associated with decreased event survival

Heather A. Wolfe, Ryan W. Morgan, Bingqing Zhang, Alexis A. Topjian, Ericka L. Fink, Robert A. Berg, Vinay M. Nadkarni, Akira Nishisaki, Janell Mensinger, Robert M. Sutton, …
Resuscitation, v 149
01 Apr 2020
DOI: https://doi.org/10.1016/j.resuscitation.2020.01.035
PMID: 32057946
Featured in Collection :   UN Sustainable Development Goals @ Drexel

Abstract

Critical Care Medicine Emergency Medicine General & Internal Medicine Life Sciences & Biomedicine Science & Technology
Background: Deviations (DEVs) from resuscitation guidelines are associated with worse outcomes after adult in-hospital cardiac arrest (IHCA), but impact during pediatric IHCA is unknown. Methods: Retrospective cohort study of prospectively collected data from the American Heart Association's Get With The Guidelines-Resuscitation registry. Children who had an index IHCA of >= 1 min from 2000 to 2014 were included. DEVs are defined by the registry by category (airway, medications, etc.) A composite measure termed circulation DEV(C-DEV), defined as at least one process deviation in the following categories: medications, defibrillation, vascular access, or chest compressions, was the primary exposure variable. Primary outcome was survival to hospital discharge. Mixed-effect models with random intercept for each hospital assessed the relationship of DEVs with survival to hospital discharge. Robustness of findings was assessed via planned secondary analysis using propensity score matching. Results: Among 7078 eligible index IHCA events, 1200 (17.0%) had DEVs reported. Airway DEVs (466; 38.8%) and medication DEVs (321; 26.8%) were most common. C-DEVs were present in 629 (52.4%). Before matching, C-DEVs were associated with decreased rate of ROSC (aOR = 0.53, CI95: 0.43-0.64, p < 0.001) and survival to hospital discharge (aOR = 0.71, CI95: 0.60-0.86, p < 0.001). In the matched cohort (C-DEV n = 573, no C-DEV n = 1146), C-DEVs were associated with decreased rate of ROSC (aOR 0.76, CI95 0.60-0.96, p = 0.02), but no association with survival to hospital discharge (aOR 1.01, CI95 0.81-1.25, p = 0.96). Conclusions: DEVs were common in this cohort of pediatric IHCA. In a propensity matched cohort, while survival to hospital discharge was similar between groups, events with C-DEVs were less likely to achieve ROSC.

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20 citations in Web of Science
21 citations in Scopus

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Collaboration types
Domestic collaboration
Web of Science research areas
Critical Care Medicine
Emergency Medicine
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