Clinical Outcomes & Quality Lead Children's Hospital Colorado Denver, Colorado, United States
Abstract:
Introduction: In-hospital cardiac arrest (IHCA) in patients with congenital heart disease (CHD) is associated with poor neurologic and neurodevelopmental (ND) outcomes. The primary objective of this study was to evaluate the association between IHCA in the CICU and neurologic outcomes. The secondary objective was to investigate the association between duration of chest compressions and neurologic outcome.
Methods: A retrospective chart review was performed to obtain Pediatric Cerebral Performance Category (PCPC) scores at CICU admission, CICU discharge and hospital discharge in all CICU patients who sustained IHCA from Jan 1, 2021 to June 1, 2022. PCPC scores range from 1-6 and progressively increase from 1, representing no disability, to 6, representing death. A standard definition of favorable neurologic outcome following IHCA may be generally considered a PCPC score of < 3, or no change in PCPC from baseline. Two independent reviewers scored each patient. These scores were averaged for analysis. Wilcoxon Signed Rank Test was applied to compare the difference in PCPC from CICU admission to CICU and hospital discharge. Multivariable modeling was used to determine the association between duration of chest compressions and change in PCPC score after controlling for race, ethnicity, chest compression duration and eCPR.
Results: The cohort consisted of 35 patients who sustained 45 IHCA. Twenty-two patients (63%) survived to hospital discharge. One has not been discharged. Demographics, cardiac arrest and hospitalization characteristics are described in table 1. CICU patients who sustained IHCA had increased median PCPC scores from CICU admission to CICU discharge, (M = 2.14; p< 0.0001). There was also an increase in PCPC scores from CICU admission to hospital discharge, (M = 2.40; p< 0.0001). Duration of chest compressions was related to worse PCPC score as the PCPC increased by 0.06 points (p = 0.034) with each 1-minute increase in duration of chest compressions from CICU admission to CICU discharge and by 0.07 points (p = 0.025) from CICU admission to hospital discharge.
Conclusion: We demonstrated an association between IHCA in the CICU and a clinically significant change in PCPC score, suggesting worse neurologic outcomes post-ICHA in patients with CHD. Duration of chest compressions was related to worse PCPC scores. While multivariable modeling was used to control for confounders, future studies should compare changes in PCPC score from CICU admission to discharge in a matched cohort of patients who do not suffer an IHCA. Future studies should also focus on the association between IHCA and chest compression duration on short- and long-term ND outcomes. This study highlights the importance of IHCA prevention and quality resuscitation to decrease time to return of spontaneous circulation as well as the need for implementation of post-arrest-neuroprotective interventions to help improve outcomes.
