Pediatric CPR plays a pivotal role in addressing cardiac emergencies among children, and understanding the trends in survival rates is paramount for advancing pediatric healthcare.
Although cardiac arrest in hospitalized children is generally associated with poor outcomes, current studies lack information on survival trends over time. From 2000 to 2018, the American Heart Association (AHA) conducted an observational study that analyzed survival trends after pediatric in-hospital cardiac arrests. Additionally, the AHA's National Registry of Cardiopulmonary Resuscitation, which began in 1999, collects resuscitation data from hospitals nationwide to create evidence-based guidelines for inpatient CPR.
Here's a look at some of the latest findings around pediatric cardiac arrest and the pivotal role CPR can play.
Increased Survival Rates Among Pediatric Patients
In 2019, the AHA released the details of its decades-long observational study. The study analyzed data from 7,433 patients who experienced a pulseless cardiac arrest and 5,751 patients who had a nonpulseless event.
The study revealed several findings:
- The survival rate to discharge for pulseless cardiac arrest jumped from 19% in 2000 to 38% in 2018, showing a 0.67% increase in survival per year (19% between 2000 and 2018).
- Survival rates to discharge for pediatric patients with nonpulseless events (bradycardia and poor perfusion) rose from 57% in 2000 to 66% in 2018, marking a 0.80% increase in survival per year (9% between 2000 and 2018).
The increased survival rates over the study period reflect significant improvements in the management and care of pediatric patients experiencing cardiac arrest. This trend suggests advancements in resuscitation techniques, such as:
- Improved training protocols
- Standardized guidelines
- Quality improvement initiatives aimed to enhance CPR effectiveness in hospitals
Survival Rates Plateaued After 2010
Despite the overall improvement detected during the AHA's observational study period, survival rates for in-hospital pulseless cardiac arrests plateaued after 2010. This highlights the need for ongoing research and interventions to address potential barriers and optimize outcomes in pediatric CPR. It also emphasizes the importance of sustained efforts in quality improvement and clinical focus.
Differential Survival Trends Based on Medical History
Preliminary research presented at the AHA's Resuscitation Science Symposium 2022 revealed significant variations in pediatric survival rates among different patient groups.
Scientists analyzed data from the AHA's Get With The Guidelines® - Resuscitation registry, reviewing information from almost 17,700 instances of in-hospital pediatric cardiac arrest from 2000 to 2021. They then categorized patient data into five-year segments for analysis.
Researchers grouped patients into three categories based on illness:
- Cardiovascular disease (CVD) with recent cardiac surgery (surgical-cardiac)
- CVD with no recent cardiac surgery (medical-cardiac)
- No CVD (non-cardiac)
Among the patients studied, 18% had recent cardiac surgery, 18% had CVD without recent surgery, and 64% didn't have CVD.
Survival rates to hospital discharge among surgical-cardiac patients increased from 46% between 2000 and 2004 to over 62% between 2015 and 2021. Medical-cardiac patients saw an increase from nearly 37% to 47% during the same period.
The study highlights the disparities in survival outcomes between these groups. Specifically, children who underwent recent cardiac surgery showed notable improvements in survival rates following cardiac arrest. In contrast, those with cardiovascular disease but no recent surgical history exhibited slower rates of improvement.
Targeted Interventions Needed for Higher-Risk Patients
This observation emphasizes the importance of targeted interventions to enhance medical-cardiac patients' survival, who appear to lag behind their surgical-cardiac counterparts.
Such focused interventions could encompass a multifaceted approach, including but not limited to:
- Optimizing pre-arrest management strategies
- Refining post-arrest care protocols
- Implementing specialized treatment modalities tailored to medical-cardiac patients' unique physiological profiles and clinical needs
This data underscores the importance of fostering collaboration between researchers, clinicians, and healthcare stakeholders. They must develop evidence-based interventions to address the challenges medical-cardiac pediatric patients face in achieving more favorable outcomes post-cardiac arrest.
Closing the Gap in Patient Outcomes
Through targeted interventions and collaborative efforts, healthcare professionals can strive to narrow the gap and improve overall survival outcomes among different patient groups. Leveraging the RQI Healthcare Pediatric Advanced Life Support program and keeping CPR skills sharp using a low-dose, high-frequency training model can help measure and verify medical providers' competence while focusing on quality improvement.
Though providers can't plan for sudden cardiac arrest among children, they can then feel more confident and capable by regularly practicing and refining the required response.
