Etiology, clinical characteristics, treatments and results of cardiac arrest in pediatric patients undergoing cardiopulmonary resuscitation

Aim: Cardiac arrest is a significant cause of mortality and morbidity in critically ill children. In our study, we aimed to share the clinical characteristics of children who experienced cardiac arrest (CA), the interventions performed during cardiopulmonary resuscitation (CPR), and their outcomes. Materials and Methods: Data of patients aged 1 month to 18 years who experienced CA between 1 October 2020- 31 September 2022 were recorded. The study included patients who experienced CA during their stay in the pediatric intensive care unit (PICU) or were admitted to the PICU within 24 hours after an out-of-unit CA, received CPR for more than 1 minute, or received epinephrine at least once during CPR. Results: A total of 107 patients were included in the study. The median age of the patients was 24 (1-216) months. 61 (57%) patients were male, and 46 (43%) were female. The most common underlying diseases among the patients were cardiac (26.2%, n=28), neurological (16.8%, n=18), and previously healthy (15%, n=16). The reasons for PICU admission were respiratory in 26.2% (n=28), post-CA in 24.3% (n=26), postoperative care in 12.1% (n=13), and sepsis-related in 12% (n=12). The most common of CA was respiratory, accounting for 43% (n= 46 cases). 71% (n=76) of the CAs occurred in the PICU, 10.3% (n=11) out of the hospital, 7.5% (n=8) in the emergency department, and 6.5% (n=7) in the inpatient ward. The initial identified rhythm for CA was asystole in 42.1% (n=45), bradycardia in 41.1% (n=44), and ventricular fibrillation/pulseless ventricular tachycardia in 8% (n=8). During CPR, 86% (n=92) of the patients received epinephrine, 36.4% (n=39) received sodium bicarbonate, and 24.3% (n=26) received calcium. Of the administered medications, 66.4% (n=71) were given through a central venous catheter, 34.6% (n=37) through a peripheral intravenous line, and 7.5% (n=8) through intraosseous access. 8.4% (n=9) of the patients underwent extracorporeal CPR (ECPR), and 3.7% (n=4) received continuous renal replacement therapy (CRRT). The average duration of CPR was 20 minutes (1-105), and 65.4% (n=70) of the patients achieved return of spontaneous circulation. The 28- day survival rate was 34.6% (n=37 cases). Determining factors that increase mortality rate include the presence of underlying immunological and hemato-oncological diseases, the use of calcium during CPR, and the administration of inotropic agents to patients before CA (p < 0.05). Conclusion: Our study demonstrates that mortality remains high in patients who receive CPR, emphasizing the importance of preventing cardiac arrest and providing post cardiac arrest care. Keywords: Pediatric cardiac arrest, cardiopulmonary resuscitation, pediatric intensive care unit, return of spontaneous circulation, survival