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Trends in Survival after Pediatric In-Hospital Cardiac Arrest in the United States.

Background: Cardiac arrest in hospitalized children is associated with poor outcomes, but no contemporary study has reported whether trends in survival have changed over time. In this study, we examined temporal trends in survival for pediatric patients with an in-hospital pulseless cardiac arrest and pediatric patients with a non-pulseless cardiopulmonary resuscitation event from 2000 to 2018. Methods: This was an observational study of hospitalized pediatric patients (≤18 years of age) who received cardiopulmonary resuscitation from January 2000 to December 2018 and were included in the Get With The Guidelines®-Resuscitation registry, a US-based in-hospital cardiac arrest registry. The primary outcome was survival to hospital discharge and the secondary outcome was return of spontaneous circulation (binary outcomes). Generalized estimation equations were used to obtain unadjusted trends in outcomes over time. Separate analyses were performed for patients with a pulseless cardiac arrest and patients with a non-pulseless event (bradycardia with poor perfusion) requiring cardiopulmonary resuscitation. A subgroup analysis was conducted for shockable vs non-shockable initial rhythms in pulseless events. Results: A total of 7433 patients with a pulseless cardiac arrest and 5751 patients with a non-pulseless event were included for the analyses. For pulseless cardiac arrests, survival was 19% (95%CI, 11%-29%) in 2000 and 38% (95%CI, 34%-43%) in 2018, with an absolute change of 0.67% (95%CI, 0.40%-0.95%; p <0.001) per year, although the increase in survival appeared to stagnate following 2010. Return of spontaneous circulation also increased over time, with an absolute change of 0.83% (95%CI, 0.53%-1.14%; p <0.001) per year. We found no interaction between survival to hospital discharge and the initial rhythm. For non-pulseless events, survival was 57% (95%CI, 39%-75%) in 2000 and 66% (95%CI, 61%-72%) in 2018, with an absolute change of 0.80% (95%CI, 0.32%-1.27%; p = 0.001) per year. Conclusions: Survival has improved for pediatric events requiring cardiopulmonary resuscitation in the US, with a 19% absolute increase in survival for in-hospital pulseless cardiac arrests and a 9% absolute increase in survival for non-pulseless events between 2000 and 2018. However, survival from pulseless cardiac arrests appeared to have reached a plateau following 2010.