Outcome of cardiopulmonary resuscitation in a pediatric cardiac intensive care unit

Objective: To determine the eventual outcome of children with heart disease who had cardiopulmonary resuscitation (CPR) in a specialized pediatric car diac intensive care unit (CICU), and to define the influence of any prearre st variables on the outcome. Design:A retrospective review of patients' medical records. Setting: A pediatric CICU of a tertiary pediatric teaching hospital, Patients and Methods: Patients were all children who presented with cardiop ulmonary arrest and who were administered CPR in the pediatric CICU between June 1995 and June 1997, Prearrest variables such as age, diagnosis, prior cardiac surgery, and inotropic support with epinephrine, as well as cause of arrest, were evaluated. Measurements and Main Results:Thirty-two patients, ranging in age from 1 da y to 21 yrs (median, 1 month), satisfied criteria for inclusion in the stud y group. These 32 patients had a total of 38 episodes of cardiopulmonary ar rest. Twenty-five of these patients (78%) had cardiac surgery before arrest . Inotropic support with continuous infusion of epinephrine was being admin istered at the time of arrest in 18 of 38 (47%) arrests. These prearrest va riables did not influence outcome of CPR. Of the 38 episodes of CPR, 24 epi sodes (63%) were successful, with 20 episodes resulting in return of sponta neous circulation and four patients being successfully placed on mechanical cardiopulmonary support. fourteen children, including all four patients wh o were rescued with mechanical cardiopulmonary support, survived to dischar ge. At 6-month follow-up, 11 patients were still alive, with three having n eurologic impairment. Conclusions:After cardiopulmonary resuscitation in this pediatric CICU, the rate of success was 63% and the rate of survival was 42%, Prior cardiac su rgery and use of epinephrine before arrest did not influence the outcome of CPR, The availability of effective mechanical cardiopulmonary support can improve the outcome of CPR.