Elsevier

Resuscitation

Volume 155, October 2020, Pages 165-171
Resuscitation

Clinical paper
The landscape of paediatric in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit

https://doi.org/10.1016/j.resuscitation.2020.07.026Get rights and content

Abstract

Aim

To report the patient characteristics and clinical outcome of paediatric in-hospital cardiac arrest in the United Kingdom (UK) National Cardiac Arrest Audit (NCAA) database.

Methods

Analysis of all recorded paediatric cardiac arrests in the NCAA dataset over a seven-year period ending on 31 December 2018, within acute children’s hospitals (including standalone paediatric hospitals and hospitals with tertiary paediatric services) and acute general hospitals participating in NCAA. In this period 1456 patients (with 1580 events), 1 month to 16 years of age, received chest compressions and/or defibrillation and were attended by a hospital-based resuscitation team in response to an emergency call. The main outcome measure was survival to discharge.

Results

For this cohort of paediatric in-hospital cardiac arrest patients the overall rates of sustained return of spontaneous circulation (ROSC) were 69.1% with unadjusted survival to hospital discharge of 54.2%. The presenting rhythm was shockable in 4.3% of events and non-shockable in 82.1% (remainder undetermined); rates of survival to hospital discharge associated with these rhythms were 63.9% and 51.7%. A difference in outcomes was observed between Children’s hospitals and acute general hospitals with ROSC rates of 79.1% and 55.5% respectively and survival to hospital discharge rates of 57.7% and 49.3% respectively.

Conclusions

These first results from the NCAA database describing the outcome of paediatric in-hospital cardiac arrest in UK hospitals will serve as a benchmark from which to assess the future impact of changes in service delivery, organisation and treatment for in-hospital cardiac arrest in young people. Outcomes for specialist paediatric centres should be studied further as higher rates of ROSC and survival to hospital discharge were observed.

Introduction

Paediatric in-hospital cardiac arrest (IHCA) is a relatively rare event with reported outcomes varying across institutions internationally.1 Outcomes in the UK have not previously been published because of the small numbers and hence difficulties drawing conclusions. The NCAA is a national clinical audit for in-hospital cardiac arrest that provides validated, comparative data to support improvements in resuscitation to the contributing centres. This analysis describes the current landscape of UK paediatric arrests captured by NCAA to facilitate international benchmarking.

Section snippets

NCAA

NCAA collates data for patients in acute hospitals in the UK who receive CPR and are attended by the hospital resuscitation team in response to an emergency call; the emergency number called in all hospitals in the UK is 2222 so the teams are often referred to as 2222 teams. CPR is defined by NCAA as the receipt of chest compressions and/or defibrillation. NCAA received approval from the National Information Governance Board (now the Confidentiality Advisory Group within the Health Research

Results

110,705 cardiac arrests were reported over the study period, 1580 (1.4%) were paediatric events. Table S4 summarises numbers of events by year with reference to numbers of participating hospitals, overall and by hospital type. An incidence of 0.34 per 1000 admissions was calculated from 5 participating stand-alone paediatric hospitals. Table 1 summarises patients and event characteristics, with a breakdown by type of hospital available in the supplement (Table S5). The median [IQR] age of

Discussion

There are relatively few IHCA events in children each year in the UK compared to adults which makes it difficult to compare paediatric data year on year for participating hospitals. Nonetheless, this is the first description of paediatric IHCA in a significant number of patients (events >1500) in the UK and provides insights to the national picture.

Outcome from paediatric IHCA patients is better than for adults (survival to hospital discharge 54% in paediatric patients compared to 21% survival

Limitations

Whilst this is the first description of a large paediatric IHCA cohort in the UK it only includes events attended by the emergency (2222) team, who may not always attend events in the ED and intensive care unit (ICU). However, for paediatric CA most ED would call 2222 to summon paediatric assistance so this number is believed to be low. Arrests in PICU are likely to be under-represented but it can be seen from our results that 29.9% of the arrests recorded occurred in the

Conclusion

This is the first report that characterises a large cohort of paediatric IHCA in the UK. Outcomes appear comparable to international data and allow hospitals to benchmark performance of their clinical emergency teams, service delivery and organisation. Observed differences in outcomes between hospital types requires further evaluation but may provide useful insight into effective service models which could then be applied nationally. Future collection of paediatric admission numbers to all

Conflict of interest

Sophie Skellett and Peter-Marc Fortune are paediatric members of the NCAA steering group.

Izabella Orzechowska and Karen Thomas work for ICNARC/NCAA.

Acknowledgments

The authors wish to thank all the staff at hospitals participating in NCAA, the National Audit Programme Team at ICNARC and the NCAA Steering Group.

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