Clinical paperThe landscape of paediatric in-hospital cardiac arrest in the United Kingdom National Cardiac Arrest Audit
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.
References (37)
Assessing the outcome of pediatric intensive care
J Pediatr
(1992)- et al.
Development and validation of risk models to predict outcomes following in-hospital cardiac arrest attended by a hospital-based resuscitation team
Resuscitation
(2014) - et al.
In-hospital pediatric cardiac arrest in Spain
Rev Esp Cardiol
(2014) - et al.
Long-term evolution after in-hospital cardiac arrest in children: prospective multicenter multinational study
Resuscitation
(2015) - et al.
The epidemiology and resuscitation effects of cardiopulmonary arrest among hospitalized children and adolescents in Beijing: an observational study
Resuscitation
(2013) - et al.
Survey of outcome of CPR in pediatric in-hospital cardiac arrest in a medical center in Taiwan
Resuscitation
(2009) - et al.
Utstein style reporting of-in hospital paediatric cardiopulmonary resuscitation
Resuscitation
(2000) - et al.
Paediatric in-hospital cardiac arrest: factors associated with survival and neurobehavioural outcome one year later
Resuscitation
(2018) - et al.
Out‐of‐hospital cardiac arrests in children and adolescents: incidences, outcomes, and household socioeconomic status
Resuscitation
(2015) - et al.
A quantitative analysis of out-of-hospital pediatric and adolescent resuscitation quality. A report from the ROC epistry‒cardiac arrest
Resuscitation
(2015)
Out‐of‐hospital pediatric cardiac arrest: an epidemiologic review and assessment of current knowledge
Ann Emerg Med
Unchanged pediatric out-of-hospital cardiac arrest incidence and survival rates with regional variation in North America
Resuscitation
Cardiac arrest and resuscitation in the pediatric intensive care unit: a prospective multicenter multinational study
Resuscitation.
Survival trends in pediatric in-hospital cardiac arrests: an analysis from get with the guidelines–resuscitation; for the American Heart Association get with the Guidelines–Resuscitation Investigators
Circ Cardiovasc Qual Outcomes
Cited by (10)
What can be learned from the literature about intervals and strategies for paediatric CPR retraining of healthcare professionals? A scoping review of literature
2022, Resuscitation PlusCitation Excerpt :Previous studies demonstrated that learners acquire CPR knowledge and skills irrespective of the method it is delivered7–13 however, evidence shows that CPR skills decay within weeks to months after training, demonstrating that the current retraining intervals of one or two years is ineffective.9,14–16 This, coupled with paediatric cardiac arrest being an uncommon event, with an incidence of 8.04/100,000 for out-of-hospital cardiac arrests and around 1/1000 admissions for in-hospital cardiac arrests, further perpetuates the challenge in retaining pCPR skill.17–19 Current resuscitation guidelines recommend a distributed practice model for teaching and learning CPR skills, however, there is no clarity over the optimal gap between training or retraining sessions.19–21
Comment on: Global mortality of children after perioperative cardiac arrest: A systematic review, meta-analysis, and meta-regression
2022, Annals of Medicine and SurgeryResuscitation practices in hospitals caring for children: Insights from get with the guidelines-resuscitation
2022, Resuscitation PlusCitation Excerpt :We included some smaller volume combined hospitals in the study cohort as the focus was on description of resuscitation practices among hospitals caring for children with IHCA, and not on survival outcomes. We also did not detect a difference in survival rates between the two hospital types at the patient level, although another patient-level analysis of resuscitation events in children from the United Kingdom found higher rates of survival to discharge for children at specialized pediatric hospitals.25 Our study should be interpreted in the context of the following limitations.
Is your hospital doing everything it can to be ready for the next paediatric cardiac arrest?
2022, Resuscitation PlusGlobal mortality of children after perioperative cardiac arrest: A systematic review, meta-analysis, and meta-regression
2022, Annals of Medicine and SurgeryCitation Excerpt :The current study was intended to investigate the overall perioperative cardiac arrest and mortality, anesthesia-related cardiac arrest and mortality, and its determinants among children receiving anesthetics. This systematic review revealed that the incidence of perioperative cardiac arrest was 2.54 per 1000 anesthetics which is lower than the reports of included studies and a meta-analysis of perioperative mortality conducted in brazil [2,3,8,12,15,19,22,24,25,28–30,43–49,54,55,57,59,62,63,65,67]. This discrepancy might be explained by the inclusion of many studies with a large sample from different countries globally.