In-hospital cardiac arrest survival rates among children have improved in past 20 years

Research Highlights:

• Among children who experienced in-hospital cardiac arrest in the last 20 years, survival rates increased significantly – more so for those who had surgery and cardiac arrest. However, the survival rate increased more slowly for children with cardiovascular disease (CVD) and no history of surgery.
• Health care professionals should focus work on improving survival rates among children with CVD and no history of surgery, researchers said.

Embargoed until 4 a.m. CT/5 a.m. ET Monday, October 31, 2022

(NewMediaWire) - October 31, 2022 - DALLAS — Among children who experienced in-hospital cardiac arrest in the last 20 years, survival rates have increased significantly. Greater improvements have been seen among children who had recent cardiac surgery and cardiac arrest, with lesser gains in survival seen among children who had cardiovascular disease (CVD) and no recent history of cardiac surgery, according to preliminary research to be presented at the American Heart Association’s Resuscitation Science Symposium 2022. The 2022 meeting will be held in person in Chicago, November 5-6, 2022, and will feature the most recent advances related to treating cardiopulmonary arrest and life-threatening traumatic injury.

Researchers examined the American Heart Association Get With The Guidelines® - Resuscitation registry to review data for nearly 17,700 in-hospital pediatric cardiac arrest events in children younger than 18 years of age between 2000 and 2021, and patient data were grouped together in five-year intervals. They analyzed trends in treatment and patient outcomes after cardiac arrest on three illness categories: cardiovascular disease (CVD) with recent cardiac surgery (surgical-cardiac); CVD with no recent cardiac surgery (medical-cardiac); and no CVD (non-cardiac).

Rates of survival to hospital discharge among surgical-cardiac patients increased from 46% during the 2000-2004 timeframe to more than 62% during the 2015-2021 timeframe. Survival to discharge rates for medical-cardiac patients increased from nearly 37% to 47% during the same two timeframes. The researchers  also found:

• Of the cardiac arrests investigated, 18% of the patients were in the surgical-cardiac group, 18% were in the medical-cardiac group and 64% were in the non-cardiac group.
• The children in the surgical-cardiac category had the highest rate of survival to discharge (56%), compared to the medical-cardiac group at 43% and the non-cardiac group at 46%.
• After controlling for age, location of event and hospital size, the odds of survival were 28% higher among surgical-cardiac patients and 13% higher for medical-cardiac patients, compared to non-cardiac patients.
• Surgical-cardiac patients had a 24% increased chance of survival to hospital discharge in every five-year period from 2000 through 2021, compared to non-cardiac patients.
• Medical-cardiac patients had a slower survival rate with only 14% increased odds of survival per five-year period.   

These findings indicate survival rates increased across all children in all time intervals. However, they also point to the need for more emphasis on the subset of medical-cardiac patients who are ‘lagging behind’ in improvement of outcomes, the researchers noted.

“Children with a history of cardiovascular disease often are not studied as a specific population in larger cardiac arrest studies, even though the difference between medical-cardiac and surgical-cardiac patients is important,” said the study’s lead author Monique Gardner, M.D., an attending physician in cardiac critical care medicine at the Children’s Hospital of Philadelphia and an assistant professor of anesthesiology and critical care and pediatrics at the Perelman School of Medicine at the University of Pennsylvania in Philadelphia. “These patient groups have different physiology that may impact medical treatments and survival, and thus, they may need particular focused interventions from researchers and clinicians to determine ways to improve survival.”

There are a few limitations to the study. The medical-cardiac group included children with varying degrees and types of cardiovascular disease. Additionally, in a large database such as the one used for the study, detailed data, such as for anatomy, physiology and type of cardiac arrest, were not available.     

“With the medical-cardiac patients’ survival rates increasing at a slower rate, the study reflects a need for more research in resuscitation science and a challenge for health care professionals to acknowledge this gap and look for ways to improve survival among these vulnerable patients,” Gardner said. “Future research should focus on the physiology of these patients to improve cardiac arrest prevention, cardiac arrest response and post-arrest care.”

Get With The Guidelines® is the American Heart Association/American Stroke Association’s hospital-based, quality improvement program that provides hospitals with the latest research-based guidelines to make it easier to provide consistent quality care. Developed with the goal of saving lives and hastening recovery, Get With The Guidelines has touched the lives of more than 10 million patients since 2001.

Co-authors are Ryan W. Morgan, M.D., M.T.R.; Ron Reeder, Ph.D., M.S.; Kimia Ghaffari, M.P.H.; Laura Ortmann, M.D.; Tia T. Raymond, M.D.; Javier J. Lasa, M.D.; Jessica Fowler, M.D., M.P.H.; Maya Dewan, M.D., M.P.H.; Vinay M. Nadkarni, M.D., M.S., FAHA; Robert A. Berg, M.D., FAHA; Robert M. Sutton, M.D., M.S.C.E.; and Alexis A. Topjian, M.D., M.S.C.E., FAHA. Authors’ disclosures are listed in the abstract.

The study was funded by the Clinical Resuscitation Science Endowed Chair at the Children’s Hospital of Philadelphia Research Institute Resuscitation Science Center.

Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.

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Additional Resources:

• Multimedia is available on the right column of the release link https://newsroom.heart.org/news/in-hospital-cardiac-arrest-survival-rates-among-children-have-improved-in-past-20-years?preview=2d1a1e193393f1591ba2976c62db5b2b
• Link to abstract and AHA Resuscitation Science Symposium 2022 Online Program Planner
• AHA health information: CPR in Schools
• AHA health information: 2020 American Heart Association Guidelines for CPR and ECC
• AHA health information: 2018 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care 
• AHA health information: Cardiovascular Risk Reduction in High-Risk Pediatric Patients: A Scientific Statement From the American Heart Association
• AHA health information: Cardiac Arrest vs. Heart Attack Infographic
• For more news at AHA Scientific Sessions 2022, follow us on Twitter @HeartNews #AHA22

The American Heart Association’s Resuscitation Science Symposium 2022 (ReSS) is an international forum for fundamental, translational, clinical and population scientists and care professionals to discuss recent advances related to treating cardiopulmonary arrest and life-threatening traumatic injury. The meeting is Saturday-Sunday, Nov. 5-6, 2022, in Chicago and will feature the latest scientific research science focused on understanding the shared pathophysiology between cardiac arrest and traumatic injury. The Resuscitation Science Symposium 2022 program is planned by the American Heart Association’s Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation’s. The meeting is of special interest to emergency physicians, trauma surgeons, neurosurgeons, cardiologists, critical-care nurses, intensivists, emergency medical providers, resuscitation educators, and researchers with basic, bioengineering, clinical or other experience related to treatment of cardiac arrest and trauma. Follow the conference on Twitter at @ReSS22.

About the American Heart Association

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