Survival Measures After Cardiopulmonary Resuscitation and Related Factors Among Children: Retrospective Cohort Study in Iran

Abstract

Background: Although cardiopulmonary resuscitation (CPR) is infrequently performed in pediatric emergencies, it is crucial that CPR is administered correctly and promptly for children requiring resuscitation. Objectives: This study aims to examine the demographic characteristics, etiological factors, and survival outcomes of patients who underwent CPR in the emergency department of the Children's Medical Center. Methods: In this retrospective cohort study, we gathered data from 149 resuscitated cases over a 2-year period. All patients under 18 years old who underwent CPR in the emergency department of the Children's Medical Center Hospital for any reason from April 2021 to March 2023 were retrospectively assessed. Demographic information and information related to the factors causing resuscitation, underlying diseases, vital and clinical signs on arrival, and resuscitation results were obtained by reviewing archived patient records. Results: The median age of patients was 18.0 months (IQR: 6.0-70.0), and 51% were boys. 64.4% of patients achieved return of spontaneous circulation (ROSC), 53.7% survived for 24 hours after the event, and 24.2% survived until discharge. The analysis of the association between contributing factors and survival measures in pediatric resuscitation efforts reveals several insights. The reason for resuscitation is an important factor, with respiratory arrest being strongly associated with better outcomes at all stages, while cardiac and cardiopulmonary arrests show poorer prognoses (P < 0.001). The rhythm prior to chest compressions is also a significant predictor, with asystole and pulseless electrical activity (PEA) being associated with lower chances of ROSC and survival (P < 0.001). The location of the arrest is a pivotal factor, with in-hospital cardiac arrests (IHCAs) showing better outcomes compared to out-of-hospital cardiac arrests (OHCAs) (P <0.001). Conclusions: In conclusion, this study underscores the critical importance of prompt and correct administration of CPR in pediatric emergencies. These insights provide valuable guidance for improving resuscitation protocols and training programs to enhance survival rates in pediatric CPR scenarios.