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INCIDENCE, OUTCOME, AND RISK FACTORS OF IN-HOSPITAL CARDIAC ARREST AND ASSOCIATED MORTALITY IN PEDIATRIC CRITICALLY ILL CARDIAC PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS
- Francesca Sperotto (United States of America)
Abstract
Background and Aims
Critically-ill cardiac patients are at high risk of ineffective circulation, arrhythmias, and cardiac arrest (CA). We systematically reviewed data on incidence of in-hospital CA, associated mortality, and risk factors in children with cardiac disease admitted to the intensive care unit.
Methods
Systematic review and meta-analysis (inception -Sept2021; PROSPERO CRD42020156247, Figure 1a). Random effects meta-analysis was used to compute pooled proportions and ORs. Meta-regression adjusted for type of study (registry vs cohort) and diagnostic category (surgical vs general cardiac) was used to evaluate trends in incidence and mortality.
Results
Of the 2,574 studies identified, 25 were included (126,087 children, 5,185 CAs). Nighty-five percent of studies were good or fair in quality. Five percent (95%CI: 4-7%) of patients experienced CA. In centers with ECMO expertise, 21% (95%CI: 15-28%) underwent E-CPR. Thirty-five percent of patients (95%CI: 27-44%) did not reach ROSC. The pooled in-hospital mortality rate was 54% (95%CI: 47-62%). Both incidence of CA and in-hospital mortality significantly decreased (p<0.001 and p=0.020, Figure 1b&c), while the proportion of patients achieving ROSC did not change (p=0.572). Main risk factors for CA and mortality were neonatal age, prematurity, genetic syndrome, univentricular physiology, arrhythmias, comorbidities, pre-operative mechanical ventilation or ECMO, and higher surgical complexity.
Conclusions
A non-negligible proportion (5%) of critically-ill cardiac pediatric patients experience CA. Incidence and associated in-hospital mortality are significantly decreasing over time; however, the percentage of patients achieving ROSC did not change. Strong effort should be made in improving prevention and resuscitation strategies in this delicate cohort of patients.