METHODS: Pediatric patients >30 days and <18 years of age who received
CPR at hospitals participating in Get With The Guidelines-
Resuscitation during 2000 to 2016 were included. Each
CPR event was classified as
bradycardia with pulse,
bradycardia with subsequent pulselessness, and initial pulseless
cardiac arrest. We assessed risk-adjusted rates of survival to hospital discharge using multilevel Poisson regression models.
RESULTS: Overall, 5592 pediatric patients were treated with
CPR, of whom 2799 (50.1%) received
CPR for
bradycardia with poor perfusion and 2793 (49.9%) for initial pulseless
cardiac arrest. Among those with
bradycardia, 869 (31.0%, or 15.5% of cohort) became pulseless after a median of 3 minutes of
CPR (interquartile range, 1-9 minutes). Rates of survival to discharge were 70.0% (1351 of 1930) for
bradycardia with pulse, 30.1% (262 of 869) for
bradycardia progressing to pulselessness, and 37.5% (1046 of 2793) for initial pulseless
cardiac arrest (P for difference across groups <0.001). Children who became pulseless despite
CPR for
bradycardia had
a 19% lower likelihood (risk ratio, 0.81 [95% CI, 0.70, 0.93]; P=0.004) of surviving to hospital discharge than those who were initially pulseless. Among children who progressed to pulselessness despite
CPR for
bradycardia, a longer interval between
CPR and pulselessness was a predictor of lower survival (reference, <2 minutes; for 2-5 minutes, risk ratio, 0.54 [95% CI, 0.41-0.70]; for >5 minutes, risk ratio, 0.41 [95% CI, 0.32-0.53]).
CONCLUSIONS: Among hospitalized children in whom
CPR is initiated, half have
bradycardia with poor perfusion at the initiation of chest compressions, and nearly one-third of these progress to pulseless in-hospital
cardiac arrest despite
CPR. Survival was significantly lower for children who progress to pulselessness despite
CPR compared with those who were initially pulseless. These findings suggest that pediatric patients who lose their pulse despite
resuscitation attempts are at particularly high risk and require a renewed focus on postresuscitation care.