Survival and neurological outcome following in-hospital paediatric cardiopulmonary resuscitation in North India

Background: Data on outcome of children undergoing in-hospital cardiopulmonary resuscitation (CPR) in low-and middle-income countries are scarce. Aims: To describe the clinical profile and outcome of children undergoing in-hospital CPR. Methods: This prospective observational study was undertaken in the Advanced Pediatric Center, PGIMER, Chandigarh. All patients aged 1 month to 12 years who underwent in-hospital CPR between July 2010 and March 2011 were included. Data were recorded using the 'Utstein style'. Outcome variables included 'sustained return of spontaneous circulation' (ROSC), survival at discharge and neurological outcome at 1 year. Results: The incidence of in-hospital CPR in all hospital admissions (n=54654) was 6.7% (n=5314). 64.6% (n=5203) achieved ROSC, 14% (n=44) survived to hospital discharge and 11.1% (n=535) survived at 1 year. Three-quarters of survivors had a good neurological outcome at 1-year follow-up. Sixty per cent of patients were malnourished. The Median Pediatric Risk of Mortality-III (PRISM-III) score was 16 (IQR 9-25). Sepsis (71%), respiratory (39.5%) and neurological (31.5%) illness were the most common diagnoses. The most common initial arrhythmia was bradycardia (52.2%). On multivariate logistic regression, duration of CPR, diagnosis of sepsis and requirement for vasoactive support prior to arrest were independent predictors of decreased hospital survival. Conclusions: The requirement for in-hospital CPR is common in PGIMER. ROSC was achieved in two-thirds of children, but mortality was higher than in high-income countries because of delayed presentation, malnutrition and severity of illness. CPR >15 min was associated with death. Survivors had good long-term neurological outcome, demonstrating the value of timely CPR.