Hospital variation in pediatric in-hospital cardiac arrest survival

(HealthDay)—Despite risk-standardization, there is substantial hospital variation in survival for pediatric in-hospital cardiac arrest, according to a review published online June 17 in Circulation: Cardiovascular Quality and Outcomes.

Natalie Jayaram, M.D., from Saint Luke's Mid America Heart Institute in Kansas City, Mo., and colleagues used the American Heart Association's Get With the Guidelines-Resuscitation registry for in-hospital cardiac arrest to identify 1,551 cardiac arrests in children (<18 years). A model was developed and validated a model to predict survival to hospital discharge.

The researchers found that a total of 13 patient-level predictors were identified: age, sex, cardiac arrest rhythm, location of arrest, mechanical ventilation, acute nonstroke neurological event, major trauma, hypotension, metabolic or electrolyte abnormalities, renal insufficiency, sepsis, illness category, and need for intravenous vasoactive agents prior to the arrest. Good discrimination (C-statistic of 0.71) was seen with the model, which was confirmed by bootstrap validation (validation C-statistic of 0.69). Unadjusted hospital survival rates varied considerably (median, 37 percent), among 30 hospitals with ≥ 10 cardiac arrests. After risk-standardization, variation in survival persisted, although the range of hospital survival rates narrowed.

"Leveraging these models, future studies can identify best practices at high-performing hospitals to improve survival outcomes for pediatric cardiac arrest," the authors write.

One author discloses having worked as a consultant with the American Heart Association.