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(HealthNewsDigest.com) – DALLAS, Dec. 18, 2012 — Hospitalized children who suffer cardiac arrest are nearly three times more likely to survive than they were about a decade ago, and no more likely to suffer brain impairment, according to new research in the American Heart Association journal Circulation: Cardiovascular Quality & Outcomes.
Researchers analyzed the cases of 1,031 children who suffered cardiac
arrest at 12 urban U.S. teaching hospitals from 2000-2009. The
hospitals participate in the American Heart Association’s Get With the
Guidelines(R)-Resuscitation program, a quality-improvement effort that
promotes consistent application of the latest scientific guidance for
resuscitation.
In 2009, 43.4 percent of children studied survived until they were
released from the hospital compared to 14.3 percent in 2000. Among
surviving children, the risk of brain impairment has remained unchanged
during this period.
“Survival in children who experience a cardiac arrest in the hospital
has increased nearly threefold during the past decade, and most of
those who survive are without severe neurological disability,” said
Saket Girotra, M.D., lead author of the study and an interventional
cardiologist at the University of Iowa Hospitals & Clinics in Iowa
City.
Most children who suffer in-hospital cardiac arrests are already
critically ill, Girotra said. These children typically have respiratory
illnesses such as pneumonia, severe infections or have had heart
surgery or are receiving care for conditions such as heart failure.
At the time of their cardiac arrest, almost 85 percent of the children
in the study had “non-shockable” initial heart rhythms like asystole or
pulseless electrical activity. Survival rates are lower in this group
than for children with “shockable” rhythms such as pulseless
ventricular tachycardia or ventricular fibrillation, which are more
often linked to underlying heart disease.
Over the course of the study, the proportion of children with cardiac
arrest from pulseless electrical activity increased substantially,
perhaps due to an increase in acute illnesses that were not
heart-related, Girotra said.
“What was striking was that, despite this trend, survival still
improved,” Girotra said.
Survival rates also improved across age groups, gender and initial
cardiac rhythm.
The researchers also explored whether better survival was due to better
care during the resuscitation phase, when the heart is restarted, or
better care during the post-resuscitation phase, when doctors treat
underlying illness while supporting organ function. While improvements
were noted in both phases, the largest gains stemmed primarily from
better care during the resuscitation phase, with survival rates during
that window rising from 42.9 percent in 2000 to 81.2 percent in 2009.
Although the study could not determine specifically what fueled the
survival gains, Girotra said the improvement was probably due to a
combination of factors, a number of which have been emphasized by the
American Heart Association and other professional groups.
Those includes early recognition of cardiac arrest with the use of
monitoring systems, high-quality chest compressions, timely
defibrillation in patients with shockable heart rhythms, appropriate
use of medicines during cardiac arrest and optimal care for
resuscitated patients. The findings, he said, underscore the importance
of continuing efforts to improve the quality of resuscitation.
Because of their participation in the Get With the
Guidelines-Resuscitation program, hospitals in the study may differ
from non-GWTG participating hospitals in important ways, Girotra said,
such as additional resources and commitment to quality improvement,
which may have accounted for the dramatic survival gains.
“Our results may not reflect performance at non-participating
hospitals,” he said.
Co-authors are John A. Spertus, M.D., M.P.H.; Yan Li, Ph.D.; Robert A.
Berg, M.D.; Vinay M. Nadkarni, M.D.; and Paul S. Chan, M.D., M.Sc.
Author disclosures and sources of funding are on the manuscript.
The American Heart Association has more information for parents with
children at risk for cardiac arrest, including information on being
prepared to give CPR if you witness a cardiac arrest.
Learn more about Get With The Guidelines-Resuscitation and other
American Heart Association programs at www.heart.org/quality.
Statements and conclusions of study authors published in American Heart
Association scientific journals are solely those of the study authors
and do not necessarily reflect the association’s policy or position.
The association makes no representation or guarantee as to their
accuracy or reliability. The association receives funding primarily
from individuals; foundations and corporations (including
pharmaceutical, device manufacturers and other companies) also make
donations and fund specific association programs and events. The
association has strict policies to prevent these relationships from
influencing the science content. Revenues from pharmaceutical and
device corporations are available at www.heart.org/corporatefunding
The American Heart Association logo is available at
http://www.globenewswire.com/
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