Outcomes of children with out-of-hospital cardiac arrest admitted to the pediatric intensive care unit after the return of spontaneous circulation: A multi-center retrospective study.

purposeThis study aimed to explore the epidemiological features and outcomes of out-of-hospital cardiac arrest (OHCA) among children hospitalized in the pediatric intensive care units (PICUs) after return of spontaneous circulation (ROSC) and to determine the factors associated with the thirty-day survival (TDS) rate.

methodsThis retrospective cohort study was conducted between January 2016 and December 2022 at two French PICUs and included patients under 18 years old hospitalized with ROSC after OHCA.

resultsDuring the study period, 53 patients were included, 27 (51%) were males the median age was 4 years old. Drowning (n = 15, 28%) and other causes of respiratory failure (n = 9, 17%) were the most common causes of cardiac arrest. The TDS rate was 38% (n = 20), and 15 patients (75%) of the survivals were considered to have good cognitive function discharged from the PICU. Neurological dysfunction was the most common cause of death including brain death in 19 patients (35%) and withdrawal of life-sustaining therapy due to poor neurological prognosis. Witnessed cardiac arrest and length of low flow < 20 min increased the chances of survival by 4.2-fold and 5.6-fold, respectively. Asystole as the initial rhythm, epinephrine use, severe acidosis, bilateral areflexic mydriasis on admission, liver, and renal failure, and disseminated intravascular coagulation were associated with a lower TDS rate, whereas shockable rhythms were associated with a higher TDS rate.

conclusionIn our study, TDS rate of children hospitalized in the PICU after OHCA with ROSC was 38%. Among most of the survivors the neurological prognosis was good. Further, the data implies that primary prevention and optimal early response remain the key strategies to improve survival after OHCA. In addition, neurological dysfunction was the most common cause of death after ROSC, highlighting the opportunity to increase organ donation for transplantation. WHAT IS KNOWN: • Out-of-hospital cardiac arrest (OHCA) is a significant cause of morbidity and mortality in children. • Survival rates for pediatric OHCA are low and influenced by age, cause of arrest, bystander CPR, and promptness of advanced life support. WHAT IS NEW: • Survival after return of spontaneous circulation (ROSC) following OHCA in pediatric patients is being reported for the first time in France. While the survival rate is low, the neurological prognosis of most survivors is good. • Primary prevention and optimal early response are key strategies to improve survival. The high occurrence of brain death among nonsurvivors highlights a potential opportunity for organ donation, which appears to be underutilized.