Trends in Cardiac Arrest Outcomes & Management in Children with Cardiac Disease: An Analysis from the AHA Get With The Guidelines(R)-Resuscitation Registry

IntroductionContemporary rates of survival after pediatric in-hospital cardiac arrest (IHCA) and trends in survival over the last 20 years have not been compared based on illness category. We hypothesized that survival to hospital discharge for surgical-cardiac category is higher than the non-cardiac category, and rates of survival after IHCA increased over time in all categories. MethodsThe AHA Get With The Guidelines(R)-Resuscitation registry was queried for index IHCA events in children <18 years of age from 2000-2021. Categories were surgical-cardiac (IHCA following cardiac surgery); medical-cardiac (IHCA in non-surgical cardiac disease); and non-cardiac (IHCA in patients without cardiac disease). The primary outcome was survival to hospital discharge. We compared eras 2000-2004, 2005-2009, 2010-2014, and 2015-2021 with mixed logistic regression models, including event year as a continuous predictor and site as a random effect. ResultsOf 17,696 index events, IHCA rates by illness category were: 18% surgical-cardiac, 18% medical-cardiac, and 64% non-cardiac. Surgical-cardiac category had the highest rate of survival to discharge compared to medical-cardiac and non-cardiac categories (56% vs. 43% vs. 46%; p<0.001). After controlling for age, location of event, and hospital size, the odds of survival were highest for surgical-cardiac category (aOR 1.28, 95% CI 1.16-1.40) and lower for medical-cardiac category (aOR 0.87, 0.80-0.95), compared to the non-cardiac category. Odds of survival increased for all illness categories from the 2000-2004 era to the 2015-2021 era. Rates of improvement differed among illness categories with medical-cardiac having the lowest increased odds per era. Surgical-cardiac patients had the highest rates of extracorporeal resuscitation (ECPR) (20% across the cohort), though the greatest increase in ECPR utilization was in the non-cardiac population (44% increased odds per era). ConclusionsOver the last 20 years, both survival to hospital discharge and ECPR use has increased in all IHCA illness categories. Children with surgical-cardiac IHCA have higher odds of survival to hospital discharge compared to non-cardiac IHCA categories, whereas odds of survival were lowest with medical-cardiac IHCA.