: There is limited data on paediatric resuscitation outcomes in Asia. We aimed to describe outcomes of paediatric in-hospital cardiac arrests (IHCA) and peri-resuscitation factors associated with mortality in our institution.: Using data from our hospital's code registry from 2009 to 2014, we analysed all patients younger than 18 years of age with IHCA who required cardiopulmonary resuscitation (CPR). Exposure variables were obtained from clinical demographics, CPR and post-resuscitation data. Outcomes measured were: survival after initial CPR event and survival to hospital discharge. We analysed categorical and continuous variables with Fisher's exact and Wilcoxon rank- sum tests respectively. Statistical significance was taken as<0.05.: We identified 51 patients in the study period. Median age of patients was 1.9 (interquartile range [IQR]: 0.3, 5.5) years. Twenty-six (51%) patients had bradycardia as the first-recorded rhythm. The most common pre-existing medical condition was respiratory-related (n = 25, 48%). Thirty-eight (75%) achieved sustained return of spontaneous circulation, 24 (47%) survived to paediatric intensive care unit (PICU) discharge and 23 (45%) survived to hospital discharge. Risk factors for hospital mortality included: age, duration of CPR, adrenaline, calcium or bicarbonate administration during CPR, Paediatric Index of Mortality (PIM)- II scores, first recorded post-resuscitation pH and hyperglycaemia within 24 hours of resuscitation.: We demonstrated an association between clinical demographics (age, PIM-II scores), CPR variables (duration of CPR and administration of adrenaline, calcium or bicarbonate) and post-resuscitation laboratory results (first recorded pH and hyperglycaemia within 24 hours) with PICU survival. The availability and quality of post- resuscitation care may have implications on survival after paediatric IHCA.
Adolescent ; Bicarbonates ; therapeutic use ; Calcium ; therapeutic use ; Cardiopulmonary Resuscitation ; methods ; Child ; Child, Preschool ; Epinephrine ; therapeutic use ; Female ; Heart Arrest ; mortality ; therapy ; Humans ; Hydrogen-Ion Concentration ; Hyperglycemia ; epidemiology ; Infant ; Infant, Newborn ; Male ; Patient Discharge ; Retrospective Studies ; Risk Factors ; Singapore ; epidemiology ; Survival Rate ; Sympathomimetics ; therapeutic use

Massive pulmonary embolism (PE) is associated with poor prognosis and high mortality. Moreover, patients with massive PE who present with shock have mortality rates ranging from 30% to 50%. Thrombolysis should be administered to patients with massive PE unless there are absolute contraindications to its use. However, treatment failure still occurs, and there is no consensus for the management of massive PE with cardiopulmonary arrest with regard to thrombolysis. In this study, two cases of massive PE with cardiopulmonary arrest are described, both of which were successfully treated with thrombolysis and hemodynamic support, which was administered by extracorporeal membrane oxygenation (ECMO). This report suggests that ECMO may provide safe and adequate cardiopulmonary support in patients with massive PE with refractory thrombolysis and cardiopulmonary arrest.
Consensus ; Extracorporeal Membrane Oxygenation ; Heart Arrest* ; Hemodynamics ; Humans ; Membranes* ; Mortality ; Oxygenators, Membrane* ; Prognosis ; Pulmonary Embolism* ; Shock ; Thrombolytic Therapy ; Treatment Failure

This retrospective observational study investigated the clinical course and predisposing factors of acute kidney injury (AKI) developed after cardiac arrest and resuscitation. Eighty-two patients aged over 18 yr who survived more than 24 hr after cardiac arrest were divided into AKI and non-AKI groups according to the diagnostic criteria of the Kidney Disease/Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for AKI. Among 82 patients resuscitated from cardiac arrest, AKI was developed in 66 (80.5%) patients (AKI group) leaving 16 (19.5%) patients in the non-AKI group. Nineteen (28.8%) patients of the AKI group had stage 3 AKI and 7 (10.6%) patients received renal replacement therapy during admission. The duration of shock developed within 24 hr after resuscitation was shorter in the non-AKI group than in the AKI group (OR 1.02, 95% CI 1.01-1.04, P < 0.05). On Multiple logistic regression analysis, the only predisposing factor of post-cardiac arrest AKI was the duration of shock. In conclusion, occurrence and severity of post-cardiac arrest AKI is associated with the duration of shock after resuscitation. Renal replacement therapy is required for patients with severe degree (stage 3) post-cardiac arrest AKI.
Acute Kidney Injury/*mortality/*therapy ; Aged ; Female ; Heart Arrest/*mortality/*therapy ; Humans ; Incidence ; Male ; Middle Aged ; Renal Replacement Therapy/mortality ; Republic of Korea/epidemiology ; Resuscitation/*mortality ; Retrospective Studies ; Risk Factors ; Severity of Illness Index ; Shock/*mortality ; Survival Rate ; Treatment Outcome

BACKGROUND: The purpose of the study was to evaluate the prevalence, related factors, and outcome of acute renal failure (ARF) developed in the patients who survived following a cardiac arrest. METHODS: A retrospective analysis of medical records was underwent in 24 patients who survived among 68 patients receiving cardiopulmonary resuscitation (CPR) at the emergency center of Inha-hospital, Sungnam, Korea, from January 1999 to February 2001. Clinical factors before, during and after CPR were compared and contrasted between the patients who manifested ARF after CPR and those who did not. RESULTS: ARF occurs at 33% following CPR. ARF group showed high baseline creatine kinase (CK) level, longer duration of resuscitation, and larger dosages of epinephrine usage during CPR. During 24 hours after CPR, mean arterial pressure and hourly urine output were significantly lower and dopamine was administered significantly higher in ARF group. Among them seven patients died in 2.3+/-0.8 hospital day with a mean serum creatinine of 2.8+/-1.7 mg/dL. None required renal replacement therapy in ARF group. Mean admission durations were 4.4+/-2.8 and 14.0+/-11.5 days. Survival rate was 12.5% in ARF group, which was significantly low compared to 75% in non-ARF group. CONCLUSION: In spite of high mortality rate in ARF group, ARF by itself was not a direct cause of death. We suggest that the development of ARF is a predicting but not a causative factor of death in the survivors following CPR.
Acute Kidney Injury ; Arterial Pressure ; Cardiopulmonary Resuscitation* ; Cause of Death ; Creatine Kinase ; Creatinine ; Dopamine ; Emergencies ; Epinephrine ; Gyeonggi-do ; Heart Arrest ; Humans ; Korea ; Medical Records ; Mortality ; Prevalence ; Renal Replacement Therapy ; Resuscitation ; Retrospective Studies ; Survival Rate ; Survivors

BACKGROUND: The purpose of the study was to evaluate the prevalence, related factors, and outcome of acute renal failure (ARF) developed in the patients who survived following a cardiac arrest. METHODS: A retrospective analysis of medical records was underwent in 24 patients who survived among 68 patients receiving cardiopulmonary resuscitation (CPR) at the emergency center of Inha-hospital, Sungnam, Korea, from January 1999 to February 2001. Clinical factors before, during and after CPR were compared and contrasted between the patients who manifested ARF after CPR and those who did not. RESULTS: ARF occurs at 33% following CPR. ARF group showed high baseline creatine kinase (CK) level, longer duration of resuscitation, and larger dosages of epinephrine usage during CPR. During 24 hours after CPR, mean arterial pressure and hourly urine output were significantly lower and dopamine was administered significantly higher in ARF group. Among them seven patients died in 2.3+/-0.8 hospital day with a mean serum creatinine of 2.8+/-1.7 mg/dL. None required renal replacement therapy in ARF group. Mean admission durations were 4.4+/-2.8 and 14.0+/-11.5 days. Survival rate was 12.5% in ARF group, which was significantly low compared to 75% in non-ARF group. CONCLUSION: In spite of high mortality rate in ARF group, ARF by itself was not a direct cause of death. We suggest that the development of ARF is a predicting but not a causative factor of death in the survivors following CPR.
Acute Kidney Injury ; Arterial Pressure ; Cardiopulmonary Resuscitation* ; Cause of Death ; Creatine Kinase ; Creatinine ; Dopamine ; Emergencies ; Epinephrine ; Gyeonggi-do ; Heart Arrest ; Humans ; Korea ; Medical Records ; Mortality ; Prevalence ; Renal Replacement Therapy ; Resuscitation ; Retrospective Studies ; Survival Rate ; Survivors