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An evaluation of pediatric in-hospital advanced life support interventions using the pediatric Utstein guidelines: a review of 203 cardiorespiratory arrests

[Une évaluation des interventions de réanimation cardiorespiratoire avancée en pédiatrie hospitalière à l’aide des directives Utstein pour enfants : une revue de 203 cas]

Joanne Guay, MD FRCPC^* and Louise Lortie, RN

^* From the Department of Anesthesia and Pediatrics, Maisonneuve-Rosemont Hospital; and
The Research Center, Ste-Justine Hospital, University of Montreal, Montreal, Quebec, Canada.

Address correspondence to: Dr. Joanne Guay, Department of Anesthesia, Maisonneuve-Rosemont Hospital, 5415 l’Assomption Boulevard, Montreal, Quebec H1T 2M4, Canada. Phone: 514-252-3426, Fax: 514-252-3542; E-mail: joanne.guay{at}umontreal.ca

Purpose: Evaluate the efficacy of advanced life support interventions using the pediatric Utstein guidelines.

Methods: Charts from all patients for whom a cardiorespiratory arrest code was called during a six-year period in a university affiliated centre were reviewed. Data were recorded according to the pediatric Utstein guidelines and a P < 0.05 was considered significant.

Results: Of the 234 calls, 203 were retained for analysis. The overall survival rate at one year was 26.0% of which 10% had deterioration of their neurologic status compared to the pre-cardiorespiratory arrest evaluation. Time to achieve sustained return of spontaneous circulation (ROSC; P < 0.0001) and sustained measurable blood pressure (P = 0.002), to perform endotracheal intubation (P = 0.04) and the dose of sodium bicarbonate (P < 0.0001) were indicators of long-term survival. Two patients were alive at one year with unchanged neurologic status despite a time to achieve sustained ROSC longer than 30 min (38 and 44 min). The mean first epinephrine dose of patients for whom ROSC was achieved but unsustained was higher than those for whom ROSC was achieved and sustained (0.038 ± 0.069 mg•kg^–1 vs 0.011 ± 0.006 mg•kg^–1; P = 0.004). Survival rate and mean first epinephrine dose of patients who received their first epinephrine dose endotracheally (13.3%; 0.011 ± 0.004 mg•kg^–1) were comparable to those of patients who received their first epinephrine dose intravenously (7%; 0.015 ± 0.027 mg•kg^–1).

Conclusions: For intravenously administered epinephrine, a dose of 0.01 mg•kg^–1 seems appropriate as the first dose. The endotracheal route is a valuable alternative for epinephrine administration and, for infants, the dose does not need to be increased. A minimal resuscitation duration time of 30 min can be misleading if ROSC is used as the indicator.

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