Predicting cardiac arrests in pediatric intensive care units

Murray M Pollack, Richard Holubkov, Robert A Berg, Christopher J L Newth, Kathleen L Meert, Rick E Harrison, Joseph Carcillo, Heidi Dalton, David L Wessel, J Michael Dean
Resuscitation 2018, 133: 25-32

BACKGROUND: Early identification of children at risk for cardiac arrest would allow for skill training associated with improved outcomes and provides a prevention opportunity.

OBJECTIVE: Develop and assess a predictive model for cardiopulmonary arrest using data available in the first 4 h.

METHODS: Data from PICU patients from 8 institutions included descriptive, severity of illness, cardiac arrest, and outcomes.

RESULTS: Of the 10074 patients, 120 satisfying inclusion criteria sustained a cardiac arrest and 67 (55.9%) died. In univariate analysis, patients with cardiac arrest prior to admission were over 6 times and those with cardiac arrests during the first 4 h were over 50 times more likely to have a subsequent arrest. The multivariate logistic regression model performance was excellent (area under the ROC curve = 0.85 and Hosmer-Lemeshow statistic, p = 0.35). The variables with the highest odds ratio's for sustaining a cardiac arrest in the multivariable model were admission from an inpatient unit (8.23 (CI: 4.35-15.54)), and cardiac arrest in the first 4 h (6.48 (CI: 2.07-20.36). The average risk predicted by the model was highest (11.6%) among children sustaining an arrest during hours >4-12 and continued to be high even for days after the risk assessment period; the average predicted risk was 9.5% for arrests that occurred after 8 PICU days.

CONCLUSIONS: Patients at high risk of cardiac arrest can be identified with routinely available data after 4 h. The cardiac arrest may occur relatively close to the risk assessment period or days later.

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