Epidemiologic Trends of Adoption of Do-Not-Resuscitate Status After Pediatric In-Hospital Cardiac Arrest*. Issue 9 (September 2019)

• Record Type: Journal Article
• Authors: Gupta, Punkaj; Rettiganti, Mallikarjuna; Gossett, Jeffrey M.; Nadkarni, Vinay M.; Berg, Robert A.; Raymond, Tia T.; Parshuram, Christopher S.
• Is Part Of: Pediatric critical care medicine. Volume 20:Issue 9(2019)
• Publication Date: 2019-09
• Subjects: cardiac arrest -- children -- do-not-resuscitate -- epidemiologic trends -- mortality; Pediatric intensive care -- Periodicals; Pediatric emergencies -- Periodicals; 618.05
• DOI: 10.1097/PCC.0000000000002048
• Languages: English
• ISSNs: 1529-7535

Abstract

Abstract : Objectives: To evaluate the prevalence of do-not-resuscitate status, assess the epidemiologic trends of do-not-resuscitate status, and assess the factors associated with do-not-resuscitate status in children after in-hospital cardiac arrest using large, multi-institutional data. Design: Generalized estimating equations logistic regression model was used to evaluate the trends of do-not-resuscitate status and evaluate the factors associated with do-not-resuscitate status after cardiac arrest. Setting: American Heart Association's Get With the Guidelines-Resuscitation Registry. Patients: Children (< 18 yr old) with an index in-hospital cardiac arrest and greater than or equal to 1 minute of documented chest compressions were included (2006–2015). Patients with no return of spontaneous circulation after cardiac arrest were excluded. Interventions: None. Measurements and Main Results: In total, 8, 062 patients qualified for inclusion. Of these, 1, 160 patients (14.4%) adopted do-not-resuscitate status after cardiac arrest. We found low rates of survival to hospital discharge among children with do-not-resuscitate status (do-not-resuscitate vs no do-not-resuscitate: 6.0% vs 69.7%). Our study found that rates of do-not-resuscitate status after cardiac arrest are highest in children with Hispanic ethnicity (16.4%), white race (15.0%), and treatment at institutions with larger PICUs (> 50 PICU beds: 17.8%) and at institutions located in North Central (17.6%) and South Atlantic/Puerto Rico (17.1%) regions of the United States. Do-not-resuscitate status was more common among patients with more preexisting conditions, longer duration of cardiac arrest, greater than 1 cardiac arrest, and among patients requiring extracorporeal cardiopulmonary resuscitation. We also found that trends of do-not-resuscitate status after cardiac arrest in children are decreasing in recent years (2013–2015: 13.8%), compared with previous years (2006–2009: 16.0%). Conclusions: Patient-, hospital-, and regional-level factors are associated with do-not-resuscitate status after pediatric cardiac arrest. As cardiac arrest might be a signal of terminal chronic illness, a timely discussion of do-not-resuscitate status after cardiac arrest might help families prioritize quality of end-of-life care. Abstract : Supplemental Digital Content is available in the text.