Background: The outcome of cardiopulmonary resuscitation (CPR) in a pediatric cardiac intensive care unit is unknown. The reported incidence of CPR in general pediatric intensive care unit is between 1.4% and 6.0%, and CPR success and survival rates vary from 12% to 64% and 9% to 31% respectively. The objective of this study was to determine the rates of success and survival of children who had CPR in a specialized cardiac intensive care unit setting, and define the influence of pre-arrest variables, if any, on the outcome.

Methods: We reviewed the medical records of all children admitted between June 1995 to June 1997 who had cardiopulmonary arrest (CPA) in the cardiac intensive care unit (CICU) and required CPR. Cardiopulmonary arrest was defined as cessation of circulation and respiration of any duration that required CPR. An arrest that occurred 2 hours after the first arrest was considered as a separate arrest. All patients underwent pediatric advanced life support techniques. Several pre-arrest variables (age, cardiac surgery, level of inotropic support) as well as the initial causes of arrest were evaluated. Success of CPR was defined as return of spontaneous circulation(ROSC) or initiation of effective mechanical cardiopulmonary support (CPS). Survival was defined as discharge from the hospital.

Results: During this study, of the 786 patients admitted to the CICU, 32 (4%) had 38 episodes of CPA. The age of the patients ranged from 1 day to 21 years (mean of 3.5 years). Twenty five patients (78%) had cardiac surgery prior to CPA. Epinephrine was continuously infused during 18 of the 38(47%) episodes. Of the 38 episodes, 24 (63%)were successfully resuscitated (20 to ROSC and 4 to CPS) and 16 (42%) survived to discharge. All 4 patients placed on CPS survived to discharge. Patients who had previous cardiac surgery had CPR success and survival rates of 65% and 46% respectively, whereas patients without a previous cardiac surgery had lower success (58%) and survival (33%) rates.

Conclusion: The incidence of CPA in our pediatric cardiac intensive care unit is similar to the incidence reported from general pediatric intensive care units. Previous cardiac surgery or the administration of continuous infusion of epinephrine at the time of CPR did not influence the outcome of CPR. Survival rate of CPR in this particular pediatric cardiac intensive care unit is higher than that reported from general pediatric intensive care units. The use of effective mechanical cardiopulmonary support improves the outcome of patients who undergo CPR.