Key statistics from the National Cardiac Arrest Audit: Paediatric arrests April 2012 to March 2017
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1 Key statistics from the National Cardiac Arrest Audit: Paediatric arrests April 12 to March 17 Supported by Resuscitation Council (UK) and Intensive Care National Audit & Research Centre (ICNARC)
2 Data collection scope (NCAA Version 1.3) NCAA data are collected for all individuals (excluding neonates) receiving chest compression(s) and/or defibrillation and attended by the hospital-based resuscitation team (or equivalent) in response to a 2222 call. Available data This report is based on data for in-hospital cardiac arrests of children aged less than 16 years in NHS paediatric and acute general hospitals. The following team visits were therefore excluded: Team visits taking place in specialist or non-acute hospitals Team visits to adults aged 16 years and above Team visits (meeting the scope of NCAA) in response to pre-hospital cardiac arrests Time period Children s hospitals Acute general hospitals Number of children s hospitals participating in NCAA Total number of reported paediatric in-hospital cardiac arrests Number of acute general hospitals participating in NCAA Total number of reported paediatric in-hospital cardiac arrests April 12 March April 16 March April 15 March April 14 March April 13 March April 12 March NCAA 17
3 Number of paediatric in-hospital cardiac arrests attended by the team Number of in-hospital cardiac arrests attended by the team Apr-Jun 12 Jul-Sep 12 Oct-Dec 12 Jan-Mar 13 Apr-Jun 13 Jul-Sep 13 Oct-Dec 13 Quarterly number Jan-Mar 14 Apr-Jun 14 Jul-Sep 14 Oct-Dec 14 Jan-Mar 15 Apr-Jun 15 Jul-Sep 15 Oct-Dec 15 Quarter of 2222 call Average over period Jan-Mar 16 Apr-Jun 16 Jul-Sep 16 Oct-Dec 16 Jan-Mar 17 NCAA 17 Note: number of hospitals participating in NCAA has increased over time 3 NCAA 17
4 Patient characteristics Age (years), n (%) <1 487 (47.7) (27.) (15.2) (1.2) Mean (SD) 3 (4.4) Median (IQR) 1 (, 5) Sex, n (%) Female 445 (43.5) Male 577 (56.5) Reason for admission to/attendance at/visit to your hospital, n (%) Patient - trauma 21 (2.1) Patient - medical 835 (81.7) Patient - elective/scheduled surgery 73 (7.1) Patient - emergency/urgent surgery 85 (8.3) Outpatient 8 (.8) IQR, interquartile range; SD, standard deviation. 4 NCAA 17
5 Trends in patient characteristics Mean age 4 3 Mean age (years) 2 1 NCAA 17 Sex: Male Sex: Male (%) NCAA 17 Reason for attendance: Medical 1 Reason for attendance: Medical (%) NCAA 17 5 NCAA 17
6 Team visit characteristics Number of days from admission to 2222 call, n (%) 443 (43.3) (11.8) (16.6) (12.7) >3 158 (15.5) Mean (SD) 22.6 (84.1) Median (IQR) 1 (, 11) Location of arrest, n (%) Emergency department 297 (29.1) Emergency admissions unit 1 (1.) Theatre & recovery 45 (4.4) Imaging department 19 (1.9) Cardiac catheter laboratory 6 (.6) Specialist treatment area 5 (.5) ICU or ICU/HDU 3 (2.9) HDU 8 (.8) PICU 164 (16.) PHDU 89 (8.7) Coronary care unit 1 (.1) Other intermediate care area 7 (.7) Obstetrics area 1 (.1) Ward 33 (32.3) Other internal location 1 (.1) Clinic 5 (.5) Non-clinical area 3 (.3) Missing 1 (.1) Status at team arrival, n (%) Dead - resuscitation stopped 6 (.6) Resuscitation ongoing 752 (73.6) ROSC achieved before team arrival 152 (14.9) Deteriorating (not yet arrested) 112 (11.) Presenting/first documented rhythm, n (%) Shockable - VF 21 (2.1) Shockable - VT (2.) Shockable - unknown rhythm 4 (.4) Non-shockable - asystole 245 (24.) Non-shockable - PEA 314 (3.7) Non-shockable - bradycardia 281 (27.5) Non-shockable - unknown rhythm 39 (3.8) Never determined 34 (3.3) Unknown 64 (6.3) HDU, high dependency unit; ICU, intensive care unit; IQR, interquartile range; PEA, pulseless electrical activity; PHDU, paediatric high dependency unit; PICU, paediatric intensive care unit; ROSC, return of spontaneous circulation; SD, standard deviation; VF, ventricular fibrillation; VT, ventricular tachycardia. 6 NCAA 17
7 Trends in team visit characteristics Mean number of days from admission to 2222 call Mean number of days from admission to 2222 call 3 1 NCAA 17 Location of arrest: Ward Location of arrest: Ward (%) 3 1 NCAA 17 Status at team arrival: Resuscitation ongoing Status at team arrival: Resuscitation ongoing (%) NCAA 17 7 NCAA 17
8 Presenting/first documented rhythm Percentage of in-hospital cardiac arrests 3 1 Shockable - VF/VT Non-shockable - asystole Non-shockable - PEA NCAA 17 8 NCAA 17
9 Outcomes Reason resuscitation stopped at end of team visit, n (%) Alive - ROSC > minutes 69 (67.5) Dead - ROSC < minutes 28 (2.7) Dead - no ROSC 263 (25.7) Dead - DNACPR 7 (.7) Dead - futility 34 (3.3) Post-arrest location, n (% of ROSC > minutes) Emergency admissions unit 2 (.3) ICU or ICU/HDU 59 (8.6) HDU 8 (1.2) PICU 297 (43.) PHDU 54 (7.8) CCU 3 (.4) Other intermediate care area 5 (.7) Obstetrics area 2 (.3) Ward 89 (12.9) Other internal location 1 (.1) Mortuary 14 (2.) Other hospital 156 (22.6) Paediatric CPC at hospital discharge, n (% of survivors) (.6) 2 32 (1.1) 3 19 (6.) 4 15 (4.7) 5 19 (6.) Missing (12.6) CPC, cerebral performance category; DNACPR, do not attempt cardiopulmonary resuscitation; HDU, high dependency unit; ICU, intensive care unit; PHDU, paediatric high dependency unit; PICU, paediatric intensive care unit; ROSC, return of spontaneous circulation. 9 NCAA 17
10 Outcome flow All percentages are reported as the percentage of all individuals (N=953). 1 NCAA 17
11 Trends in outcomes Reason resuscitation stopped: ROSC > minutes ROSC > minutes (%) NCAA 17 Post-arrest location: PICU 5 Post-arrest location: PICU (% of ROSC > minutes) 3 1 NCAA 17 Survival to hospital discharge Survival to hospital discharge (% of individuals) NCAA NCAA 17
12 Paediatric CPC at hospital discharge (survivors) 1 Percentage of paediatric survivors CPC 1 or 2 CPC 3 or 4 or 5 CPC missing NCAA NCAA 17
13 Outcomes by patient subgroups ROSC > minutes Subgroup Number of in-hospital cardiac arrests* Number with ROSC > min Percentage (95% confidence interval) Overall 1, (64.6, 7.3) By presenting rhythm: Shockable - VF/VT (.7, 86.2) Non-shockable - asystole (31.7, 43.8) Non-shockable - PEA (59.5, 7.) By age group (years): < (7.1, 77.8) (58.3, 69.6) (49.5, 64.9) (51., 69.4) PEA, pulseless electrical activity; ROSC, return of spontaneous circulation; VF, ventricular fibrillation; VT, ventricular tachycardia. Survival to hospital discharge Subgroup Number of individuals* Number of hospital survivors Percentage (95% confidence interval) Overall (48.7, 55.1) By presenting rhythm: Shockable - VF/VT (54.2, 82.5) Non-shockable - asystole (19.6, 3.6) Non-shockable - PEA (39.2, 5.6) By age group (years): < (54.4, 63.7) (43.6, 55.7) (33.1, 48.7) (33.9, 53.2) PEA, pulseless electrical activity; VF, ventricular fibrillation; VT, ventricular tachycardia. * Excluding individuals still in hospital (N=22) 13 NCAA 17
14 Trends in outcomes by patient subgroups ROSC > minutes by presenting/first documented rhythm 1 ROSC > minutes (%) Shockable - VF/VT Non-shockable - asystole Non-shockable - PEA ROSC > minutes by age group NCAA 17 ROSC > minutes (%) < NCAA NCAA 17
15 Survival to hospital discharge by presenting/first documented rhythm 1 Survival to hospital discharge (% of individuals) Shockable - VF/VT Non-shockable - asystole Non-shockable - PEA Survival to hospital discharge by age group NCAA 17 Survival to hospital discharge (% of individuals) < NCAA NCAA 17
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