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IOWA CITY – More children are surviving in-hospital cardiac arrest than they did one decade ago, according to a University of Iowa-led study of data from hospitals using resuscitation guidelines from the American Heart Association.
Lead author Dr. Saket Girotra, an interventional cardiologist at UI Hospitals & Clinics in Iowa City, said three times as many children survived in 2009, as compared to 2000 in the 12 hospitals in the Heart Association's “Get with the Guidelines” registry.
In 2000, just 14.3 percent of children survived to be released from the hospital after suffering cardiac arrest, a condition in which the heart stops beating. By 2009, that increased to 43.4 percent of children.
“We need to better understand what led to the improvement,” Girotra said, noting that it was unknown what specific practices at participating hospitals were driving that improvement in survival.
While neurological damage that occurs during cardiac arrest can lead to significant disability, among the 359 surviving children of 1,031 in the study, the risk of brain impairment remained unchanged.
Girotra said most children who suffer in-hospital cardiac arrest are already critically ill, with respiratory illness such as pneumonia or severe infections. Others have had heart surgery or are receiving care for conditions such as heart failure.
The Heart Association's guidelines include early recognition of cardiac arrest with the use of monitoring systems; high-quality chest compressions; timely defibrillation in patients with shockable heart rhythms and appropriate use of medicines during cardiac arrest.
Girotra said results also showed improvement in a study of adult patients with cardiac arrest at hospitals in the database.
The rate of survival among adults increased from 13.7 percent in 2000 to 22.3 percent in 2009 among nearly 85,000 patients. That study was published last month in the New England Journal of Medicine.
Among adults, the rate of neurological disability decreased from 32.9 percent in 2000 to 28.1 percent in 2009.
“It's a pretty dramatic magnitude of improvement,” Girotra said. “Not only were more people living, but there was a greater chance they would have good neurological function.”
Girotra said it will be important to study the underlying reasons for the improved outcomes.
“What kind of processes do they have in place that allows them to perform better than the average hospital,” he said.