Dataset Information

Predictors and outcome of cardiac arrest in paediatric patients presenting to emergency medicine department of tertiary hospitals in Tanzania.

ABSTRACT:

Background

The survival of children who suffer cardiac arrest is poor. This study aimed to determine the predictors and outcome of cardiac arrest in paediatric patients presenting to an emergency department of a tertiary hospital in Tanzania.

Methodology

This was a prospective cohort study of paediatric patients > 1 month to ≤ 14 years presenting to Emergency Medicine Department of Muhimbili National Hospital (EMD) in Tanzania from September 2019 to January 2020 and triaged as Emergency and Priority. We enrolled consecutive patients during study periods where patients' demographic and clinical presentation, emergency interventions and outcome were recorded. Logistic regression analysis was performed to identify the predictors of cardiac arrest.

Results

We enrolled 481 patients, 294 (61.1%) were males, and the median age was 2 years [IQR 1-5 years]. Among studied patients, 38 (7.9%) developed cardiac arrest in the EMD, of whom 84.2% were ≤ 5 years. Referred patients were over-represented among those who had an arrest (84.2%). The majority 33 (86.8%) of those who developed cardiac arrest died. Compromised circulation on primary survey (OR 5.9 (95% CI 2.1-16.6)), bradycardia for age on arrival (OR 20.0 (CI 1.6-249.3)), hyperkalemia (OR 8.2 (95% CI 1.4-47.7)), elevated lactate levels > 2 mmol/L (OR 5.2 (95% CI 1.4-19.7)), oxygen therapy requirement (OR 5.9 (95% CI 1.3-26.1)) and intubation within the EMD (OR 4.8 (95% CI 1.3-17.6)) were independent predictors of cardiac arrest.

Conclusion

Thirty-eight children developed cardiac arrest in the EMD, with a very high mortality. Those who arrested were more likely to present with signs of hypoxia, shock and acidosis, which suggest they were at later stage in their illness. Outcomes can be improved by strengthening the pre-referral care and providing timely critical management to prevent cardiac arrest.

SUBMITTER: Yussuf AO

PROVIDER: S-EPMC9277961 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectivesBrought in dead (BID) presentation is profoundly related to prehospital variables including disease-related determinants and social and system-related factors. Identifying these factors would help us recognise various gaps in health services.SettingTertiary paediatric emergency department (ED) in north India.PatientsChildren aged 12 years or younger presented in cardiac arrest between April 2016 and March 2017 were prospectively enrolled irrespective of outcome of cardiopulmonary resuscitation (CPR). Data were collected from multiple sources including referral documents, direct interview from parents and field observations at the referring facility.ResultsOf 100 BID cases enrolled, 55 were neonates. Low birth weight (n=43, 78%) and malnutrition (n=31, 69%) were respectively common in neonates and postneonatal children. The most frequent symptom was breathing difficulty (n=80). Common diagnoses included respiratory distress syndrome (n=21, 38%), birth asphyxia (n=19, 35%) and sepsis (n=11, 20%) in neonates, and pneumonia (n=11, 25%), congenital heart disease (n=6, 13%) and acute gastroenteritis (n=5, 11%) in postneonatal children. Eighty-nine cases were referred from another healthcare facility, majority after first healthcare contact (n=77, 87%). Progressive severity of illness (n=61, 71%) and lack of expertise for acute care (n=35, 39%) were the common reasons for referral. Ambulance (n=77) was the most common mode of transport; median (IQR) distance and duration of travel were 80 (25-111.5) km and 120 (60-180) min, respectively. Respiratory support during transport included supplemental nasal oxygen (n=41, 46%) and bag and tube ventilation (n=30, 34%). Clinical deterioration was recognised in 62 children during transport, only five received CPR en route. Ninety-five children underwent CPR at the referral centre, two had return of spontaneous circulation.ConclusionSocial and system-related factors contribute to children presenting to ED in BID state. Streamlining the referral process and linking transport to hospital care could reduce decompensated referrals and thereby decrease child mortality.