Nneka Edwards-Jackson1, Krysten North2, Msandeni Chiume3, Wisdom Nakanga4, Charles Schubert5,6, Amber Hathcock7, Ajib Phiri8, Michelle Eckerle5,6. 1. Department of Paediatrics, Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA. 2. Department of Paediatrics, Division of Neonatology, University of North Carolina, Chapel Hill, NC, USA. 3. Department of Paediatrics, Kamuzu Central Hospital, Lilongwe, Malawi. 4. Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi. 5. Department of Paediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 6. Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA. 7. Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, USA. 8. College of Medicine, University of Malawi, Blantyre, Malawi.
Abstract
Background: There are scarce data on outcomes of in-hospital paediatric cardiac arrest (CA) in resource-poor settings and none for World Bank-defined low-income countries.Aim: To report the outcomes of in-hospital paediatric CA from a university-affiliated referral hospital in Malawi. Methods: Data were collected prospectively on patients aged 30 days to 13 years who experienced CA and underwent cardiopulmonary resuscitation (CPR) at Kamuzu Central Hospital in Lilongwe, Malawi from January through June 2017. Utstein-style reporting guidelines for CAs were used to define outcomes; the primary outcome was survival to hospital discharge. A data collection form was used to record patient, arrest and resuscitation characteristics. Results: A total of 135 patients fulfilled the criteria for inclusion in the study. Resuscitation outcomes are presented in Figure 1 using a modified Utstein template. In-hospital CA was associated with 100% mortality. Return of spontaneous circulation (ROSC) was obtained in 6% of patients and sustained ROSC in 4%; 24-h survival was zero. The most common admission diagnosis was malaria (51%). Most arrests occurred on the paediatric ward (90%) rather than critical care units. Most resuscitations were led by trainees and mid-level providers (58%) rather than paediatricians (23%). Conclusion: Survival following in-hospital paediatric CA was zero, suggesting that CPR may have no benefit in this tertiary hospital. Future efforts to improve outcomes should focus on advocating better pre-arrest care and research interventions aimed to identify and treat children at risk of CA within the resource constraints of this setting.
Background: There are scarce data on outcomes of in-hospital paediatric cardiac arrest (CA) in resource-poor settings and none for World Bank-defined low-income countries.Aim: To report the outcomes of in-hospital paediatric CA from a university-affiliated referral hospital in Malawi. Methods: Data were collected prospectively on patients aged 30 days to 13 years who experienced CA and underwent cardiopulmonary resuscitation (CPR) at Kamuzu Central Hospital in Lilongwe, Malawi from January through June 2017. Utstein-style reporting guidelines for CAs were used to define outcomes; the primary outcome was survival to hospital discharge. A data collection form was used to record patient, arrest and resuscitation characteristics. Results: A total of 135 patients fulfilled the criteria for inclusion in the study. Resuscitation outcomes are presented in Figure 1 using a modified Utstein template. In-hospital CA was associated with 100% mortality. Return of spontaneous circulation (ROSC) was obtained in 6% of patients and sustained ROSC in 4%; 24-h survival was zero. The most common admission diagnosis was malaria (51%). Most arrests occurred on the paediatric ward (90%) rather than critical care units. Most resuscitations were led by trainees and mid-level providers (58%) rather than paediatricians (23%). Conclusion: Survival following in-hospital paediatric CA was zero, suggesting that CPR may have no benefit in this tertiary hospital. Future efforts to improve outcomes should focus on advocating better pre-arrest care and research interventions aimed to identify and treat children at risk of CA within the resource constraints of this setting.
Authors: Amne O Yussuf; Said S Kilindimo; Hendry R Sawe; Elishah N Premji; Hussein K Manji; Alphonce N Simbila; Juma A Mfinanga; Ellen J Weber Journal: BMC Emerg Med Date: 2022-07-12
Authors: Matthew F Yuyun; Aimé Bonny; G André Ng; Karen Sliwa; Andre Pascal Kengne; Ashley Chin; Ana Olga Mocumbi; Marcus Ngantcha; Olujimi A Ajijola; Gene Bukhman Journal: Glob Heart Date: 2020-05-08