Outcomes of in-hospital paediatric cardiac arrest from a tertiary hospital in a low-income African country

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.

KEYWORDS:

• Cardiac arrest
• paediatric
• cardiopulmonary resuscitation
• low-income county
• low-resource setting
• sub-Saharan Africa
• Utstein guidelines
• critical care

Acknowledgments

We would like to acknowledge Tiyamike Kachula for her assistance with data collection, and Dr Armand Antommaria for his contribution to the discussion of medical ethics.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Notes on contributors

Nneka Edwards-Jackson

Dr. Nneka Edwards-Jackson, is a General Pediatrician who currently works as a Pediatric Hospitalist at Children’s Hospital Los Angeles. She received her medical degree from Columbia University College of Physicians & Surgeons and underwent residency training at University of California San Francisco. She worked at Kamuzu Central Hospital in Lilongwe, Malawi from September 2015 to December 2016, through an affiliation with Cincinnati Children’s Hospital Medical Center and later Baylor College of Medicine Children’s Foundation of Malawi. Her research interests include cardiopulmonary resuscitation outcomes in low-resource settings and health disparities among low-income and minority child populations in the United States.