Abstract
BACKGROUND: Bradycardia with poor perfusion is the most common reason for in-hospital cardiopulmonary resuscitation (CPR) in children. To date, validated methods to risk-standardize pediatric survival rates for CPR events in hospitals that includes bradycardia with poor perfusion do not exist. METHODS: Within Get With the Guidelines-Resuscitation, we identified 8080 children who underwent CPR between 2016 and 2023. Using hierarchical logistic regression, we derived and validated a model for survival to hospital discharge to calculate risk-standardized survival rates (RSSRs) for hospitals. RESULTS: Bradycardia with poor perfusion comprised 56.4% of pediatric CPR events. An initial full model in the derivation cohort identified 16 predictors of survival (c-statistic = 0.772), and a parsimonious model with 13 predictors maintained good discrimination (c-statistic = 0.769). The model calibrated well in the validation cohort (R(2) = 0.993). Final predictors included: age group, illness category, initial rhythm, arrest location, renal insufficiency, hepatic insufficiency, sepsis, metabolic or electrolyte abnormality, metastatic or hematologic malignancy, cardiac acyanotic congenital abnormality, congenital noncardiac abnormality, and mechanical ventilation or continuous intravenous vasopressor at the time of the CPR event. Among 100 hospitals with ≥5 CPR events, the median RSSR was 51.8% (IQR: 50.1-54.5%; range: 40.5-62.9%). The adjusted median OR was 1.32 (95% CI: 1.18-1.43), which suggests that the odds of survival to discharge for two children with similar characteristics varied by 32% between hospitals. CONCLUSION: We developed and validated a model to risk-standardize hospital rates of survival for children undergoing CPR, including those with bradycardia and poor perfusion. This model can facilitate efforts to benchmark hospitals in resuscitation outcomes for children.