Survival for children following in-hospital cardiac arrest may be lower if given CPR at night

After adjusting for numerous factors, children who received cardiopulmonary resuscitation (CPR) at night after in-hospital cardiac arrests had a lower rate of survival to hospital discharge compared to children who received CPR during the day or evening, according to a registry analysis.

The rate of survival was similar among children who received CPR during the week or on weekends following in-hospital cardiac arrest.

The researchers defined nighttime as between 11:00 p.m. and 6:59 a.m. and day/evening hours as 7:00 a.m. to 10:59 p.m. They also defined weekdays as 7:00 a.m. on Monday until 10:59 p.m. on Friday and weekends as 11:00 p.m. on Friday to 6:59 a.m. on Monday.

Lead researcher Farhan Bhanji, MD, of McGill University in Montreal, Canada, and colleagues published their results online Nov. 7 in JAMA Pediatrics.

Most of the nearly 600,000 children in the U.S. who receive CPR each year do not survive to hospital discharge, according to the researchers.

For this analysis, the researchers analyzed data on 12,404 children who were part of the American Heart Association’s Get With the Guidelines–Resuscitation (GWTG-R) registry of in-hospital cardiac arrests. They included children from 354 hospitals who received CPR for at least two minutes from 2000 to 2012.

Of the children, 70.4 percent experienced a return of circulation lasting more than 20 minutes, 58.4 percent survived for 24 hours and 36.2 percent survived to hospital discharge. More than 69 percent of the events occurred during the day or evening. Children who had CPR at night were similar to those who had CPR during the day or evening with regards to age, sex, hypotensive cause of the cardiac arrest and first documented rhythm.

The unadjusted rate of survival to hospital discharge was 33.9 percent for children who had CPR at night and 37.2 percent for children who had CPR during the day or evening. Meanwhile, the unadjusted rate of survival to hospital discharge was 33.2 percent on weekends and 37.5 percent on weekdays.

After adjusting for potential patient-, event- and hospital-related confounders, the rate of survival to hospital discharge remained significantly lower at night than during the day and evening. However, the rate of survival was not significantly different on weekdays and weekends.

The researchers cited a few limitations of the study, including that participation in the registry was voluntary. In addition, the data was collected during a long period of time when CPR trends and practice might have changed. They also acknowledged there could have been unmeasured confounding variables. Further, the study did not identify underlying causes for the differences in survival.

“Discrepancy between daytime and nighttime outcomes represents an important patient safety concern that war- rants further investigation,” the researchers wrote.