For kids who had cardiac arrest with cardiopulmonary resuscitation (CPR) at night, rate of surviving to discharge was lower with during the daytime and evening, finds study published in JAMA Pediatrics.
Nearly 6,000 children in the United States receive CPR in the hospital each year and many of these children do not survive to be discharged from the hospital. Some studies of adults have suggested patients have worse outcomes when they have cardiac arrest at night.
Farhan Bhanji, M.D., M.Sc.(Ed.), F.R.C.P.C., of McGill University, Montreal, Canada, and coauthors used the American Heart Association's Get With the Guidelines Resuscitation registry, a large multicenter registry of in-hospital cardiac arrests, to examine survival rates for hospitalized children who had cardiac arrest by the time of day and day of the week.
Of the 12,404 children, 8,731 (70.4 percent) experienced a return of circulation that lasted more than 20 minutes, 7,248 (58.4 percent) survived for 24 hours and 4,488 (36.2 percent) survived to hospital discharge, according to the results.
After adjusting for potential mitigating factors, the rate of survival to hospital discharge was about 12 percent lower during nights than during days and evenings but was not different between weekends and weekdays, the authors report. "Although the absolute rate of survival to hospital discharge was lower on weekends than weekdays, this difference did not reach statistical significance when adjusted for confounding factors," the authors write. The study also acknowledges several limitations, including an inability to identify underlying causes for the differences in survival.
"This is especially pertinent because suboptimal resuscitative efforts are a potentially preventable harm. Assuming an annual CPR rate of 6,000 events per year, we found that simply improving overall survival (currently at 36.2%) to match the weekday daytime epoch survival (41.1%) would result in almost 300 additional children's lives saved per year in the United States. These findings may have important implications for hospital staffing, training, and resource allocation," according to the paper.
The study concludes: "Discrepancy between daytime and nighttime outcomes represents an important patient safety concern that warrants further investigation."