Pediatric In-Hospital Acute Respiratory Compromise: A Report From the American Heart Association's Get With the Guidelines-Resuscitation Registry

Pediatr Crit Care Med. 2017 Sep;18(9):838-849. doi: 10.1097/PCC.0000000000001204.


Objectives: The main objectives of this study were to describe in-hospital acute respiratory compromise among children (< 18 yr old), and its association with cardiac arrest and in-hospital mortality.

Design: Observational study using prospectively collected data.

Setting: U.S. hospitals reporting data to the "Get With The Guidelines-Resuscitation" registry.

Patients: Pediatric patients (< 18 yr old) with acute respiratory compromise. Acute respiratory compromise was defined as absent, agonal, or inadequate respiration that required emergency assisted ventilation and elicited a hospital-wide or unit-based emergency response.

Interventions: None.

Measurements and main results: The primary outcome was in-hospital mortality. Cardiac arrest during the event was a secondary outcome. To assess the association between patient, event, and hospital characteristics and the outcomes, we created multivariable logistic regressions models accounting for within-hospital clustering. One thousand nine hundred fifty-two patients from 151 hospitals were included. Forty percent of the events occurred on the wards, 19% in the emergency department, 25% in the ICU, and 16% in other locations. Two hundred eighty patients (14.6%) died before hospital discharge. Preexisting hypotension (odds ratio, 3.26 [95% CI, 1.89-5.62]; p < 0.001) and septicemia (odds ratio, 2.46 [95% CI, 1.52-3.97]; p < 0.001) were associated with increased mortality. The acute respiratory compromise event was temporally associated with a cardiac arrest in 182 patients (9.3%), among whom 46.2% died. One thousand two hundred eight patients (62%) required tracheal intubation during the event. In-hospital mortality among patients requiring tracheal intubation during the event was 18.6%.

Conclusions: In this large, multicenter study of acute respiratory compromise, 40% occurred in ward settings, 9.3% had an associated cardiac arrest, and overall in-hospital mortality was 14.6%. Preevent hypotension and septicemia were associated with increased mortality rate.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Acute Disease
  • Adolescent
  • American Heart Association
  • Child
  • Child, Preschool
  • Female
  • Heart Arrest / etiology*
  • Heart Arrest / mortality
  • Hospital Mortality*
  • Hospitalization
  • Humans
  • Infant
  • Infant, Newborn
  • Logistic Models
  • Male
  • Registries
  • Respiration, Artificial
  • Respiratory Insufficiency / complications
  • Respiratory Insufficiency / diagnosis
  • Respiratory Insufficiency / epidemiology*
  • Respiratory Insufficiency / therapy
  • Treatment Outcome
  • United States / epidemiology