(1518) The Impact of Early Infections on Survival After Pediatric Out-of-Hospital Cardiac Arrest

Introduction: Rates of survival following pediatric out-of-hospital cardiac arrest (OHCA) remain low. Infections are common after adult OHCA and negatively affect outcomes, but the impact on children is unknown. We hypothesized that presence of a bacterial infection in the first 48 hours after pediatric OHCA is associated with decreased survival to ICU and hospital discharge.

Methods: Retrospective cohort study of 99 children admitted to a single pediatric ICU between 2017-2022 after OHCA. Invasive bacterial infections in the first 48 hours were defined using standardized definitions and classified into 2 groups: “definite/probable” or “possible/no infection” based on chart review. Non-parametric descriptive statistics were used to compare clinical and demographic characteristics. Multivariate logistic regression was used for the primary outcome of survival to ICU discharge.

Results: Of the 99 patients admitted after OHCA, patients were mostly male (69%), White (44%), previously healthy (38%) and an average of 3.5 years old (1.05-11.5 yr). Arrests were most commonly caused by respiratory failure (34%) or drowning (25%) with an average CPR time of 10 minutes (3-30 min). Blood cultures were obtained in 55%, urine in 35%, respiratory in 26%, and CSF in 4% of patients. 19 patients (19%) were identified as having a “definite/probable” bacterial infection, including 1% (n=1) bacteremia and 22% (n=18) pneumonia. No patients met criteria for urinary tract infection or meningitis. Patients with a “definite/probable” infection had lower odds of survival to 24 hours of admission (63% vs. 95%, p< 0.001) and to ICU discharge (11% vs. 68%, p< 0.001) compared to patients with “possible/no” infection. In the multivariable model adjusted for age and CPR time, patients with “definite/probable” infections still had a lower odds of survival to ICU discharge (OR 0.09, CI 0.01-0.58).

Conclusions: In this single center, retrospective cohort study, we determined that infectious testing practices and antibiotic use were variable in children admitted after OHCA. Patients with “definite/probable” bacterial infections had a lower odds of survival compared to children without infections. Future multicenter work is needed to validate our findings and to further investigate the impact of early antibiotics following pediatric OHCA.