# Clinical outcomes of cardiac arrest in pediatric patients presenting to the emergency department of a tertiary hospital in Kabul, Afghanistan: a retrospective cohort study

## TL;DR

This study examines factors affecting survival and neurological outcomes in pediatric cardiac arrest cases in Kabul, identifying key interventions that improve outcomes.

## Contribution

The study identifies specific clinical factors associated with improved survival and neurological outcomes in pediatric cardiac arrest in a low-resource setting.

## Key findings

- 67% of pediatric patients achieved return of spontaneous circulation after CPR.
- Timely administration of epinephrine and shorter CPR duration were strongly associated with better outcomes.
- Early monitoring and rapid response times were linked to improved survival to hospital discharge.

## Abstract

Outcomes of pediatric cardiac arrest in our country remain suboptimal. Understanding the factors that influence these outcomes is essential for improving survival rates. This study aimed to evaluate the clinical outcomes of pediatric cardiac arrest in the emergency department and to identify the factors associated with these outcomes.

A retrospective cohort study was conducted involving patients aged < 18 years who underwent cardiopulmonary resuscitation (CPR) in the emergency department of the French Medical Institute for Mothers and Children (FMIC) in Kabul, Afghanistan, between January 2021 and January 2025. Data were collected using the Utstein style of reporting. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with survival outcomes.

Of the 200 patients who underwent CPR in the ED, sustained return of spontaneous circulation (ROSC) and survival to hospital discharge (STD) were achieved in 134 (67%) and 60 (30%) patients, respectively. Favorable neurological outcomes at hospital discharge were observed in 29 (14.5%) patients. Independent predictors of ROSC included IV/IO access established prior to arrest (AOR: 3.26, 95% CI: 1.68–6.3, p < 0.001), monitoring at the time of arrest (p = 0.003), administration of epinephrine during CPR (AOR: 18.3, 95% CI: 6.8–49.6, p < 0.001), endotracheal intubation during CPR (p < 0.001), and CPR duration ≤ 20 min (p < 0.001). Factors associated with survival to hospital discharge included response time ≤ 1 min (AOR: 7.2, 95% CI: 1.9–26.4, p = 0.003), time to first epinephrine dose ≤ 2 min (AOR: 5.3, 95% CI: 1.1–24.6, p = 0.03), administration of ≤ 2 doses of epinephrine during CPR (AOR: 5.3, 95% CI: 1.1–24.6, p = 0.03), CPR duration ≤ 15 min (p = 0.003), and post-resuscitation vasopressor/inotrope therapy (AOR: 5.79, 95% CI: 2.6–12.6, p < 0.001).

Factors associated with favorable post-cardiac arrest outcomes included monitoring at the time of arrest, response time ≤ 1 min, endotracheal intubation during CPR, administration of ≤ 2 doses of epinephrine during CPR, and CPR duration ≤ 15 min. Early recognition, immediate cardiac monitoring for at-risk patients, and timely high-quality CPR may significantly improve post-arrest outcomes.