Most in-hospital cardiac arrests are caused by progressive respiratory failure and shock, not by a sudden arrhythmia, according to a major study involving 36,902 adults and 880 children. What's more, adult and pediatric cardiac arrests are more similar than many clinicians realize, a finding with important treatment implications.

Researchers analyzed data on in-hospital cardiac arrests from 253 U.S. and Canadian hospitals in a 51-month period. They found that in adults and children, the first documented pulseless rhythm during most in-hospital cardiac arrests was asystole or pulseless electrical activity, not ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT). In children, however, the prevalence of VF or pulseless VT was higher than expected.

The rate of survival to hospital discharge following cardiac arrest was 27% for children and 18% for adults. This is a better survival rate than many physicians assume. Most survivors also had good neurological outcomes.

The researchers say their study has these implications for practice.

* Clinicians should give more attention to the rapid recognition and treatment of progressive respiratory failure and shock because these conditions are implicated in most in-hospital cardiac arrests.

* Clinicians caring for children should be prepared to rapidly recognize and treat shockable rhythms, which may be more common in pediatric patients than was once thought.

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