Association between shockable rhythms and long-term outcome after pediatric out-of-hospital cardiac arrest in Rotterdam, the Netherlands: An 18-year observational study

Abstract

Introduction: Shockable rhythm following pediatric out-of-hospital cardiac arrest (pOHCA) is consistently associated with hospital and short-term survival. Little is known about the relationship between shockable rhythm and long-term outcomes (>1 year) after pOHCA. The aim was to investigate the association between first documented rhythm and long-term outcomes in a pOHCA cohort over 18 years.Methods: All children aged 1 dayÀ18 years who experienced non-traumatic pOHCA between 2002À2019 and were subsequently admitted to the emergency department (ED) or pediatric intensive care unit (PICU) of Erasmus MC-Sophia Children's Hospital were included. Data was abstracted retrospectively from patient files, (ground) ambulance and Helicopter Emergency Medical Service (HEMS) records, and follow-up clinics. Long-term outcome was determined using a Pediatric Cerebral Performance Category (PCPC) score at the longest available follow-up interval through august 2020. The primary outcome measure was survival with favorable neurologic outcome, defined as PCPC 1À2 or no difference between pre-and post-arrest PCPC. The association between first documented rhythm and the primary outcome was calculated in a multivariable regression model.Results: 369 children were admitted, nine children were lost to follow-up. Median age at arrest was age 3.4 (IQR 0.8À9.9) years, 63% were male and 14% had a shockable rhythm (66% non-shockable, 20% unknown or return of spontaneous circulation (ROSC) before emergency medical service (EMS) arrival). In adolescents (aged 12À18 years), 39% had shockable rhythm. 142 (39%) of children survived to hospital discharge. On median followup interval of 25 months (IQR 5.1À49.6), 115/142 (81%) of hospital survivors had favorable neurologic outcome. In multivariable analysis, shockable rhythm was associated with survival with favorable long-term neurologic outcome (OR 8.9 [95%CI 3.1À25.9]).

Long-Term Outcomes after Non-Traumatic Out-of-Hospital Cardiac Arrest in Pediatric Patients: A Systematic Review

“…Mean age ranged from 1.5 to 6.4 years. Three studies were conducted in the United States of America [ 22 , 23 , 24 ], two were conducted in the Netherlands [ 25 , 26 ], one in Finland [ 27 ], and one in Taiwan [ 28 ]. Two studies were prospective cohort studies, and five were retrospective cohort studies.…”

“…In terms of survival beyond 1 year, only two [ 25 , 26 ] studies reported this outcome. Albrecht et al reported a survival of 95% at a median follow-up time of 26.3 months, while Hunfeld et al reported a survival of 98% at a mean follow-up time of 24 months.…”

“…In terms of survival with favorable neurological outcomes beyond 1 year, only two [ 25 , 26 ] studies reported this outcome. Albrecht et al reported that 10% of patients had a favorable neurological outcome at a median follow-up time of 3.7 years, while Hunfeld et al reported that 71% of patients had a favorable neurological outcome at a mean follow-up time of 2 years.…”

“…Only one [ 25 ] study reported outcomes for patients stratified by age. Albrecht et al reported stratified analyses at several time points, with this paper taking the time point at the longest follow-up into consideration: 27% of infants (aged < 1 year), 32% of children (aged 1–11 years), and 38% of adolescents (aged 12–18 years) were reported to have favorable neurological outcome beyond one year.…”

“…This may be due to having a cardiac arrest data collection workflow (which is a feature of a developed emergency medical system). The studies of Albrecht et al [ 25 ] and Hunfeld et al [ 26 ] were both conducted in the Netherlands, and the protocols taken by the Dutch Emergency Medical Services (EMS) have been detailed in considerable thoroughness by Bardai et al [ 32 ]. From individuals dialing the national emergency number to EMS response with personnel equipped with manual defibrillators and qualified in performing advanced life support, the Netherlands has demonstrated that it has a well-developed EMS.…”