Epidemiology and Outcomes From Out-of-Hospital Cardiac Arrest in Children

Abstract

Background-Population-based data for pediatric cardiac arrest are scant and largely from urban areas. TheResuscitation Outcomes Consortium (ROC) Epistry-Cardiac Arrest is a population-based emergency medical services registry of out-of-hospital nontraumatic cardiac arrest (OHCA). This study examined age-stratified incidence and outcomes of pediatric OHCA. We hypothesized that survival to hospital discharge is less frequent from pediatric OHCA than adult OHCA. Methods and Results-This prospective population-based cohort study in 11 US and Canadian ROC sites included persons Ͻ20 years of age who received cardiopulmonary resuscitation or defibrillation by emergency medical service providers and/or received bystander automatic external defibrillator shock or who were pulseless but received no resuscitation by emergency medical services between December 2005 and March 2007. Patients were stratified a priori into 3 age groups: Ͻ1 year (infants; nϭ277), 1 to 11 years (children; nϭ154), and 12 to 19 years (adolescents; nϭ193). The incidence of pediatric OHCA was 8.04 per 100 000 person-years (72.71 in infants, 3.73 in children, and 6.37 in adolescents) versus 126.52 per 100 000 person-years for adults. Survival for all pediatric OHCA was 6.4% (3.3% for infants, 9.1% for children, and 8.9% for adolescents) versus 4.5% for adults (Pϭ0.03). Unadjusted odds ratio for pediatric survival to discharge compared with adults was 0.71 (95% confidence interval, 0.37 to 1.39) for infants, 2.11 (95% confidence interval, 1.21 to 3.66) for children, and 2.04 (95% confidence interval, 1.24 to 3.38) for adolescents. Conclusions-This study demonstrates that the incidence of OHCA in infants approaches that observed in adults but is lower among children and adolescents. Survival to discharge was more common among children and adolescents than infants or adults.

Survival After Out‐of‐Hospital Cardiac Arrest in Children

“…However, wide variation in overall survival has been reported in these studies. In one of the largest studies of OHCA containing 624 pediatric patients, the authors reported similar survival rates (7.8%) compared with those of our study cohort 3. Similarly, a study of 459 pediatric patients from Denmark reported an overall survival rate of 8.1%, with survival lowest among patients less than 1 year of age 13.…”

“…To date, the few pediatric reports that exist have reported wide ranges in survival from 2% to 24% 1, 2, 3, 4. These prior studies typically have been limited by small study samples, often including no more than a few centers, thereby limiting their generalizability.…”

Pediatric Neurocritical Care

“…Unlike adult cardiac arrest, the majority of pediatric cardiac arrest occurs second to respiratory failure or circulatory shock, with a preceding period of hypoxia-ischemia that likely compounds the neurological insult. The presenting rhythm is most commonly asystole or pulseless electrical activity, with ventricular fibrillation or pulseless ventricular tachycardia being relatively rare (7-10%) [164,165]. Although hypothermia following nonshockable adult cardiac arrest is not endorsed by current guidelines, a recently published systematic review and meta-analysis of induced hypothermia in nonshockable adult cardiac arrest patients lent support to the idea that hypothermia therapy might be associated with reduced in-hospital mortality in this population.…”

“…The groundwork for this study has been well built. Three large, retrospective cohort studies that included patients from 15 hospitals affiliated with the Pediatric Emergency Care Applied Research Network have examined the outcome and identified risk factors associated with poor outcome for both in-hospital and out-of-hospital pediatric cardiac arrest [161][162][163][164][165][166][167][168][169][170][171]. Surveys from the United Kingdom and the United States have demonstrated both variability in the practice of cooling, and a widespread willingness and interest in a randomized controlled trial to study its use [172,173].…”

Untitled

“…Survival with good neurological outcomes after child or infant cardiopulmonary arrest is dependent on the initiation of prompt cardiopulmonary resuscitation (CPR; Atkins et al, 2009;Kitamura et al, 2010;Mogayzel et al, 1995). There are an estimated 16,000 episodes of pediatric cardiopulmonary arrest annually in the United States alone, and many of these events occur at home (Swor et al, 2003).…”