Out-of-hospital cardiac arrest due to drowning among children and adults from the Utstein Osaka Project

Abstract

Background Children have better outcomes after out-of-hospital cardiac arrest (OHCA) than adults. However, little is known about the difference in outcomes between children and adults after OHCA due to drowning. Objectives The aim of this study is to assess the outcome after OHCA due to drowning between children and adults. Our hypothesis is that outcomes after OHCA due to drowning would be in better among children (<18 years old) compared with adults (≥18 years old). Method This prospective population-based, observational study included all emergency medical service-treated OHCA due to drowning in Osaka, Japan, between 1999 and 2010 (excluding 2004). Outcomes were evaluated between younger children (0–4 years old), older children (5–17 years old), and adults (≥18 years old). Major outcome measures were one-month survival and neurologically favorable one-month survival defined as cerebral performance category 1 or 2. Multivariate logistic regression analyses were used to account for potential confounders. Results During the study period, 66,716 OHCAs were documented, and resuscitation was attempted for 62,048 patients (1300 children [2%] and 60,748 adults [98%]). Among these OHCAs, 1737 (3% of OHCAs) were due to drowning (36 younger children [2%], 32 older children [2%], and 1669 adults [96%]). The odds of one-month survival were significantly higher for younger children (28% [10/36]; adjusted odds ratio [AOR], 20.20 [95% confidence interval {CI} 7.45–54.78]) and older children (9% [3/32]; AOR, 4.47 [95% CI 1.04–19.27]) when compared with adults (2% [28/1669]). However, younger children (6% [2/36]; AOR, 5.23 [95% CI 0.52–51.73]) and older children (3% [1/32]; AOR, 2.53 [95% CI 0.19–34.07]) did not have a higher odds of neurologically favorable outcome than adult s (1% [11/1669]). Conclusion In this large OHCA registry, children had better one-month survival rates after OHCA due to drowning compared with adults. Most survivors in all groups had unfavorable neurological outcomes.

Characteristics and Outcomes of Bath-Related Out-of-Hospital Cardiac Arrest in Japan

“…A previous study indicated that the proportion of survivors with favorable neurologic outcomes after OHCAs, which were caused by drowning irrespective of location and behavior, was 0.8%. 34 Another study also reported that the proportion of survivors with favorable neurologic outcomes after bystanderwitnessed OHCA of cardiac origin was 5.4% at home and 20.8% in public places. 35 The outcomes of our study subjects were much poorer compared with these results.…”

Part 3: Adult Basic Life Support and Automated External Defibrillation

“…For the critical outcome of favorable neurologic outcome, we found very-low-quality evidence (downgraded for indirectness and imprecision) from 1 observational study 62 involving 1737 patients. Univariate analysis reported by the study authors indicates an unadjusted OR for good outcomes in the group where submersion was witnessed (OR, 16.33; 95% CI, 5.58-47.77).…”

“…For the critical outcome of survival, we found lowquality evidence (downgraded for risk of bias, indirectness, and imprecision) from 4 studies 62,68,69,71 involving a total of 2857 victims. Two studies 67,69 were from the same EMS system, and both used multivariate analysis.…”

“…53,[55][56][57][58][59][60][61][62][63][64] Of the 7 pediatric studies, 6 found that young age, variably defined as less than 3, 4, 5, or 6 years, was not associated with favorable neurologic outcome. [55][56][57][58][59]61 A single pediatric study including 166 children aged less than 15 years reported better outcomes in children aged less than 5 years (RR, 0.12; 95% CI, 0.03-0.44).…”

“…60 Four studies considered drowning victims of all ages; 3 found no relationship between age and outcome. [62][63][64] One reported worse outcomes among children aged greater than 5 years (RR, 0.66; 95% CI, 0.51-0.85). 53 For the critical outcome of survival, we identified verylow-quality evidence (downgraded for risk of bias, inconsistency, indirectness, and imprecision) from 6 observational studies, which included 1313 patients.…”