Poor Long-Term Survival of Out-of-Hospital Cardiac Arrest in Children

Abstract

The effect of post-cardiac arrest care in children with out-of-hospital cardiac arrest (OHCA) has not been adequately established, and the long-term outcome after pediatric OHCA has not been sufficiently investigated. We describe here detailed in-hospital characteristics, actual management, and survival, including neurological status, 90 days after OHCA occurrence in children with OHCA transported to critical care medical centers (CCMCs). We analyzed the database of the Comprehensive Registry of Intensive Care for OHCA Survival (CRITI-CAL) study, which is a multicenter, prospective observational data registry designed to accumulate both preand in-hospital data on OHCA treatments. We enrolled all consecutive pediatric patients aged <18 years who had an OHCA and for whom resuscitation was attempted and who were transported to CCMCs between 2012 and 2016. A total of 263 pediatric patients with OHCA were enrolled. The average age of the patients was 6.3 years, 38.0% were aged < 1 year, and 60.8% were male. After hospital arrival, 4.9% of these pediatric patients received defibrillation; 1.9%, extracorporeal life support; 6.5%, target temperature management; and 88.2% adrenaline administration. The proportions of patients with 90-day survival and a pediatric cerebral performance category (PCPC) score of 1 or 2 were 6.1% and 1.9%, respectively. The proportion of patients with a PCPC score of 1 or 2 at 90 days after OHCA occurrence did not significantly improve during the study period. The proportion of pediatric patients with a 90-day PCPC score of 1 or 2 transported to CCMCs was extremely low, and no significant improvements were observed during the study period.

Verification of the termination of resuscitation rules in pediatric out-of-hospital cardiac arrest cases

“…All TOR rules in this study showed highly accurate PPVs and specificity for unfavorable neurological outcomes, similar to studies in adults. 1 , 7 , 14 , 15 Studies of pOHCA are limited, and the ALS and BLS TOR rules, which have been evaluated in the past, have shown high accuracy in predicting unfavorable neuroprognosis, 8 similar to this study.…”

“…Pediatric out-of-hospital cardiac arrest (pOHCA) has an unfavorable prognosis, with only 6–8% of patients being discharged from the hospital and only 1–2% experiencing favorable neurological outcomes among those who survive. 1 , 2 , 3 Pediatric patients typically survive longer, making decisions regarding the termination of resuscitation (TOR) ethically complex. 4 Therefore, accurate prognosis prediction is crucial for determining a treatment plan that aligns with the family’s preferences.…”

“… 5 , 6 Multiple studies have investigated the association between the TOR rules and mortality and neurological outcomes, demonstrating its high accuracy. 1 , 7 , 8 …”

Reducing Barriers to Optimal Automated External Defibrillator Use: An Elementary School Intervention Study

“…[1][2][3][4] However, the outcome is often poor and the consequences are devastating for both the family and the community. 4,5 Sudden cardiac death is responsible for approximately 5%-10% of all deaths in children 5-19 of age. 6 During a pediatric SCA, rapid access to an automated external defibrillator (AED) is critical, 7 because the survival rate of SCA in educational institutions without an action plan is as low as 10%.…”

Evaluation of hospital management of paediatric out-of-hospital cardiac arrest

“… 1 , 2 , 3 , 4 , 5 Of survivors, many are left with devastating neurological injury. 3 , 6 A recent epidemiological study by Fink et al found no change in incidence or survival rates of POHCA events in North America over time, highlighting the need for further investigation into this field. 5 …”