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Global burden of out-of-hospital cardiac arrest in children: a systematic review, meta-analysis, and meta-regression. Pediatr Res 2023:10.1038/s41390-022-02462-5. [PMID: 36646884 DOI: 10.1038/s41390-022-02462-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 11/18/2022] [Accepted: 12/15/2022] [Indexed: 01/18/2023]
Abstract
The incidence of out-of-hospital cardiac arrest (OHCA) and its mortality among children decreased globally over the years. However, the incidence, mortality, and its determinants are heterogeneous globally. The current study was designed to investigate the incidence of OHCA, mortality, and its determinants based on a systematic review of published literature. A comprehensive search was conducted in PubMed/Medline; Science Direct, Cochrane Library, Hinari, and LILACS without language and date restrictions. The data were extracted with two independent authors in a customized format. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa appraisal tool. A total of 2526 articles were identified from different databases with an initial search. Forty-eight articles with 138.3 million participants were included in the systematic review. The meta-analysis showed that the pooled rate of mortality was found to be 70% (95% CI: 57-81%, 42 studies, 28,345 participants). The incidence of OHCA and mortality among children was very high among children with significant regional disparity. Those children with cardiovascular causes of arrest, and initial nonshockable rhythm were independent predictors of OHCA-related mortality. This systematic review and meta-analysis is registered in Prospero (CRD42022316602). IMPACT: This systematic review addresses a significant health problem in a global context from 1995 to 2022. The meta-regression revealed that the incidence of OHCA and mortality of children decline over the years in high-income countries despite regional dispraises among individual studies. Body of evidence on the incidence of OHCA and mortality is lacking in low- and middle-income countries.
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Schneck E, Janßen G, Vaillant V, Voelker T, Dechert O, Trocan L, Schmitz L, Rohde M, Sander M, Hauch H. Cardiopulmonary resuscitation in pediatric patients under palliative home care - A multicenter retrospective study. Front Pediatr 2022; 10:1105609. [PMID: 36704133 PMCID: PMC9872029 DOI: 10.3389/fped.2022.1105609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction: Patients under palliative home care have special needs for their end-of-life support, which in general does not automatically include cardiopulmonary resuscitation. However, emergency medical services (EMS) respond to emergencies in children under palliative care that lead to cardiopulmonary resuscitation. To understand the underlying steps of decision-making, this retrospective, cross-sectional, multicenter study aimed to analyze pediatric patients under palliative home care who had been resuscitated. Methods: This study included patients from three spezialized pediatric palliative home care (SHPC) teams. The primary study parameters were the prevalence of cardiopulmonary resuscitation and the decision-making for carrying out pediatric advanced life support (PALS). Further analyses included the causes of cardiac arrest, the type of CPR (basic life support, advanced life support), the patient´s outcome, and involvement of the SHPC in the resuscitation. Descriptive statistical analysis was performed. Results: In total, 880 pediatric patients under palliative home care were included over 8.5 years, of which 17 patients were resuscitated once and two patients twice (overall, 19 events with CPR, 21.6 per 1,000 cases). In 10 of the 19 incidents (52.6%), cardiac arrest occurred suddenly without being predictable. The causes of cardiac arrest varied widely. PALS was performed in 78.9% of the cases by EMS teams. In 12 of 19 events (63.2%) resuscitation was performed on explicit wish of the parents. However, from a medical point of view, only four resuscitation attempts were reasonable. In total 7 of 17 (41.2%) patients survived cardiac arrest with a comparable quality of life. Discussion: Overall, resuscitation attempts were rare events in children under home palliative therapy, but if they occur, EMS are often the primary caregivers. Most resuscitation attempts occurred on explicit wish of the parents independently of the meaningfulness of the medical procedure. Despite the presence of a life-limiting disease, survival with a similar quality was achieved in one third of all resuscitated patients. This study indicates that EMS should be trained for advanced life support in children under home palliative therapy and SHPC should address the scenario of cardiac arrest also in early stages of palliative treatment. These results underline that advance care planning for these children is urgently needed.
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Affiliation(s)
- Emmanuel Schneck
- Department for Anaesthesiology, Intensive Care Medicine and Pain Therapy, Justus Liebig University, Giessen, Hesse, Germany
| | - Gisela Janßen
- Palliative Care Team for Children, Heinrich-Heine-University, Duesseldorf, North Rhine-Westphalia, Germany
| | - Vera Vaillant
- Palliative Care Team for Children, Justus Liebig University, Giessen, Hesse, Germany
| | - Thomas Voelker
- Palliative Care Team for Children, Kleine Riesen Kassel, Kassel, Hesse, Germany
| | - Oliver Dechert
- Palliative Care Team for Children, Heinrich-Heine-University, Duesseldorf, North Rhine-Westphalia, Germany
| | - Laura Trocan
- Palliative Care Team for Children, Heinrich-Heine-University, Duesseldorf, North Rhine-Westphalia, Germany
| | - Lioba Schmitz
- Palliative Care Team for Children, Heinrich-Heine-University, Duesseldorf, North Rhine-Westphalia, Germany
| | - Marius Rohde
- Department for Pediatric Oncology and Hematology, Justus Liebig University, Giessen, Hesse, Germany
| | - Michael Sander
- Department for Anaesthesiology, Intensive Care Medicine and Pain Therapy, Justus Liebig University, Giessen, Hesse, Germany
| | - Holger Hauch
- Palliative Care Team for Children, Justus Liebig University, Giessen, Hesse, Germany
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Overgaard MF, Heino A, Andersen SA, Thomas O, Holmén J, Mikkelsen S. Physician staffed emergency medical service for children: a retrospective population-based registry cohort study in Odense region, Southern Denmark. BMJ Open 2020; 10:e037567. [PMID: 32792443 PMCID: PMC7430407 DOI: 10.1136/bmjopen-2020-037567] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The aim of this study is to determine diagnostic patterns in the prehospital paediatric population, age distribution, the level of monitoring and the treatment initiated in the prehospital paediatric case. Hypothesis was that advanced prehospital interventions are rare in the paediatric patient population. SETTING We performed a retrospective population-based registry cohort study of children attended by a physician-staffed emergency medical service (EMS) unit (P-EMS), in the Odense area of Denmark during a 10-year study period. PARTICIPANTS We screened 44 882 EMS contacts and included 5043 children. Patient characteristics, monitoring and interventions performed by the P-EMS crews were determined. RESULTS We found that paediatric patients were a minority among patients attended by P-EMS units: 11.2% (10.9 to 11.5) (95% CI) of patients were children. The majority of the children were <5 years old; one-third being <2 years old. Respiratory problems, traffic accidents and febrile seizures were the three most common dispatch codes. Oxygen supplementation, intravenous access and application of a cervical collar were the three most common interventions. Oxygen saturation and heart rate were documented in more than half of the cases, but more than one-third of the children had no vital parameters documented. Only 22% of the children had respiratory rate, saturation, heart rate and blood pressure documented. Prehospital invasive procedures such as tracheal intubation (n=74), intraosseous access (n=22) and chest drainage (n=2) were infrequently performed. CONCLUSION Prehospital paediatric contacts are uncommon, more frequently involving smaller children. Monitoring or at least documentation of basic vital parameters is infrequent and may be an area for improvement. Advanced and potentially life-saving prehospital interventions provide a dilemma since these likely occur too infrequently to allow service providers to maintain their technical skills working solely in the prehospital environment.
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Affiliation(s)
- Morten Føhrby Overgaard
- Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark
- Department of Anaesthesia and Intensive Care Medicine, The Hospital of South West Jutland, Esbjerg, Denmark
| | - Anssi Heino
- Department of Perioperative Services, Intensive Care Medicine and Pain management, Turku University Hospital, Turku Finnish University Association, Turku, Finland
| | - Sofie Allerød Andersen
- Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark
| | - Owain Thomas
- Paediatric Anesthesia and Intensive Care, Skåne University Hospital Lund, Lund, Skåne, Sweden
- Institution of Clinical Sciences, Lund University, Lund, Sweden
| | - Johan Holmén
- Pediatric Anesthesia and Intensive Care, Department of Prehospital and Emergency Care, Queen Silvia's Children's Hospital, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Søren Mikkelsen
- Department of Anaesthesiology and Intensive Care Medicine, Odense University Hospital, Odense, Denmark
- Mobile Emergency Care Unit, Odense University Hospital, Odense, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Yurtseven A, Turan C, Akarca FK, Saz EU. Pediatric cardiac arrest in the emergency department: Outcome is related to the time of admission. Pak J Med Sci 2019; 35:1434-1440. [PMID: 31489021 PMCID: PMC6717451 DOI: 10.12669/pjms.35.5.487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives: Nights and weekends represent a potentially high-risk time for pediatric cardiac arrest (CA) patients in emergency departments. Data regarding night or weekend arrest and its impact on outcomes is controversial. The purpose of this study was to determine the relationship between cardiopulmonary resuscitation during the various emergency department shifts and survival to discharge. Methods: We conducted a retrospective, observational study of patients who had visited our Emergency Department for CAs from January 2014 to December 2016. Medical records and patient characteristics of 67 children with CA were retrieved from patient admission files. Results: The mean age was 54.7±7.3 months and 59% were male. Rates of survival to discharge 35% (11/31) within working hours’ vs. out of working hours 3% (1/36). Among the CAs presenting to the emergency department, the survival rates were higher for working hours than for non-working hours (OR: 37.6 (2.62-539.7), p: 008). The rate of return of spontaneous circulation within working hours was higher than that of non-working hours (71% vs.19%) (p<0.001). Patients who received chest compression for more than 10 minutes had the lowest survival rate (2%) (p<0.001), whereas better outcome was associated with in-hospital CA, younger age (less than 12 months) and respiratory failure. Conclusion: Survival rates from pediatric CAs were significantly lower during non-working hours. Poor outcome was associated with prolonged cardiopulmonary resuscitation, out of hospital CA and older age.
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Affiliation(s)
- Ali Yurtseven
- Ali Yurtseven, MD. Department of Pediatrics, Division of Emergency Medicine, Ege University School of Medicine, Izmir, Turkey
| | - Caner Turan
- Caner Turan, MD. Department of Pediatrics, Division of Emergency Medicine, Ege University School of Medicine, Izmir, Turkey
| | - Funda Karbek Akarca
- Funda Karbek Akarca, MD. Associate Professor, Department of Emergency Medicine, Ege University School of Medicine, Izmir, Turkey
| | - Eylem Ulas Saz
- Prof. Eylem Ulas Saz, MD. Department of Pediatrics, Division of Emergency Medicine, Ege University School of Medicine, Izmir, Turkey
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