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Somma V, Pflaumer A, Connell V, Rowe S, Fahy L, Zentner D, James P, Ingles J, Semsarian C, Stub D, Nehme Z, La Gerche A, Paratz ED. Epidemiology of pediatric out-of-hospital cardiac arrest compared with adults. Heart Rhythm 2023; 20:1525-1531. [PMID: 37331677 DOI: 10.1016/j.hrthm.2023.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/30/2023] [Accepted: 06/12/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) is associated with ∼90% mortality rate. In the pediatric population, this would equate to a large number of years of life lost, posing a heavy medical and economic burden to society. OBJECTIVE The purpose of this study was to outline the characteristics and causes of pediatric OHCA (pOHCA) and associations with survival until discharge in patients enrolled in the End Unexplained Cardiac Death Registry. METHODS A prospective statewide multisource registry identified all pOHCAs cases in patients aged 1-18 years in Victoria, Australia (population 6.5 million), from April 2019 to April 2021. Cases were adjudicated using ambulance, hospital, and forensic records; clinic assessments; and interviews of survivors and family members. RESULTS The analysis included 106 cases after adjudication (62, 58.5% male), 45 (42.5%) of which were due to cardiac causes of OHCA, with unascertained (n = 33 [31.1%]) being the most common cardiac cause reported. Respiratory events (n = 28 [26.4%]) were the most common noncardiac cause of pOHCA. Noncardiac causes were more likely to present with asystole or pulseless electrical activity (P = .007). The overall survival to hospital discharge rate was 11.3% and associated with increasing age, witnessed cardiac arrest, and initial ventricular arrhythmias (P < .05). CONCLUSION The incidence of pOHCA in the study population was 3.69 per 100,000 child-years. In contrast to young adults with OHCA, the most common etiology was noncardiac in pediatric patients. Prognostic factors associated with survival to discharge included increasing age, witnessed arrest, and initial ventricular arrhythmias. Rates of cardiopulmonary resuscitation and defibrillation were suboptimal.
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Affiliation(s)
- Vincenzo Somma
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Andreas Pflaumer
- Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Children's Research Institute, Parkville, Victoria, Australia; Melbourne University, Parkville, Victoria, Australia
| | | | - Stephanie Rowe
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Baker Heart and Diabetes Institute, Prahran, Victoria, Australia
| | - Louise Fahy
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Baker Heart and Diabetes Institute, Prahran, Victoria, Australia
| | - Dominica Zentner
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Royal Melbourne Hospital, St Parkville, Victoria, Australia
| | - Paul James
- Murdoch Children's Research Institute, Parkville, Victoria, Australia; Royal Melbourne Hospital, St Parkville, Victoria, Australia
| | - Jodie Ingles
- Garvan Institute of Medical Research, St Darlinghurst, New South Wales, Australia
| | - Christopher Semsarian
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, The University of Sydney, Camperdown, New South Wales, Australia
| | - Dion Stub
- Alfred Hospital, Prahran, Victoria, Australia
| | - Ziad Nehme
- Ambulance Victoria, Blackburn North, Victoria, Australia
| | - Andre La Gerche
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Melbourne University, Parkville, Victoria, Australia; Baker Heart and Diabetes Institute, Prahran, Victoria, Australia
| | - Elizabeth D Paratz
- St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia; Melbourne University, Parkville, Victoria, Australia; Baker Heart and Diabetes Institute, Prahran, Victoria, Australia.
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Obara T, Yumoto T, Nojima T, Hongo T, Tsukahara K, Matsumoto N, Yorifuji T, Nakao A, Elmer J, Naito H. Association of Prehospital Physician Presence During Pediatric Out-of-Hospital Cardiac Arrest With Neurologic Outcomes. Pediatr Crit Care Med 2023; 24:e244-e252. [PMID: 36749942 DOI: 10.1097/pcc.0000000000003206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
OBJECTIVES To examine the association of prehospital physician presence with neurologic outcomes of pediatric patients with out-of-hospital cardiac arrest (OHCA). DESIGN Retrospective cohort study. SETTING Data from the Japanese Association for Acute Medicine-OHCA Registry. INTERVENTIONS None. PATIENTS Pediatric patients (age 17 yr old or younger) registered in the database between June 2014 and December 2019. MEASUREMENT AND MAIN RESULTS We used logistic regression models with stabilized inverse probability of treatment weighting (IPTW) to estimate the associated treatment effect of a prehospital physician with 1-month neurologically intact survival. Secondary outcomes included in-hospital return of spontaneous circulation (ROSC) and 1-month survival after OHCA. A total of 1,187 patients (276 in the physician presence group and 911 in the physician absence group) were included (median age 3 yr [interquartile range 0-14 yr]; 723 [61%] male). Comparison of the physician presence group, versus the physician absence, showed 1-month favorable neurologic outcomes of 8.3% (23/276) versus 3.6% (33/911). Physician presence was associated with greater odds of 1-month neurologically intact survival after stabilized IPTW adjustment (adjusted odds ratio [aOR] 1.98, 95% CI 1.08-3.66). We also found an association in the secondary outcome between physician presence, opposed to absence, and in-hospital ROSC (aOR 1.48, 95% CI 1.08-2.04). However, we failed to identify an association with 1-month survival (aOR 1.49, 95% CI 0.97-2.88). CONCLUSIONS Among pediatric patients with OHCA, prehospital physician presence, compared with absence, was associated almost two-fold greater odds of 1-month favorable neurologic outcomes.
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Affiliation(s)
- Takafumi Obara
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tetsuya Yumoto
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Tsuyoshi Nojima
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takashi Hongo
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Kohei Tsukahara
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Naomi Matsumoto
- Department of Epidemiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Takashi Yorifuji
- Department of Epidemiology, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Atsunori Nakao
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
| | - Jonathan Elmer
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
- Department of Neurology, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Hiromichi Naito
- Department of Emergency, Critical Care, and Disaster Medicine, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, Okayama, Japan
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Tham LP, Fook-Chong S, Binte Ahmad NS, Ong MEH. Reply to: Potential selection bias in the baseline. Resuscitation 2022; 178:127-129. [PMID: 35820560 DOI: 10.1016/j.resuscitation.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/02/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Lai Peng Tham
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore 229899, Singapore.
| | - Stephanie Fook-Chong
- Prehospital Emergency & Research Centre, Duke- NUS Medical School, Singapore, Singapore
| | | | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore; For the Pan-Asian Resuscitation Outcomes Study Clinical Research Network, Singapore
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Peng Tham L, Fook-Chong S, Shahidah N, Fu-Wah Ho A, Tanaka H, Do Shin S, Chow-In Ko P, Darin Wong K, Jirapong S, Ramana Rao GV, Cai W, Al Qahtani S, Eng Hock Ong M. PRE-HOSPITAL AIRWAY MANAGEMENT AND SURVIVAL OUTCOMES AFTER PAEDIATRIC OUT-OF-HOSPITAL CARDIAC ARRESTS. Resuscitation 2022; 176:9-18. [PMID: 35483494 DOI: 10.1016/j.resuscitation.2022.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Paediatric out-of-hospital cardiac arrest (OHCA) results in high mortality and poor neurological outcomes. We conducted this study to describe and compare the effects of pre-hospital airway management on survival outcomes for paediatric OHCA in the Asia-pacific region. METHODS We performed a retrospective analysis of the Pan Asian Resuscitation Outcomes Study (PAROS) data from January 2009 to June 2018. PAROS is a prospective, observational, multi-centre cohort study from eleven countries. The primary outcomes were one-month survival and survival with favourable neurological status, defined as Cerebral Performance Category1 or 2. We performed multivariate analyses of the unmatched and propensity matched cohort. RESULTS We included 3131 patients less than 18 years in the study. 2679 (85.6%) children received bag-valve-mask (BVM) ventilations, 81 (2.6%) endotracheal intubations (ETI) and 371 (11.8%) supraglottic airways (SGA). 792 patients underwent propensity score matching. In the matched cohort, advanced airway management (AAM: SGA and ETI) when compared with BVM group was associated with decreased one-month survival [AAM: 28/396 (7.1%) versus BVM: 55/396 (13.9%); adjusted odds ratio (aOR), 0.46 (95% CI, 0.29 - 0.75); p = 0.002] and survival with favourable neurological status [AAM: 8/396 (2.0%) versus BVM: 31/396 (7.8%); aOR, 0.22 (95% CI, 0.10 - 0.50); p < 0.001]. For SGA group, we observed less 1-month survival [SGA: 24/337 (7.1%) versus BVM: 52/337 (15.4%); aOR, 0.41 (95%CI, 0.25 - 0.69), p = 0.001] and survival with favourable neurological status. CONCLUSION In children with OHCA in the Asia-Pacific region, pre-hospital AAM was associated with decreased one-month survival and less favourable neurological status.
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Affiliation(s)
- Lai Peng Tham
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore.
| | - Stephanie Fook-Chong
- Prehospital Emergency & Research Centre, Duke- NUS Medical School, Singapore, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Andrew Fu-Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore; National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
| | - Hideharu Tanaka
- Department of EMS System, Graduate School, Kokushikan University, Tokyo, Japan
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Patrick Chow-In Ko
- Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | - G V Ramana Rao
- GVK Emergency Management and Research Institute (GVK EMRI), Secunderabad, Telangana, India
| | - Wenwei Cai
- Department of Emergency Medicine, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | | | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore
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McKenzie K, Cameron S, Odoardi N, Gray K, Miller MR, Tijssen JA. Evaluation of Local Pediatric Out-of-Hospital Cardiac Arrest and Emergency Services Response. Front Pediatr 2022; 10:826294. [PMID: 35273929 PMCID: PMC8901601 DOI: 10.3389/fped.2022.826294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Survival after pediatric out-of-hospital cardiac arrest is poor. Paramedic services provide critical interventions that impact survival outcomes. We aimed to describe local pediatric out-of-hospital cardiac arrest (POHCA) events and evaluate the impact of the paramedic service response to POHCA. Methods The Canadian Resuscitation Outcomes Consortium and corresponding ambulance call records were used to evaluate deviations from best practice by paramedics for patients aged 1 day to <18 years who had an atraumatic out-of-hospital cardiac arrest between 2012 and 2020 in Middlesex-London County. Deviations were any departure from protocol as defined by Middlesex-London Paramedic Services. Results Fifty-one patients were included in this study. All POHCA events had at least one deviation, with a total of 188 deviations for the study cohort. Return of spontaneous circulation (ROSC) was achieved in 35.3% of patients and 5.8% survived to hospital discharge. All survivors developed a new, severe neurological impairment. Medication deviations were most common (n = 40, 21.3%) followed by process timing (n = 38, 20.2%), vascular access (n = 27, 14.4%), and airway (n = 27, 14.4%). A delay in vascular access was the most common deviation (n = 25, 49.0%). The median (IQR) time to epinephrine administration was 8.6 (5.90-10.95) min from paramedic arrival. Cardiac arrests occurring in public settings had more deviations than private settings (p = 0.04). ROSC was higher in events with a deviation in any circulation category (p = 0.03). Conclusion Patient and arrest characteristics were similar to other POHCA studies. This cohort exhibited high rates of ROSC and bystander cardiopulmonary resuscitation but low survival to hospital discharge. The study was underpowered for its primary outcome of survival. The total deviations scored was low relative to the total number of tasks in a resuscitation. Epinephrine was frequently administered outside of the recommended timeframe, highlighting an important quality improvement opportunity.
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Affiliation(s)
- Kate McKenzie
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Saoirse Cameron
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Natalya Odoardi
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katelyn Gray
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Michael R. Miller
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada
| | - Janice A. Tijssen
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada
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Harris MI, Crowe RP, Anders J, D'Acunto S, Adelgais KM, Fishe J. Applying a set of termination of resuscitation criteria to paediatric out-of-hospital cardiac arrest. Resuscitation 2021; 169:175-181. [PMID: 34555488 DOI: 10.1016/j.resuscitation.2021.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Prehospital Termination of Resuscitation (TOR) protocols for adults can reduce the number of futile transports of patients in cardiac arrest, yet similar protocols are not widely available for paediatric out-of-hospital cardiac arrest (POHCA). The objective of this study was to apply a set of criteria for paediatric TOR (pTOR) from the Maryland Institute for Emergency Medical Services Systems (MIEMSS) to a large national cohort and determine its association with return of spontaneous circulation (ROSC) after POHCA. METHODS We identified patients ages 0-17 treated by Emergency Medical Services (EMS) with cardiac arrest in 2019 from the ESO dataset and and applied the applicable pTOR certeria for medical or traumatic arrests. We calculated predictive test characteristics for the outcome of prehospital ROSC, stratified by medical and traumatic cause of arrest. RESULTS We analyzed records for 1595 POHCA patients. Eighty-eight percent (n = 1395) were classified as medical. ROSC rates were 23% among medical POHCA and 27% among traumatic POHCA. The medical criteria correctly classified >99% (322/323) of patients who achieved ROSC as ineligible for TOR. The trauma criteria correctly classified 93% (50/54) of patients with ROSC as ineligible for TOR. Of the five misclassified patients, three were involved in drowning incidents. CONCLUSIONS The Maryland pTOR criteria identified eligible patients who did not achieve prehospital ROSC, while reliably excluding those who did achieve prehospital ROSC. As most misclassified patients were victims of drowning, we recommend considering the exclusion of drowning patients from future pTOR guidelines. Further studies are needed to evaluate the long-term survival and neurologic outcome of patients misclassified by pTOR criteria.
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Affiliation(s)
- Matthew I Harris
- Northwell Hofstra School of Medicine, Departments of Paediatrics and Emergency, Medicine, New Hyde Park, NY, United States.
| | | | - Jennifer Anders
- Johns Hopkins School of Medicine, Department of Paediatrics, Baltimore, MD, United States
| | - Salvatore D'Acunto
- University of Florida College of Medicine - Jacksonville, Center for Data Solutions, Jacksonville, FL United States
| | - Kathleen M Adelgais
- University of Colorado School of Medicine, Department of Paediatrics, Section of Paediatric Emergency Medicine, Aurora, CO, United States
| | - Jennifer Fishe
- University of Florida College of Medicine - Jacksonville, Center for Data Solutions, Jacksonville, FL United States; University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, FL, United States
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