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Minami S, Toida C, Shinohara M, Abe T, Takeuchi I. Verification of the termination of resuscitation rules in pediatric out-of-hospital cardiac arrest cases. Resusc Plus 2024; 19:100686. [PMID: 38957703 PMCID: PMC11217751 DOI: 10.1016/j.resplu.2024.100686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 07/04/2024] Open
Abstract
Aim Pediatric out-of-hospital cardiac arrest has an unfavorable prognosis; therefore, making accurate predictions of outcomes is crucial for tailoring treatment plans. The termination of resuscitation rules must accurately predict unfavorable outcomes. In this study, we aimed to assess if the current termination of resuscitation rules for adults can predict factors associated with unfavorable outcomes in pediatric out-of-hospital cardiac arrest and examine the relationship between these factors and unfavorable outcomes. Methods A retrospective nationwide cohort study of pediatric cases registered in the Japanese Association for Acute Medicine Multicenter Out-of-Hospital Cardiac Arrest Registry from June 1, 2014, to December 31, 2020, was conducted. The association between the current termination of resuscitation rules and outcomes, such as 30-day mortality and unfavorable 30-day neurological outcomes following out-of-hospital cardiac arrest, was evaluated. Results A total of 1,216 participants were included. The positive predictive value for predicting 30-day mortality for each termination of resuscitation rule exceeded 0.9. The specificity and positive predictive value for predicting unfavorable 30-day neurological outcomes were 1.00, indicating that no rules identified favorable outcomes. Factors such as no bystander witness, no return of spontaneous circulation before hospital arrival, no automated external defibrillator or defibrillator use, and no bystander cardiopulmonary resuscitation were associated with poor 30-day mortality and neurological outcomes. Conclusion Adult termination of resuscitation rules had a high positive predictive value for predicting pediatric out-of-hospital cardiac arrest. However, surviving cases make it challenging to use these rules for end-of-resuscitation decisions, indicating the need for identifying new rules to help predict neurological outcomes.
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Affiliation(s)
- Sakura Minami
- Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
| | - Chiaki Toida
- Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
- Department of Emergency and Critical Care Medicine, Shinshu University, Nagano, Japan
| | - Mafumi Shinohara
- Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
| | - Takeru Abe
- Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
- Integrated Science Education and Research Center, Fukushima Medical University, Fukushima, Japan
| | - Ichiro Takeuchi
- Department of Emergency Medicine, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
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Smits RLA, Sødergren STF, Folke F, Møller SG, Ersbøll AK, Torp-Pedersen C, van Valkengoed IGM, Tan HL. Long-term survival following out-of-hospital cardiac arrest in women and men: Influence of comorbidities, social characteristics, and resuscitation characteristics. Resuscitation 2024; 201:110265. [PMID: 38866232 DOI: 10.1016/j.resuscitation.2024.110265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/29/2024] [Accepted: 06/03/2024] [Indexed: 06/14/2024]
Abstract
AIM We aimed to study sex differences in long-term survival following out-of-hospital cardiac arrest (OHCA) compared to the general population, and determined associations for comorbidities, social characteristics, and resuscitation characteristics with survival in women and men separately. METHODS We followed 2,452 Danish (530 women and 1,922 men) and 1,255 Dutch (259 women and 996 men) individuals aged ≥25 years, who survived 30 days post-OHCA in 2009-2015, until 2019. Using Poisson regression analyses we assessed sex differences in long-term survival and sex-specific associations of characteristics mutually adjusted, and compared survival with an age- and sex-matched general population. The potential predictive value was assessed with the Concordance-index. RESULTS Post-OHCA survival was longer in women than men (adjusted incidence rate ratio (IRR) for mortality 0.74, 95%CI 0.61-0.89 in Denmark; 0.86, 95%CI 0.65-1.15 in the Netherlands). Both sexes had a shorter survival than the general population (e.g., IRR for mortality 3.07, 95%CI 2.55-3.70 and IRR 2.15, 95%CI 1.95-2.37 in Danish women and men). Higher age, glucose lowering medication, no dyslipidaemia medication, unemployment, and a non-shockable initial rhythm were associated with shorter survival in both sexes. Cardiovascular medication, depression/anxiety medication, living alone, low household income, and residential OHCA location were associated with shorter survival in men. Not living with children and bystander cardiopulmonary resuscitation provision were associated with shorter survival in women. The Concordance-indexes ranged from 0.51 to 0.63. CONCLUSIONS Women survived longer than men post-OHCA. Several characteristics were associated with long-term post-OHCA survival, with some sex-specific characteristics. In both sexes, these characteristics had low predictive potential.
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Affiliation(s)
- R L A Smits
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - S T F Sødergren
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Emergency Medical Services, Capital Region of Denmark, Copenhagen University Hospital, Ballerup, Denmark
| | - F Folke
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Emergency Medical Services, Capital Region of Denmark, Copenhagen University Hospital, Ballerup, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - S G Møller
- Emergency Medical Services, Capital Region of Denmark, Copenhagen University Hospital, Ballerup, Denmark
| | - A K Ersbøll
- Emergency Medical Services, Capital Region of Denmark, Copenhagen University Hospital, Ballerup, Denmark; National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - C Torp-Pedersen
- Department of Cardiology, North Zealand Hospital Hilleroed, Hilleroed, Denmark
| | - I G M van Valkengoed
- Amsterdam UMC location University of Amsterdam, Department of Public and Occupational Health, Meibergdreef 9, Amsterdam, the Netherlands
| | - H L Tan
- Amsterdam UMC location University of Amsterdam, Department of Clinical and Experimental Cardiology, Heart Centre, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, the Netherlands; Netherlands Heart Institute, Utrecht, the Netherlands.
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Pinto NP, Scholefield BR, Topjian AA. Pediatric cardiac arrest: A review of recovery and survivorship. Resuscitation 2024; 194:110075. [PMID: 38097105 DOI: 10.1016/j.resuscitation.2023.110075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Neethi P Pinto
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
| | | | - Alexis A Topjian
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
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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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Matsui S, Kurosawa H, Hayashi T, Takei H, Tanizawa N, Ohnishi Y, Murata S, Ohnishi M, Henry Yoshii T, Miyawaki K, Matsumoto T, Tanaka R, Kiyohara K, Zha L, Kitamura T, Sobue T, Nitta M. Annual patterns in the outcomes and post-arrest care for pediatric out-of-hospital cardiac arrest: A nationwide multicenter prospective registry in Japan. Resuscitation 2023; 191:109942. [PMID: 37625577 DOI: 10.1016/j.resuscitation.2023.109942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023]
Abstract
AIM Out-of-hospital cardiac arrest (OHCA) has a poor prognosis in children; however, the annual patterns of prognosis and treatment have not been fully investigated. METHODS From the Japanese Association for Acute Medicine OHCA registry, a multicenter prospective observational registry in Japan, we identified pediatric patients (zero to 17 years old) between June 2014 and December 2019. The primary outcome was one-month survival. We investigated the annual patterns in patient characteristics, treatment, and one-month prognosis. RESULTS During the study period, 1188 patients were eligible for analysis. For all years, the zero-year-old group accounted for a large percentage of the total population (between 30% and 40%). There were significant increases in the rates of bystander-initiated cardiopulmonary resuscitation (CPR; from 50.6% to 62.3%, p = 0.003), dispatcher instructions (from 44.7% to 65.7%, p = 0.001), and adrenaline administration (from 2.4% to 6.9%, p = 0.014) over time, whereas the rate of advanced airway management decreased significantly (from 17.7% to 8.8%, p = 0.003). The odds ratios for one-month survival adjusted for potential resuscitation factors also did not change significantly (from 7.1% to 10.3%, adjusted odds ratio for one-year increment = 0.98, confidence interval: 0.86-1.11). CONCLUSION Despite an increase in the rate of bystander-initiated CPR and pre-hospital adrenaline administration, there was no significant change in one-month survival.
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Affiliation(s)
- Satoshi Matsui
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan; Division of Emergency Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan.
| | - Hiroshi Kurosawa
- Division of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Takuro Hayashi
- Division of Emergency Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Hirokazu Takei
- Division of Emergency Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Naoko Tanizawa
- Division of Emergency Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Yasuhiro Ohnishi
- Division of Emergency Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Satoshi Murata
- Division of Emergency Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Masahumi Ohnishi
- Division of Emergency Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Takuma Henry Yoshii
- Division of Emergency Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Kosuke Miyawaki
- Division of Emergency Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Taisuke Matsumoto
- Division of Emergency Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Ryojiro Tanaka
- Division of Emergency Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women's University, Tokyo, Japan
| | - Ling Zha
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Masahiko Nitta
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan; Department of Pediatrics, Osaka Medical and Pharmaceutical University, Osaka, Japan; Division of Patient Safety, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
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Gupte D, Assaf M, Miller MR, McKenzie K, Loosley J, Tijssen JA. Evaluation of hospital management of paediatric out-of-hospital cardiac arrest. Resusc Plus 2023; 15:100433. [PMID: 37555196 PMCID: PMC10405089 DOI: 10.1016/j.resplu.2023.100433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Pediatric out of hospital cardiac arrest (POHCA) is rare, with high mortality and neurological morbidity. Adherence to Pediatric Advanced Life Support guidelines standardizes in-hospital care and improves outcomes. We hypothesized that in-hospital care of POHCA patients was variable and deviations from guidelines were associated with higher mortality. METHODS POHCA patients in the London-Middlesex region between January 2012 and June 2020 were included. The care of children with ongoing arrest (intra-arrest) and post-arrest outcomes were reviewed using the Children's Hospital, London Health Sciences Centre (LHSC) patient database and the Adverse Event Management System. RESULTS 50 POHCA patients arrived to hospital, with 15 (30%) patients admitted and 2 (4.0%) surviving to discharge, both with poor neurological outcomes and no improvement at 90 days. Deviations occurred at every event with intra-arrest care deviations occurring mostly in medication delivery and defibrillation (98%). Post-arrest deviations occurred mostly in temperature monitoring (60%). Data missingness was 15.9% in the intra-arrest and 1.7% in the post-arrest group. DISCUSSION Deviations commonly occurred in both in-hospital arrest and post-arrest care. The study was under-powered to identify associations between DEVs and outcomes. Future work includes addressing specific deviations in intra-arrest and post-arrest care of POHCA patients and standardizing electronic documentation.
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Affiliation(s)
- Dhruv Gupte
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - Maysaa Assaf
- Department of Paediatrics, London Health Sciences Centre, 800 Commissioners Rd. E., London, ON N6A 5W9, Canada
| | - Michael R. Miller
- Department of Paediatrics, London Health Sciences Centre, 800 Commissioners Rd. E., London, ON N6A 5W9, Canada
- Children’s Health Research Institute, 800 Commissioners Rd. E., London, ON N6C 2V5, Canada
| | - Kate McKenzie
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - Jay Loosley
- Middlesex-London Paramedic Service, 1035 Adelaide St. S., London, ON N6E 1R4, Canada
| | - Janice A. Tijssen
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
- Department of Paediatrics, London Health Sciences Centre, 800 Commissioners Rd. E., London, ON N6A 5W9, Canada
- Children’s Health Research Institute, 800 Commissioners Rd. E., London, ON N6C 2V5, Canada
- Lawson Health Research Institute, 750 Base Line Rd. E., London, ON N6C 2R5, Canada
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7
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Henry M, Filipp SL, Aydin EY, Chiriboga N, Zelinka K, Smith LE, Gurka MJ, Irazuzta J, Fonseca Y, Winter MC, Pringle C. Multicentric validation of a prognostic tool for predicting brain death following out-of-hospital cardiac arrest in children. Resuscitation 2023; 185:109727. [PMID: 36764571 PMCID: PMC10065949 DOI: 10.1016/j.resuscitation.2023.109727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 01/25/2023] [Accepted: 02/02/2023] [Indexed: 02/11/2023]
Abstract
AIM Out-of-hospital cardiac arrest (OHCA) in pediatric patients is associated with high rates of mortality and neurologic injury, with no definitive evidence-based method to predict outcomes available. A prognostic scoring tool for adults, The Brain Death After Cardiac Arrest (BDCA) score, was recently developed and validated. We aimed to validate this score in pediatric patients. METHODS Retrospective cohort study of pediatric patients admitted to 5 PICUs after OHCA between 2011 and 2021. We extracted BDCA score elements for those who survived at least 24 hours but died as a result of their OHCA. We assessed score discrimination for the definitive outcome of brain death. Subgroup analysis was performed for infants < 12mo versus children ≥ 12mo, those who likely had brain death but had withdrawal of life sustaining therapy (WLST) prior to declaration, and by etiology and duration of arrest. RESULTS 389 subjects were identified across 5 institutions, with 282 meeting inclusion criteria. 169 (59.9%) were formally declared brain dead; 58 (20.6%) had findings consistent with brain death but had withdrawal of life sustaining therapies prior to completion of formal declaration. Area under the receiver operating characteristic curve for the age ≥ 12mo cohort was 0.82 [95% CI 0.75, 0.90], which mirrored the adult subject AUCs of 0.82 [0.77, 0.86] and 0.81 [0.76, 0.86] in the development and validation cohorts. Scores demonstrated worse discrimination in the infant cohort (AUC = 0.61). CONCLUSIONS The BDCA score shows promise in children ≥ 12mo following OHCA and may be considered in conjunction with existing multimodal prognostication approaches.
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Affiliation(s)
- Matthew Henry
- College of Medicine, Department of Pediatrics, Critical Care Medicine, University of Florida, PO Box 100296, Gainesville, FL 32610, United States.
| | - Stephanie L Filipp
- College of Medicine, Department of Pediatrics, Pediatric Research Hub, University of Florida, United States
| | - Elber Yuksel Aydin
- College of Medicine, Department of Pediatrics, Critical Care Medicine, University of Florida-Jacksonville, United States
| | - Nicolas Chiriboga
- Pediatric Neurocritical Care, Northwestern University Feinberg School of Medicine, United States
| | - Kailea Zelinka
- Department of Pediatrics, Critical Care Medicine, University of Maryland, United States
| | - Lorena Espinosa Smith
- Children's Hospital Los Angeles, Department of Anesthesiology Critical Care Medicine, United States
| | - Matthew J Gurka
- College of Medicine, Department of Pediatrics, Pediatric Research Hub, University of Florida, United States
| | - Jose Irazuzta
- College of Medicine, Department of Pediatrics, Critical Care Medicine, University of Florida-Jacksonville, United States
| | - Yudy Fonseca
- Department of Pediatrics, Critical Care Medicine, University of Maryland School of Medicine, United States
| | - Meredith C Winter
- Children's Hospital Los Angeles, Department of Anesthesiology Critical Care Medicine, United States; University of Southern California Keck School of Medicine, Department of Pediatrics, United States
| | - Charlene Pringle
- College of Medicine, Department of Pediatrics, Critical Care Medicine, University of Florida, PO Box 100296, Gainesville, FL 32610, United States
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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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Blanchard PG, Graham JM, Gauvin V, Lanoue MP, Péloquin F, Bertrand I, Ulrich Singbo MN, Poirier P, Émond M, Mercier E. Reducing Barriers to Optimal Automated External Defibrillator Use: An Elementary School Intervention Study. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:30-36. [PMID: 37969560 PMCID: PMC10642092 DOI: 10.1016/j.cjcpc.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2023]
Abstract
Background Timely use of an automated external defibrillator (AED) improves outcomes in sudden cardiopulmonary arrest (SCA). Our project aims were to: 1) identify the barriers to optimal AED use in the Québec City area elementary schools; 2) create targeted educational material regarding AEDs; and 3) measure the impact of the teaching module. Methods Using a quality improvement in health-care framework, a survey exploring the barriers to AED use was sent to 139 elementary schools. We then developed a video teaching module on using AEDs to address these barriers. A convenience sample of 92 elementary school professionals participated in a mock scenario. Metrics related to AED use were assessed at baseline and after completing the post-teaching module. The primary outcome was the time to first shock and secondary outcomes consisted of evaluating the completion of each step required for safe and effective AED use. Results The barrier analysis survey received a response rate of 52.5%. Most schools reported having an AED (95%), but 48.6% indicated that no formal training was offered. After the teaching module, the appropriate use of the AED in an SCA simulation improved from 53% to 92% (P < 0.001). The average time elapsed before first shock was 66 (95% confidence interval [CI], 63-70) seconds at baseline compared with 47 (95% CI, 45-49) seconds post-teaching module (P < 0.001). Conclusions Lack of training, the main barrier to optimal use of AEDs in elementary schools, can be addressed through a brief video teaching module, thus improving the ability to deliver timely and effective defibrillation.
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Affiliation(s)
- Pierre-Gilles Blanchard
- Département de médecine familiale et médecine d’urgence, Faculté de médecine, Université Laval, Québec City, Québec, Canada
- Centre de recherche du CHU de Québec–Université Laval, Québec City, Québec, Canada
- VITAM---entre de recherche en santé durable de l’Université Laval, Québec City, Québec, Canada
| | - Johann M.I. Graham
- Département de médecine familiale et médecine d’urgence, Faculté de médecine, Université Laval, Québec City, Québec, Canada
- Centre de Recherche du CISSS de Lanaudière, Québec, Canada
| | - Vincent Gauvin
- Département de médecine familiale et médecine d’urgence, Faculté de médecine, Université Laval, Québec City, Québec, Canada
| | - Marie-Pier Lanoue
- Département de médecine familiale et médecine d’urgence, Faculté de médecine, Université Laval, Québec City, Québec, Canada
| | - Fannie Péloquin
- Département de médecine familiale et médecine d’urgence, Faculté de médecine, Université Laval, Québec City, Québec, Canada
| | - Isabelle Bertrand
- Département de médecine familiale et médecine d’urgence, Faculté de médecine, Université Laval, Québec City, Québec, Canada
| | | | - Paul Poirier
- Faculté de pharmacie, Université Laval, Québec, Canada
- Institut universitaire de cardiologie et de pneumologie de Québec, Québec City, Québec, Canada
| | - Marcel Émond
- Département de médecine familiale et médecine d’urgence, Faculté de médecine, Université Laval, Québec City, Québec, Canada
- Centre de recherche du CHU de Québec–Université Laval, Québec City, Québec, Canada
- VITAM---entre de recherche en santé durable de l’Université Laval, Québec City, Québec, Canada
| | - Eric Mercier
- Département de médecine familiale et médecine d’urgence, Faculté de médecine, Université Laval, Québec City, Québec, Canada
- Centre de recherche du CHU de Québec–Université Laval, Québec City, Québec, Canada
- VITAM---entre de recherche en santé durable de l’Université Laval, Québec City, Québec, Canada
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Besserer F, Kawano T, Dirk J, Meckler G, Tijssen JA, DeCaen A, Scheuermeyer F, Beno S, Christenson J, Grunau B. The association of intraosseous vascular access and survival among pediatric patients with out-of-hospital cardiac arrest. Resuscitation 2021; 167:49-57. [PMID: 34389454 DOI: 10.1016/j.resuscitation.2021.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 05/10/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION In pediatric out-of-hospital cardiac arrest (OHCA) the effect of intraosseous (IO) or intravenous (IV) access on outcomes is unclear. METHODS We analyzed prospectively collected data of non-traumatic OHCA in the Resuscitation Outcomes Consortium registry from 2011 to 2015. We included EMS-treated patients ≤17 years of age, classified patients based on vascular access routes, and calculated success rates of IO and IV attempts. After excluding patients with obvious non-cardiac etiologies and those with unsuccessful vascular access or multiple routes, we fit a logistic regression model to evaluate the association of IO vascular access (reference IV access) with the primary outcome of survival, using multiple imputation to address missing data. We analyzed a subgroup of patients at least 2 years of age. RESULTS There were 1549 non-traumatic OHCA: 895 (57.8%) patients had an IO line attempted with 822 (91.8%) successful; 488 (31.5%) had an IV line attempted with 345 (70.7%) successful (difference 21%, 95% CI 17 to 26%). Of the 761 patients included in our logistic regression, 601 received IO (30 [5.2%] survived) and 160 received IV (40 [25%] survived) vascular access. Intraosseous access was associated with a decreased probability of survival (adjusted OR 0.46; 95% CI 0.21-0.98). Patients at least 2 years of age showed a similar association (adjusted OR 0.36; CI 0.15-0.86). CONCLUSIONS Intraosseous access was associated with decreased survival among pediatric non-traumatic OHCA. These results are exploratory and support the need for further study to evaluate the effect of intravascular access method on outcomes.
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Affiliation(s)
- Floyd Besserer
- Department of Emergency Medicine, University of British Columbia, Canada; BC Emergency Health Services, British Columbia, Canada; Canadian Resuscitation Outcomes Consortium, Canada.
| | - Takahisa Kawano
- Canadian Resuscitation Outcomes Consortium, Canada; Department of Emergency Medicine, University of Fukui Hospital, Fukui Prefecture, Japan
| | - Justin Dirk
- School of Medicine, Queen's University, Ontario, Canada
| | - Garth Meckler
- Department of Emergency Medicine, University of British Columbia, Canada; BC Emergency Health Services, British Columbia, Canada; Canadian Resuscitation Outcomes Consortium, Canada; Department of Pediatrics, University of British Columbia, Canada
| | - Janice A Tijssen
- Canadian Resuscitation Outcomes Consortium, Canada; Department of Paediatrics, Western University, Canada
| | - Allan DeCaen
- Canadian Resuscitation Outcomes Consortium, Canada; Department of Paediatrics, University of Alberta, Canada
| | - Frank Scheuermeyer
- Department of Emergency Medicine, University of British Columbia, Canada; Canadian Resuscitation Outcomes Consortium, Canada; Centre for Health Evaluation and Outcome Sciences, Canada
| | - Suzanne Beno
- Department of Paediatrics, University of Toronto, Canada
| | - Jim Christenson
- Department of Emergency Medicine, University of British Columbia, Canada; Canadian Resuscitation Outcomes Consortium, Canada; Centre for Health Evaluation and Outcome Sciences, Canada
| | - Brian Grunau
- Department of Emergency Medicine, University of British Columbia, Canada; BC Emergency Health Services, British Columbia, Canada; Canadian Resuscitation Outcomes Consortium, Canada; Centre for Health Evaluation and Outcome Sciences, Canada
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11
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Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. [Paediatric Life Support]. Notf Rett Med 2021; 24:650-719. [PMID: 34093080 PMCID: PMC8170638 DOI: 10.1007/s10049-021-00887-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/11/2022]
Abstract
The European Resuscitation Council (ERC) Paediatric Life Support (PLS) guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR). This section provides guidelines on the management of critically ill or injured infants, children and adolescents before, during and after respiratory/cardiac arrest.
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Affiliation(s)
- Patrick Van de Voorde
- Department of Emergency Medicine, Faculty of Medicine UG, Ghent University Hospital, Gent, Belgien
- Federal Department of Health, EMS Dispatch Center, East & West Flanders, Brüssel, Belgien
| | - Nigel M. Turner
- Paediatric Cardiac Anesthesiology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Niederlande
| | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Tschechien
- Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Tschechien
| | | | - Abel Martinez-Mejias
- Department of Paediatrics and Emergency Medicine, Hospital de Terassa, Consorci Sanitari de Terrassa, Barcelona, Spanien
| | - Dominique Biarent
- Paediatric Intensive Care & Emergency Department, Hôpital Universitaire des Enfants, Université Libre de Bruxelles, Brüssel, Belgien
| | - Robert Bingham
- Hon. Consultant Paediatric Anaesthetist, Great Ormond Street Hospital for Children, London, Großbritannien
| | - Olivier Brissaud
- Réanimation et Surveillance Continue Pédiatriques et Néonatales, CHU Pellegrin – Hôpital des Enfants de Bordeaux, Université de Bordeaux, Bordeaux, Frankreich
| | - Florian Hoffmann
- Pädiatrische Intensiv- und Notfallmedizin, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität, München, Deutschland
| | | | - Torsten Lauritsen
- Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen, Kopenhagen, Dänemark
| | - Ian Maconochie
- Paediatric Emergency Medicine, Faculty of Medicine Imperial College, Imperial College Healthcare Trust NHS, London, Großbritannien
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12
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Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation 2021; 161:327-387. [PMID: 33773830 DOI: 10.1016/j.resuscitation.2021.02.015] [Citation(s) in RCA: 173] [Impact Index Per Article: 57.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.
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Affiliation(s)
- Patrick Van de Voorde
- Department of Emergency Medicine Ghent University Hospital, Faculty of Medicine UG, Ghent, Belgium; EMS Dispatch Center, East & West Flanders, Federal Department of Health, Belgium.
| | - Nigel M Turner
- Paediatric Cardiac Anesthesiology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, Netherlands
| | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Czech Republic; Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Czech Republic
| | | | - Abel Martinez-Mejias
- Department of Paediatrics and Emergency Medicine, Hospital de Terassa, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Dominique Biarent
- Paediatric Intensive Care & Emergency Department, Hôpital Universitaire des Enfants, Université Libre de Bruxelles, Brussels, Belgium
| | - Robert Bingham
- Hon. Consultant Paediatric Anaesthetist, Great Ormond Street Hospital for Children, London, UK
| | - Olivier Brissaud
- Réanimation et Surveillance Continue Pédiatriques et Néonatales, CHU Pellegrin - Hôpital des Enfants de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Florian Hoffmann
- Paediatric Intensive Care and Emergency Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | | | - Torsten Lauritsen
- Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare Trust NHS, Faculty of Medicine Imperial College, London, UK
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13
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Okada A, Okada Y, Kandori K, Nakajima S, Okada N, Matsuyama T, Kitamura T, Hiromichi N, Iiduka R. Associations between initial serum pH value and outcomes of pediatric out-of-hospital cardiac arrest. Am J Emerg Med 2020; 40:89-95. [PMID: 33360395 DOI: 10.1016/j.ajem.2020.12.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 12/06/2020] [Accepted: 12/10/2020] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Pediatric out-of-hospital cardiac arrest (OHCA) is one of the most critical conditions seen in the emergency department (ED). Although initial serum pH value is reported to be associated with outcome in adult OHCA patients, the association is unclear in pediatric OHCA patients. Thus, we aimed to identify the association between initial pH value and outcome among pediatric OHCA patients. METHODS This study was a retrospective analysis of a multicenter prospective cohort registry (Japanese Association for Acute Medicine out-of-hospital cardiac arrest registry) from 87 hospitals in Japan. We included pediatric OHCA patients younger than 16 years of age who were registered in this registry between June 2014 and December 2017. Of the 34,754 patients in the database, 458 patients were ultimately included in the analysis. We equally divided the patients into four groups, based on their initial pH value, and conducted a multivariate logistic regression analysis to calculate the adjusted odds ratios of the initial pH value on hospital arrival with their 95% confidence intervals for the primary outcome. RESULTS The median (interquartile range) age was 1 (0-6) year, and 77.9% (357/458) of the first monitored rhythm was asystole. The primary outcome was 1-month survival. The overall 1-month survival was 13.3% (61/458), and a 1-month favorable neurologic outcome was seen in 5.2% (24/458) of cases. The adjusted odds ratios and 95% confidence intervals for the pH 6.81-6.64, pH 6.63-6.47, pH <6.47, and pH unknown groups compared with the pH ≥6.82 group for 1-month survival were 0.39 (0.16-0.97), 0.13 (0.04-0.44), 0.03 (0.00-0.24), and 0.07 (0.02-0.21), respectively. CONCLUSIONS This study demonstrated the association between the initial pH value on hospital arrival and 1-month survival among pediatric OHCA patients.
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Affiliation(s)
- Asami Okada
- Department of Emergency Medicine and Critical Care, Japanese Red Cross Society Kyoto Daini Hospital, 355-5 Haruobicho Kamigyoku, Kyoto 602-8026, Japan
| | - Yohei Okada
- Preventive Services, School of Public Health, Kyoto University, Yoshida-honmachi, Sakyo-ku, Kyoto 606-8501, Japan; Department of Primary care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan.
| | - Kenji Kandori
- Department of Emergency Medicine and Critical Care, Japanese Red Cross Society Kyoto Daini Hospital, 355-5 Haruobicho Kamigyoku, Kyoto 602-8026, Japan
| | - Satoshi Nakajima
- Department of Emergency Medicine and Critical Care, Japanese Red Cross Society Kyoto Daini Hospital, 355-5 Haruobicho Kamigyoku, Kyoto 602-8026, Japan; Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Nobunaga Okada
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602-8566, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Narumiya Hiromichi
- Department of Emergency Medicine and Critical Care, Japanese Red Cross Society Kyoto Daini Hospital, 355-5 Haruobicho Kamigyoku, Kyoto 602-8026, Japan
| | - Ryoji Iiduka
- Department of Emergency Medicine and Critical Care, Japanese Red Cross Society Kyoto Daini Hospital, 355-5 Haruobicho Kamigyoku, Kyoto 602-8026, Japan
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