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Sci Rep. 2019 May 7;9(1):7032. doi: 10.1038/s41598-019-43020-0.

Clinical Survey and Predictors of Outcomes of Pediatric Out-of-Hospital Cardiac Arrest Admitted to the Emergency Department.

Lee J1,2, Yang WC3,4, Lee EP1,2,5, Huang JL2,6, Hsiao HJ1,2, Lin MJ7,8, Wu HP9,10,11.

Author information

1
Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan.
2
College of Medicine, Chang Gung University, Taoyuan, Taiwan.
3
Department of Pediatric Emergency Medicine, Children Hospital, China Medical University, Taichung, Taiwan.
4
Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan.
5
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan.
6
Division of Pediatric Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan.
7
Division of Cardiology, Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical foundation, Taichung, Taiwan. esion97@gmail.com.
8
Department of Medicine, School of Medicine, Tzu Chi University, Hualien, Taiwan. esion97@gmail.com.
9
Department of Pediatric Emergency Medicine, Children Hospital, China Medical University, Taichung, Taiwan. arthur1226@gmail.com.
10
Department of Medicine, School of Medicine, China Medical University, Taichung, Taiwan. arthur1226@gmail.com.
11
Department of Medical Research, Children's Hospital, China Medical University, Taichung, Taiwan. arthur1226@gmail.com.

Abstract

Pediatric out-of-hospital cardiac arrest (OHCA) is a rare event with severe sequelae. Although the survival to hospital-discharge (STHD) rate has improved from 2-6% to 17.6-40.2%, only 1-4% of OHCA survivors have a good neurological outcome. This study investigated the characteristics of case management before and after admittance to the emergency department (ED) associated with outcomes of pediatric OHCA in an ED. This was a retrospective study of data collected from our ED resuscitation room logbooks dating from 2005 to 2016. All records of children under 18 years old with OHCA were reviewed. Outcomes of interest included sustained return of spontaneous circulation (SROSC), STHD, and neurological outcomes. From the 12-year study period, 152 patients were included. Pediatric OHCA commonly affects males (55.3%, n = 84) and infants younger than 1 year of age (47.4%, n = 72) at home (76.3%, n = 116). Most triggers of pediatric OHCA were respiratory in nature (53.2%, n = 81). Sudden infant death syndrome (SIDS) (29.6%, n = 45), unknown medical causes (25%, n = 38), and trauma (10.5%, n = 16) were the main causes of pediatric OHCA. Sixty-two initial cardiac rhythms at the scene were obtained, most of which were asystole and pulseless electrical activity (PEA) (93.5%, n/all: 58/62). Upon ED arrival, cardiopulmonary resuscitation (CPR) was continued for 32.66 ± 20.71 min in the ED and 34.9% (n = 53) gained SROSC. Among them, 13.8% (n = 21) achieved STHD and 4.6% (n = 7) had a favorable neurological outcome. In multivariate analyses, fewer ED epinephrine doses (p < 0.05), witness of OHCA (p = 0.001), and shorter ED CPR duration (p = 0.007) were factors that increased the rate of SROSC at the ED. A longer emergency medical service (EMS) scene interval (p = 0.047) and shorter ED CPR interval (p = 0.047) improved STHD.

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