Outcomes of paediatric out-of-hospital cardiac arrest according to hospital characteristic defined by the annual number of paediatric patients with invasive mechanical ventilation: A nationwide study in Japan

Takahiro Kido; Masao Iwagami; Hideo Yasunaga; Toshikazu Abe; Yuki Enomoto; Hiroki Matsui; Kiyohide Fushimi; Hidetoshi Takada; Nanako Tamiya

doi:10.1016/j.resuscitation.2019.12.020

Outcomes of paediatric out-of-hospital cardiac arrest according to hospital characteristic defined by the annual number of paediatric patients with invasive mechanical ventilation: A nationwide study in Japan

Resuscitation. 2020 Mar 1:148:49-56. doi: 10.1016/j.resuscitation.2019.12.020. Epub 2020 Jan 10.

Authors

Takahiro Kido¹, Masao Iwagami², Hideo Yasunaga³, Toshikazu Abe⁴, Yuki Enomoto⁵, Hiroki Matsui³, Kiyohide Fushimi⁶, Hidetoshi Takada⁷, Nanako Tamiya⁸

Affiliations

¹ Department of Pediatrics, University of Tsukuba Hospital, Ibaraki, Japan; Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
² Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan; Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan. Electronic address: iwagami-tky@umin.ac.jp.
³ Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan.
⁴ Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan; Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan; Department of General Medicine, Juntendo University, Tokyo, Japan.
⁵ Department of Pediatrics, University of Tsukuba Hospital, Ibaraki, Japan; Department of Critical Care and Emergency Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
⁶ Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan.
⁷ Department of Pediatrics, University of Tsukuba Hospital, Ibaraki, Japan; Department of Child Health, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan.
⁸ Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan; Health Services Research and Development Center, University of Tsukuba, Ibaraki, Japan.

PMID: 31931094
DOI: 10.1016/j.resuscitation.2019.12.020

Abstract

Aim: We examined whether outcomes of paediatric out-of-hospital cardiac arrest (OHCA) are associated with a hospital characteristic defined by the annual number of invasive mechanical ventilation cases, suggesting hospitals' experience in caring for severely ill paediatric patients.

Method: We analysed the Japanese Diagnosis Procedure Combination database from 2010 to 2017. We identified children (<18 years) with OHCA and post-resuscitation intensive care (defined as invasive mechanical ventilation and/or catecholamine infusion). Hospitals were divided into four groups by mean annual number of paediatric cases involving invasive mechanical ventilation. The primary outcome was in-hospital mortality, and the secondary outcome was unfavourable outcomes (death or medical care dependency at discharge). Multivariable logistic regression analyses were conducted to examine the relationship between hospitals' experience and outcomes.

Results: We included 2540 paediatric OHCA patients from 385 institutions. Overall in-hospital mortality was 62.4%, with rates of 69.6%, 61.3%, 61.8%, and 57.0% in hospitals with low (≤48 cases/year), low-intermediate (48-110), high-intermediate (110-164), and high (>164) experience levels (P < .001), respectively. Compared to hospitals with low experience, adjusted odds ratios (95% confidence interval) for hospitals with low-intermediate, high-intermediate, and high experience were as follows: primary outcome: 0.64 (0.40-1.01), 0.67 (0.42-1.05), and 0.46 (0.31-0.70), respectively; secondary outcome: 0.93 (0.55-1.57), 0.95 (0.63-1.43), and 0.67 (0.46-0.96), respectively.

Conclusion: Japanese hospitals with higher experience in caring for severely ill paediatric patients showed lower mortality for paediatric OHCA. This fact should be considered by the Emergency Medical Systems when deciding transport strategy.

Keywords: Cardiopulmonary resuscitation; Children; Mechanical ventilation; Out-of-hospital cardiac arrest; Volume-outcome relationship.

MeSH terms

Cardiopulmonary Resuscitation*
Child
Emergency Medical Services*
Hospitals
Humans
Japan / epidemiology
Out-of-Hospital Cardiac Arrest* / therapy
Respiration, Artificial