Time on the scene and interventions are associated with improved survival in pediatric out-of-hospital cardiac arrest

Janice A Tijssen; David K Prince; Laurie J Morrison; Dianne L Atkins; Michael A Austin; Robert Berg; Siobhan P Brown; Jim Christenson; Debra Egan; Preston J Fedor; Ericka L Fink; Garth D Meckler; Martin H Osmond; Kathryn A Sims; James S Hutchison; Resuscitation Outcomes Consortium

doi:10.1016/j.resuscitation.2015.06.012

Time on the scene and interventions are associated with improved survival in pediatric out-of-hospital cardiac arrest

Resuscitation. 2015 Sep:94:1-7. doi: 10.1016/j.resuscitation.2015.06.012. Epub 2015 Jun 19.

Authors

Affiliations

¹ Division of Pediatric Critical Care Medicine, Department of Pediatrics, London Health Sciences Centre, University of Western Ontario, London, ON, Canada; The Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada. Electronic address: Janice.Tijssen@lhsc.on.ca.
² Data Coordinating Center, Resuscitation Outcomes Consortium, University of Washington, Seattle, WA, United States.
³ Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁴ Stead Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, United States.
⁵ Department of Emergency Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
⁶ Departments of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, United States.
⁷ Department of Emergency Medicine, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada.
⁸ Division of Cardiovascular Sciences, Heart Failure and Arrhythmias Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States.
⁹ Division of Emergency Medicine, Department of Surgery, University of Texas Southwestern, Dallas, TX, United States.
¹⁰ Department of Critical Care Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Centre, Pittsburgh, PA, United States.
¹¹ Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; British Columbia Children's Hospital, Vancouver, BC, Canada.
¹² Division of Emergency Medicine, Department of Pediatrics, The University of Ottawa, Ottawa, ON, Canada; Children's Hospital of Eastern Ontario, The University of Ottawa, Ottawa, ON, Canada.
¹³ Department of Critical Care and Neuroscience and Mental Health Research Program, The Hospital for Sick Children, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, Faculty of Medicine and Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada. Electronic address: Jamie.Hutchison@sickkids.ca.

PMID: 26095301
PMCID: PMC4540668
DOI: 10.1016/j.resuscitation.2015.06.012

Abstract

Background: Survival is less than 10% for pediatric patients following out-of-hospital cardiac arrest. It is not known if more time on the scene of the cardiac arrest and advanced life support interventions by emergency services personnel are associated with improved survival.

Aim: This study was performed to determine which times on the scene and which prehospital interventions were associated with improved survival.

Methods: We studied patients aged 3 days to 19 years old with out-of-hospital cardiac arrest, using the Resuscitation Outcomes Consortium cardiac arrest database from 11 North American regions, from 2005 to 2012. We evaluated survival to hospital discharge according to on-scene times (<10, 10 to 35 and >35 min).

Results: Data were available for 2244 patients (1017 infants, 594 children and 633 adolescents). Infants had the lowest rate of survival (3.7%) compared to children (9.8%) and adolescents (16.3%). Survival improved over the 7 year study period especially among adolescents. Survival was highest in the 10 to 35 min on-scene time group (10.2%) compared to the >35 min. group (6.9%) and the <10 min. group (5.3%, p=0.01). Intravenous or intra-osseous access attempts and fluid administration were associated with improved survival, whereas advanced airway attempts were not associated with survival and resuscitation drugs were associated with worse survival.

Conclusions: In this observational study, a scene time of 10 to 35 min was associated with the highest survival, especially among adolescents. Access for fluid resuscitation was associated with increased survival but advanced airway and resuscitation drugs were not.

Keywords: Cardiac arrest; Emergency medical services; Pediatric.

Publication types

Multicenter Study
Observational Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Adolescent
Canada / epidemiology
Cardiopulmonary Resuscitation / methods*
Child
Child, Preschool
Emergency Medical Services / methods*
Female
Follow-Up Studies
Humans
Infant
Infant, Newborn
Male
Out-of-Hospital Cardiac Arrest / mortality
Out-of-Hospital Cardiac Arrest / therapy*
Prognosis
Retrospective Studies
Survival Rate / trends
Time Factors
United States / epidemiology
Young Adult

Abstract

Publication types

MeSH terms

Grants and funding