Out-of-hospital cardiac arrests in children and adolescents: Incidences, outcomes, and household socioeconomic status

Rajan, Shahzleen; Wissenberg, Mads; Folke, Fredrik; Hansen, Carolina Malta; Lippert, Freddy; Weeke, Peter; Karlsson, Lena; Søndergaard, Kathrine Bach; Kragholm, Kristian; Christensen, Erika Frischknecht; Nielsen, Søren R.K.; Køber, Lars; Gislason, Gunnar; Torp‐Pedersen, Christian

doi:10.1016/j.resuscitation.2014.11.025

Cited by 73 publications

(71 citation statements)

References 35 publications

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“…In a publication from Japan, smaller (1.4-3.5% over four years) regional variation in 1 month survival with favorable neurological outcome was seen in pediatric OHCA 27 . Notably, OHCA incidence rates in our study were higher than that reported in children in Denmark (8.3 vs. 3.3 per 100,000 persons) while survival was slightly better (10.2% vs. 8.1% for all children treated or not) 10 . In pediatric IHCA, significant hospital variation in adjusted survival (29-48%) was found among 30 hospitals studied in the Get With The Guidelines (GWTG) 28 .…”

Section: Discussioncontrasting

confidence: 87%

“…We were not able to report etiology of OHCA, airway success rates, and major social determinants of health which are important variables that may be associated with mortality 10,30 . Only short term survival outcomes were available; longer term and functional outcomes were not collected.…”

Section: Discussionmentioning

confidence: 99%

“…Data from the Resuscitation Outcomes Consortium (ROC) has also shown increased survival over time for adult OHCA victims but regional variation exists 8,9 . Data from Australia/New Zealand and Denmark have not demonstrated improvements in survival after pediatric OHCA but recent data from Sweden in children aged 0-21 years showed that 30-day survival increased from 6% in 1992–1998 to 14% in 2007–2012 10,11 .…”

Section: Introductionmentioning

confidence: 97%

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Unchanged pediatric out-of-hospital cardiac arrest incidence and survival rates with regional variation in North America

et al. 2016

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Aim Outcomes for pediatric out-of-hospital cardiac arrest (OHCA) are poor. Our objective was to determine temporal trends in incidence and mortality for pediatric OHCA. Methods Adjusted incidence and hospital mortality rates of pediatric non-traumatic OHCA patients from 2007-2012 were analyzed using the 9 region Resuscitation Outcomes Consortium - Epidemiological Registry (ROC-Epistry) database. Children were divided into 4 age groups: perinatal (< 3 days), infants (3 days - 1 year), children (1 - 11 years), and adolescents (12 - 19 years). ROC regions were analyzed post-hoc. Results We studied 1,738 children with OHCA. The age- and sex-adjusted incidence rate of OHCA was 8.3 per 100,000 person-years (75.3 for infants vs. 3.7 for children and 6.3 for adolescents, per 100,000 person-years, p<0.001). Incidence rates differed by year (p<0.001) without overall linear trend. Annual survival rates ranged from 6.7-10.2%. Survival was highest in the perinatal (25%) and adolescent (17.3%) groups. Stratified by age group, survival rates over time were unchanged (all p>0.05) but there was a non-significant linear trend (1.3% increase) in infants. In the multivariable logistic regression analysis, infants, unwitnessed event, initial rhythm of asystole, and region were associated with worse survival, all p<0.001. Survival by region ranged from 2.6-14.7%. Regions with the highest survival had more cases of EMS-witnessed OHCA, bystander CPR, and increased EMS-defibrillation (all p<0.05). Conclusions Overall incidence and survival of children with OHCA in ROC regions did not significantly change over a recent 5 year period. Regional variation represents an opportunity for further study to improve outcomes.

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Section: Discussioncontrasting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 97%

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Unchanged pediatric out-of-hospital cardiac arrest incidence and survival rates with regional variation in North America

et al. 2016

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“…In one of the largest studies of OHCA containing 624 pediatric patients, the authors reported similar survival rates (7.8%) compared with those of our study cohort 3. Similarly, a study of 459 pediatric patients from Denmark reported an overall survival rate of 8.1%, with survival lowest among patients less than 1 year of age 13. In another study of nearly 600 pediatric patients under 12 years of age, the survival rate was 8.6%, but this rate differed from the overall survival rate of 5.7% of those under 13 years of age in our cohort 2.…”

Section: Discussionsupporting

confidence: 84%

Survival After Out‐of‐Hospital Cardiac Arrest in Children

Jayaram

McNally

Tang

et al. 2015

JAHA

113

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BackgroundLittle is known about survival after out‐of‐hospital cardiac arrest (OHCA) in children. We examined whether OHCA survival in children differs by age, sex, and race, as well as recent survival trends.Methods and ResultsWithin the prospective Cardiac Arrest Registry to Enhance Survival (CARES), we identified children (age <18 years) with an OHCA from October 2005 to December 2013. Survival to hospital discharge by age (categorized as infants [0 to 1 year], younger children [2 to 7 years], older children [8 to 12 years], and teenagers [13 to 17 years]), sex, and race was assessed using modified Poisson regression. Additionally, we assessed whether survival has improved over 3 time periods: 2005–2007, 2008–2010, and 2011–2013. Of 1980 children with an OHCA, 429 (21.7%) were infants, 952 (48.1%) younger children, 276 (13.9%) older children, and 323 (16.3%) teenagers. Fifty‐nine percent of the study population was male and 31.8% of black race. Overall, 162 (8.2%) children survived to hospital discharge. After multivariable adjustment, infants (rate ratio: 0.56; 95% CI: 0.35, 0.90) and younger children (rate ratio: 0.42; 95% CI: 0.27, 0.65) were less likely to survive compared with teenagers. In contrast, there were no differences in survival by sex or race. Finally, there were no temporal trends in survival across the study periods (P=0.21).ConclusionsIn a large, national registry, we found no evidence for racial or sex differences in survival among children with OHCA, but survival was lower in younger age groups. Unlike in adults with OHCA, survival rates in children have not improved in recent years.

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“…From previous studies it is known that in adolescents, bystander CPR is linked to the parental educational level. 32 also, there could potentially be areas with a high incidence of OHCA and a low prevalence of bystander CPR. 33,34 , which we could not address.…”

Section: Discussionmentioning

confidence: 99%

Socioeconomic factors associated with outcome after cardiac arrest in patients under the age of 65

et al. 2015

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Aim In a prior study of seven North American cities Pittsburgh had the highest crude rate of cardiac arrest deaths in patients 18 to 64 years of age, particularly in neighborhoods with lower socioeconomic status (SES). We hypothesized that lower SES, associated poor health behaviors (e.g., illicit drug use) and pre-existing comorbid conditions (grouped as socioeconomic factors [SE factors]) could affect the type and severity of cardiac arrest, thus outcomes. Methods We retrospectively identified patients aged 18 to 64 years treated for in-hospital (IHCA) and out-of hospital arrest (OHCA) at two Pittsburgh hospitals between January 2010 and July 2012. We abstracted data on baseline demographics and arrest characteristics like place of residence, insurance and employment status. Favorable cerebral performance category [CPC] (1 or 2) was our primary outcome. We examined the associations between SE factors, cardiac arrest variables and outcome as well as post-resuscitation care. Results Among 415 subjects who met inclusion criteria, unfavorable CPC were more common in patients who were unemployed, had a history of drug abuse or hypertension. In OHCA, favorable CPC was more often associated with presentation with ventricular fibrillation/tachycardia (OR 3.53, 95% CI 1.43-8.74, p=0.006) and less often associated with non-cardiovascular arrest etiology (OR 0.22, 95% CI 0.08-0.62, p=0.004). We found strong associations between specific SE factors and arrest factors associated with outcome in OHCA patients only. Significant differences in post-resuscitation care existed based on injury severity, not on SES. Conclusions SE factors strongly influence type and severity of OHCA but not IHCA resulting in an association with outcomes.

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Out-of-hospital cardiac arrests in children and adolescents: Incidences, outcomes, and household socioeconomic status

Cited by 73 publications

References 35 publications

Unchanged pediatric out-of-hospital cardiac arrest incidence and survival rates with regional variation in North America

Unchanged pediatric out-of-hospital cardiac arrest incidence and survival rates with regional variation in North America

Survival After Out‐of‐Hospital Cardiac Arrest in Children

Socioeconomic factors associated with outcome after cardiac arrest in patients under the age of 65

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