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

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• 作者：Ericka L. Fink^a ; ^{finkel@ccm.upmc.edu" class="auth_mail" title="E-mail the corresponding author} ; David K. Prince^b ; Jonathan R. Kaltman^c ; Dianne L. Atkins^d ; Michael Austin^e ; Craig Warden^f ; Jamie Hutchison^g ; Mohamud Daya^h ; Scott Goldbergⁱ ; Heather Herren^b ; Janice A. Tijssen^j ; James Christenson^k ; Christian Vaillancourt^l ; Ronna Millerⁱ ; Robert H. Schmicker^b ; Clifton W. Callaway^m ; Authors are writing on behalf of the Resuscitation Outcomes Consortium
• 关键词：Pediatric ; Cardiac arrest ; Resuscitation ; Outcomes ; Epidemiology
• 刊名：Resuscitation
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：107
• 期：Complete
• 页码：121-128
• 全文大小：740 K

文摘

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 1738 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.