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2015 ; 19
(ä): 410
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Neurological outcomes in children dead on hospital arrival
#MMPMID26581332
Goto Y
; Funada A
; Nakatsu-Goto Y
Crit Care
2015[Nov]; 19
(ä): 410
PMID26581332
show ga
INTRODUCTION: Obtaining favorable neurological outcomes is extremely difficult in
children transported to a hospital without a prehospital return of spontaneous
circulation (ROSC) after out-of-hospital cardiac arrest (OHCA). However, the
crucial prehospital factors affecting outcomes in this cohort remain unclear. We
aimed to determine the prehospital factors for survival with favorable
neurological outcomes (Cerebral Performance Category 1 or 2 (CPC 1-2)) in
children without a prehospital ROSC after OHCA. METHODS: Of 9093 OHCA children,
7332 children (age <18 years) without a prehospital ROSC after attempting
resuscitation were eligible for enrollment. Data were obtained from a
prospectively recorded Japanese national Utstein-style database from 2008 to
2012. The primary endpoint was 1-month CPC 1-2 after OHCA. RESULTS: The 1-month
survival and 1-month CPC 1-2 rates were 6.92 % (n?=?508) and 0.99 % (n?=?73),
respectively. The proportions of the following prehospital variables were
significantly higher in the 1-month CPC 1-2 cohort than in the 1-month CPC 3-5
cohort: age (median, 3 years (interquartile range (IQR), 0-14) versus 1 year
(IQR, 0-11), p?<0.05), bystander-witnessed arrest (52/73 (71.2 %) versus
1830/7259 (25.2 %), p?<0.001), initial ventricular fibrillation (VF)/pulseless
ventricular tachycardia (VT) rhythm (28/73 (38.3 %) versus 241/7259 (3.3 %),
p?<0.001), presumed cardiac causes (42/73 (57.5 %) versus 2385/7259 (32.8 %),
p?<0.001), and actual shock delivery (25/73 (34.2 %) versus 314/7259 (4.3 %),
p?<0.0001). Multivariate logistic regression analysis indicated that 2
prehospital factors were associated with 1-month CPC 1-2: initial non-asystole
rhythm (VF/pulseless VT: adjusted odds ratio ( aOR), 16.0; 95 % confidence
interval (CI), 8.05-32.0; pulseless electrical activity (PEA): aOR, 5.19; 95 %
CI, 2.77-9.82) and bystander-witnessed arrest (aOR, 3.22; 95 % CI, 1.84-5.79).
The rate of 1-month CPC 1-2 in witnessed-arrest children with an initial
VF/pulseless VT was significantly higher than that in those with other initial
cardiac rhythms (15.6 % versus 2.3 % for PEA and 1.2 % for asystole, p for
trend?<0.001). CONCLUSIONS: The crucial prehospital factors for 1-month survival
with favorable neurological outcomes after OHCA were initial non-asystole rhythm
and bystander-witnessed arrest in children transported to hospitals without a
prehospital ROSC.
|*Death
[MESH]
|Adolescent
[MESH]
|Cardiopulmonary Resuscitation/mortality/statistics & numerical data
[MESH]
|Child
[MESH]
|Child, Preschool
[MESH]
|Databases, Factual
[MESH]
|Female
[MESH]
|Hospitals/*statistics & numerical data
[MESH]
|Humans
[MESH]
|Infant
[MESH]
|Infant, Newborn
[MESH]
|Japan/epidemiology
[MESH]
|Male
[MESH]
|Nervous System Diseases/epidemiology/*etiology/mortality
[MESH]
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