Outcome of out-of-hospital cardiopulmonary arrest in children: A multicenter cohort study

The aim of this study was to evaluate the demographic characteristics ofchildren who experienced out-of-hospital cardiopulmonary arrest (CPA), andto assess the impact of the bystander cardiopulmonary resuscitation (CPR) onthe survival rate of witnessed arrests and the effects of the arrest and CPRdurations on the neurological outcomes. This multicenter, retrospective studyincluded a total of 182 patients who underwent CPR for out-of-hospital CPAbetween January 2008 and December 2012 at six centers in Ankara, Turkey.The median [interquartile range (IQR)] age was 22 (5-54) months; 60.4% ofthe patients were males, and 44% were younger than one year of age. Thewitnessed arrest rate was 75.8% (138/182) and the rate of bystander CPRwas 13.9% (13/93). In these patients the rate of the return of spontaneouscirculation (ROSC) was higher (76.9%). Following resuscitation in the patientsfor whom the spontaneous circulation was able to be returned, the median(IQR) duration of arrest was 5 (1- 15) min, while it was 15 (5-40) min forthe remaining patients (p

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1. Committee PEM. The role of the emergency physician in the care of children. American College of Emergency Physicians. Pediatric Emergency Medicine Committee. Ann Emerg Med 1990; 19: 435-436.

2. Tibballs J, Kinney S. Reduction of hospital mortality and of preventable cardiac arrest and death on introduction of a pediatric medical emergency team. Pediatr Crit Care Med 2009; 10: 306-312.

3. Pruitt CM. When will we get there? The quandary of investigation in pediatric out-of-hospital cardiac arrest. Resuscitation 2015; 97: A3-A4.

4. Kitamura T, Iwami T, Kawamura T, et al. Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have outof-hospital cardiac arrests: a prospective, nationwide, population-based cohort study. Lancet 2010; 375: 1347-1354.

5. Atkins DL, Everson-Stewart S, Sears GK, et al. Resuscitation Outcomes Consortium I Epidemiology and outcomes from out-of-hospital cardiac arrest in children: the Resuscitation Outcomes Consortium Epistry-Cardiac Arrest. Circulation 2009; 119: 1484- 1491.

6. Bardai A, Berdowski J, van der Werf C, et al. Incidence, causes, and outcomes of out-of-hospital cardiac arrest in children. A comprehensive, prospective, populationbased study in the Netherlands. J Am Coll Cardiol 2011; 57: 1822-1828.

7. Young KD, Gausche-Hill M, McClung CD, Lewis RJ. A prospective, population-based study of the epidemiology and outcome of out-of-hospital pediatric cardiopulmonary arrest. Pediatrics 2004; 114: 157-164.

8. Gerein RB, Osmond MH, Stiell IG, Nesbitt LP, Burns S. What are the etiology and epidemiology of out-ofhospital pediatric cardiopulmonary arrest in Ontario, Canada? Acad Emerg Med 2006; 13: 653-658.

9. Atkins DL, Berger S. Improving outcomes from out-of-hospital cardiac arrest in young children and adolescents. Pediatr Cardiol 2012; 33: 474-483.

10. Donoghue AJ, Nadkarni V, Berg RA, et al. Out-ofhospital pediatric cardiac arrest: an epidemiologic review and assessment of current knowledge. Ann Emerg Med 2005; 46: 512-522.

11. Zuckerman GB, Gregory PM, Santos-Damiani SM. Predictors of death and neurologic impairment in pediatric submersion injuries. The Pediatric Risk of Mortality Score. Arch Pediatr Adolesc Med 1998;152:134-140.

12. Sirbaugh PE, Pepe PE, Shook JE, et al. A prospective, population-based study of the demographics, epidemiology, management, and outcome of out-ofhospital pediatric cardiopulmonary arrest. Ann Emerg Med 1999; 33: 174-184.

13. Young KD, Seidel JS. Pediatric cardiopulmonary resuscitation: a collective review. Ann Emerg Med 1999; 33: 195-205.

14. Park CB, Shin SD, Suh GJ, et al. Pediatric out-of-hospital cardiac arrest in Korea: A nationwide population-based study. Resuscitation 2010; 81: 512-517.

15. Deasy C, Bernard SA, Cameron P, et al. Epidemiology of paediatric out-of-hospital cardiac arrest in Melbourne, Australia. Resuscitation 2010; 81: 1095-1100.

16. Kitamura T, Kiyohara K, Nitta M, Nadkarni VM, Berg RA, Iwami T. Survival following witnessed pediatric out-of-hospital cardiac arrests during nights and weekends. Resuscitation 2014; 85: 1692-1698.

17. Hickey RW. Response to: Out-of-hospital pediatric cardiac arrest: an epidemiologic review and assessment of current knowledge. Ann Emerg Med 2006; 48: 219.

18. Hickey RW, Cohen DM, Strausbaugh S, Dietrich AM. Pediatric patients requiring CPR in the prehospital setting. Ann Emerg Med 1995; 25: 495-501.

19. Kuisma M, Alaspaa A. Out-of-hospital cardiac arrests of non-cardiac origin. Epidemiology and outcome. Eur Heart J 1997; 18: 1122-1128.

20. Rodriguez-Nunez A, Lopez-Herce J, Garcia C, Dominguez P, Carrillo A, Bellon JM. Spanish Study Group of Cardiopulmonary Arrest in C. Pediatric defibrillation after cardiac arrest: initial response and outcome. Crit Care 2006; 10: 113.

21. Lopez-Herce J, Garcia C, Dominguez P, et al. Spanish Study Group of Cardiopulmonary Arrest in C. Characteristics and outcome of cardiorespiratory arrest in children. Resuscitation 2004; 63: 311-320.

22. Lopez-Herce J, Garcia C, Dominguez P, et al. Spanish Study Group of Cardiopulmonary Arrest in C. Outcome of out-of-hospital cardiorespiratory arrest in children. Pediatr Emerg Care 2005; 21: 807-815.

23. Lopez-Herce J, Garcia C, Rodriguez-Nunez A, et al. Spanish Study Group of Cardiopulmonary Arrest in C . Long-term outcome of paediatric cardiorespiratory arrest in Spain. Resuscitation 2005; 64: 79-85.

24. Foltin GL, Richmond N, Treiber M, et al. Pediatric prehospital evaluation of NYC cardiac arrest survival (PHENYCS). Pediatr Emerg Care 2012; 28: 864-868.

25. Tijssen JA, Prince DK, Morrison LJ, et al. Resuscitation Outcomes C. Time on the scene and interventions are associated with improved survival in pediatric out-ofhospital cardiac arrest. Resuscitation 2015; 94: 1-7.

26. Cunningham LM, Mattu A, O'Connor RE, Brady WJ. Cardiopulmonary resuscitation for cardiac arrest: the importance of uninterrupted chest compressions in cardiac arrest resuscitation. Am J Emerg Med 2012; 30: 1630-1638.

27. Schindler MB, Bohn D, Cox PN, et al. Outcome of out-of-hospital cardiac or respiratory arrest in children. N Eng J Med 1996; 335: 1473-1479.

28. Kendirli T, Erkek N, Koroglu T, et al. Cardiopulmonary resuscitation in children with in-hospital and out-ofhospital cardiopulmonary arrest: Multicenter study from Turkey. Pediatr Emerg Care 2015; 31: 748-752.

29. Ahn JY, Lee MJ, Kim H, Yoon HD, Jang HY. Epidemiological and survival trends of pediatric cardiac arrests in emergency departments in Korea: Acrosssectional, nationwide report. J Korean Med Sci 2015; 30: 1354-1360.

30. Innes PA, Summers CA, Boyd IM, Molyneux EM. Audit of paediatric cardiopulmonary resuscitation. Arch Dis Child 1993; 68: 487-491.

31. Abramson NS, Safar P, Detre KM, et al. Neurologic recovery after cardiac arrest: Effect of duration of ischemia. Crit Care Med 1985; 13: 930–931.

32. Matos MR, Watson RS, Nadkarni VM, et al. Duration of cardiopulmonary resuscitation and illness category impact survival and neurologic outcomes for in-hospital pediatric cardiac arrests. Circulation 2013; 127: 442-451.