PEDIATRIC OUT-OF-HOSPITAL CARDIAC ARRESTS - EPIDEMIOLOGY AND OUTCOME

Objective: To determine the epidemiology and aetiology of out-of-hospi tal paediatric cardiac arrest and the outcome of resuscitation and to apply the Utstein template for the paediatric cardiac arrest populatio n. Design: Retrospective cohort study, Setting: A middle-sized urban c ity (population 516 000) served by a single emergency medical services GEMS) system, Patients: 79 consecutive paediatric (age under 16 years ) prehospital cardiac arrest patients between January 1, 1985 and Dece mber 31, 1994. No patient was excluded. Intervention: Advanced paediat ric life support according to the recommendations of American Heart As sociation. Main outcome measures: Survival from cardiac arrest to disc harge and factors associated with favourable outcome defined as alive 1 year after discharge with Bloom category I or II. Results: 79 patien ts had cardiac arrest. The incidence of paediatric out-of-hospital car diac arrest and sudden unexpected out-of-hospital death was 9.8 and 8. 9/100 000/inhabitants aged under 16, respectively. The mean age was 2. 9 years, 72.2% were under 18 months. SIDS was the leading cause of car diac arrest followed by trauma, airway related cardiac arrest and (nea r)drowning. Fifty-two patients were considered for resuscitation in wh om asystole was the most common initial rhythm (78.9%) followed by pul seless electrical activity (13.5%) and ventricular fibrillation (3.8%) . Resuscitation was attempted in 34 patients. The overall survival rat e was 9.6%, for attempted resuscitation 14.7%, for attempted resuscita tion when cardiac arrest was witnessed 25.0% and for attempted resusci tation with witnessed arrest of cardiac origin 0%. Favourable outcome was registered in four of five survivors. Factors associated with favo urable outcome were collapse in a public place, the near-drowning aeti ology of arrest, bystander initiated CPR and short duration of resusci tation. Multivariate regression analysis showed no factor related to f avourable outcome, but MICU time interval < 10 min was related with su rvival Due to the retrospective nature of this study all core times co uld not be obtained. In spite of this, the Utstein template was applic able also in our paediatric cardiac arrest population. Conclusions: Su rvival from paediatric cardiac arrest has remained low. The overall su rvival rate was 9.6%, survival after attempted resuscitation 14.7% and 0% when resuscitation was attempted in witnessed arrest of cardiac or igin. Asystole was the most common initial rhythm and the four leading causes for cardiac arrest were SIDS, trauma, airway related arrest an d (near)drowning. The Utstein template adopted for adult out-of-hospit al cardiac arrests was was found applicable also in paediatric cardiac arrests.