A Nationwide Retrospective Analysis of Out-of-Hospital Pediatric Cardiopulmonary Resuscitation Treated by Helicopter Emergency Medical Service in the Netherlands

Xavier R.J Moors,Michelle Oude Alink,Stef Bouman,Patrick Schober,Marcel De Leeuw,Nico Hoogerwerf,Margot Bergsma,Dennis Den Hartog,Robert Jan Houmes,Robert Jan Stolker

doi:10.1016/j.amj.2021.08.004

Abstract

ObjectiveThere is generally limited but conflicting literature on the incidence, causes, and outcomes of pediatric out-of-hospital cardiac arrest. This study was performed to determine the incidence and outcome of pediatric out-of-hospital cardiac arrest reported by all helicopter emergency medical services in the Netherlands and to provide a description of causes and treatments and, in particular, a description of the specific interventions that can be performed by a physician-staffed helicopter emergency medical service. MethodsA retrospective analysis was performed of all documented pediatric (0 < 18 years of age) out-of-hospital cardiac arrests from July 2015 to July 2017, attended by all 4 Dutch helicopter emergency medical service teams. ResultsTwo hundred two out-of-hospital cardiac arrests were identified. The overall incidence in the Netherlands is 3.5 out-of-hospital cardiac arrests in children per 100,000 pediatric inhabitants. The overall survival rate for out-of-hospital cardiac arrest was 11.4%. Eleven (52%) of the survivors were in the drowning group and between 12 and 96 months of age. ConclusionHelicopter emergency medical services are frequently called to pediatric out-of-hospital cardiac arrests in the Netherlands. The survival rate is normal to high compared with other countries. The 12- to 96-month age group and drowning seem to have a relatively favorable outcome.

Highlights

The overall incidence of of-hospital cardiac arrest (OHCA) in the Netherlands is 3.5 OHCAs per 100,000 pediatric inhabitants (0 < 18 years of age), but it varies by region between 0 and 17.2 per 100,000 pediatric inhabitants (Table 3)
The highest number of OHCAs in pediatric patients occurred in the 2 ambulance regions with the largest cities of the Netherlands
The other 2 ambulance regions where Helicopter emergency medical service (HEMS) are stationed received 9.6 (Groningen) and 6.2 (Gelderland-Midden) pediatric OHCAs per 100,000 pediatric inhabitants. These 2 HEMS are active in a more rural area. This can be seen in the response times (Table 4); the time from the initial 112 call and HEMS arriving on scene is prolonged in these 2 rural areas because of the increased distance to the scene

Summary

Methods

Study Setting The Netherlands has a population of over 17 million people covering an area of 41,543 km[2]. In 2020, there were approximately 2.9 million people younger than 18 years of age living in the Netherlands.[13] HEMS is dispatched either primarily according to national protocol by EMS dispatch or secondarily by the EMS at the incident location. When HEMS became operational in 1995, EMS frequently secondarily asked for assistance because of limited expertise and experience in vitally compromised children.[10,11] After a few years (well before the study period), it became standard protocol to activate HEMS primarily in vitally compromised children.[12] Since February 2011, HEMS has been available 24/7 by helicopter, but if the weather conditions are below limitations or the incident is nearby, a specially designed emergency vehicle is used to transport the HEMS team. 22% of the patients treated are under 18 years of age

Results

Discussion

Conclusion