Abstract 10559: Association of Intra-Arrest Transport versus Continued On-scene Resuscitation with Survival to Hospital Discharge Among Pediatric Patients with Out-of-Hospital Cardiac Arrest

Abstract

Introduction: For pediatric patients with out-of-hospital cardiac arrest (OHCA) who do not achieve return of spontaneous circulation (ROSC), it remains unclear whether patients should be transported to a hospital with ongoing resuscitation or remain on-scene for further resuscitation. We therefore evaluated: (1) the association between intra-arrest transport, with reference to continued on-scene resuscitation, and survival to hospital discharge; and, (2) whether the association differs across the timing of intra-arrest transport. Methods: We conducted a secondary analysis of the Resuscitation Outcomes Consortium Epidemiologic Registry. We included pediatrics (<18 years) with emergency medical services (EMS)-treated OHCA between 2005 and 2015. Our exposure of interest was intra-arrest transport, defined as transport to a hospital prior to ROSC. Patients who had intra-arrest transport at any minute after EMS arrival underwent risk-set matching with patients who had continued on-scene resuscitation within the same minute using time-dependent propensity score calculated from patient demographics, arrest characteristics, and EMS interventions. We repeated the main analysis with 5-minute strata by the time of matching. Results: Of 2,854 included patients, the median age was 1 year (IQR, 0-9), 59.3% were male, 9.8% were public location, 22.1% were bystander witnessed, 6.0% had initial shockable rhythms, and 66.3% underwent intra-arrest transport at a median of 15 minutes (IQR 9-22) after EMS arrival. In the propensity-matched cohort including 2,080 patients, 5.5 % (57/1040) in intra-arrest transport group and 5.9% (61/1040) in continued on-scene resuscitation group had survival to hospital discharge (risk ratio [RR]=0.94, 95% CI 0.65-1.37). We did not detect an association within the time-based strata: 0-5 minutes (RR=0.74, 95% CI 0.19-2.85), 5-10 minutes (RR=0.52, 95% CI 0.23-1.16), 10-15 minutes (RR=1.13, 95% CI 0.58-2.22), 15-20 minutes, (RR=1.70, 95% CI 0.78-3.71), or >20 minutes (RR=0.73, 95% CI 0.32-1.63) after EMS arrival. Conclusions: Among pediatric patients with OHCA, intra-arrest transport was not associated with survival to hospital discharge. The findings persisted across the timing of intra-arrest transport.