Abstract 121: The Influence of Age, Race, and Ethnicity on Public Automated External Defibrillator Use and Outcomes of Pediatric Out-of-Hospital Cardiac Arrest in the United States: An Analysis of the Cardiac Arrest Registry to Enhance Survival (CARES)

Abstract

Introduction: Automated external defibrillators (AEDs) are an important link in the chain of survival following out-of-hospital cardiac arrest (OHCA). While the use of AEDs are clearly beneficial for OHCA in adults, there are few data on the overall use and outcomes of public AED use in children. Hypothesis: AED use is uncommon in children and associated with neurologically favorable survival. Methods: We conducted an analysis of the Cardiac Arrest Registry to Enhance Survival database. Inclusion criteria were age ≤ 18 years of age, public arrests, and non-traumatic OHCA from January 1, 2013 through December 31, 2017. Neurologically favorable survival was defined as a Cerebral Performance Category Scale of 1 or 2 at hospital discharge. Results: Of 971 public pediatric OHCA (66% male, 32% white), AEDs were used by bystanders in 117 (10.3%). AEDs were used among 2.3% of children aged ≤ 1 year (infants), 8.3% of 2-5 year-olds, 12.4% of 6-11 year-olds, and 18.2% of 12-18 year-olds (p<0.001). AED use was similar among white (11.1%), black (9.1%), and Hispanic children (8.1%) (p=0.84). AED use was more common with the provision of bystander CPR (19.1%) vs no bystander CPR (0.9%), witnessed arrests (16.0%) vs unwitnessed arrests (4.7%), and arrests with a shockable rhythm (23.6%) vs a nonshockable rhythm (6.3%) (p<0.001 for all). Overall, adjusted neurologically favorable survival was 29.1% (95% CI 22.7%, 35.5%) when a bystander used an AED compared to 23.7% (95% confidence interval [CI] 21.1%, 26.3%) for no bystander AED use (p=0.11). There was a significant interaction with age and race/ethnicity. AEDs were associated with neurologically favorable survival among children aged 12-18 years (p=0.04) but not associated with neurologically favorable survival in children ≤ 1 year (p=0.43), 1-5 years (p=0.16) or 6-11 years (0.41). AEDs were also associated with neurologically favorable survival in white children (p=0.01) but not with black (p=0.97) or Hispanic children (p=0.06). Conclusions: AED use is uncommon in children suffering OHCA but is associated with improved neurologically favorable survival. The benefit of AEDs was evident mostly for adolescents and white children. Further study is needed to understand these disparities in AED use and outcomes after AED use.