Abstract 12348: Different Outcomes by First Documented Rhythm After Witnessed Out-of-Hospital Cardiac Arrest in Children

Abstract

Background: Preventing the tragedy of pediatric out-of-hospital cardiac arrest (OHCA) is an important public health problem, and further accumulation of evidence is needed to improve the outcomes after pediatric OHCA. However, little evidence is available about the prognostic differences by first documented rhythm. Methods and Results: We enrolled 3968 young (< 18 years old) witnessed OHCA patients between 2005 and 2012 from a prospective nationwide population-based cohort database in Japan. We assessed and compared the neurologically favorable one-month survival defined as Glasgow-Pittsburg cerebral performance category 1 or 2 by first documented rhythm (pulseless ventricular tachycardia/ventricular fibrillation [pVT/VF], pulseless electrical activity [PEA], and asystole). The number of OHCA patients with pVT/VF, PEA, and asystole were 556, 1249, and 2163, respectively. The proportion of overall neurologically favorable one-month survival in patients with pVT/VF, PEA and asystole were 36.5%, 5.0%, and 1.8%, respectively in all study population and 73.8%, 27.7%, and 13.8%, respectively in patients who achieved prehospital ROSC. Figure shows the relationship between time from collapse to first cardiopulmonary resuscitation (CPR) and the endpoint in total population with estimated probabilities of the endpoint (line) and the respective 95% confidence intervals (bands). The proportion of asystole increased as the time from collapse to CPR delayed whereas those of pVT/VF and PEA decreased (Trend p<0.001). Earlier initiation of CPR after pediatric OHCA resulted in higher achievement rate of prehospital ROSC (adjusted odds ratio 0.97, 95% confidence interval 0.95-1.00, p=0.025) which showed much better prognoses than those in total study population. Conclusions: The pediatric OHCA outcome differed by the type first documented rhythm. Shortening of time to first CPR is crucial for improving outcomes after pediatric OHCA.