Abstract 12808: Public Access Defibrillation Has Great Impact on Outcomes After Pediatric Out-of-hospital Cardiac Arrest

Abstract

Introduction: Use of automated external defibrillators (AEDs) has been recommended for pediatric out-of-hospital cardiac arrest (OHCA). Studies in adults suggest that public-access defibrillation (PAD) improves the outcomes after OHCA, but there have been no conclusive studies in children. Hypothesis: We assessed the hypothesis that PAD is associated with an increased chance of favorable outcomes after pediatric OHCA. Methods: This was a nationwide, population-based, propensity score-matched study of pediatric OHCA in Japan from January 1, 2011, to December 31, 2012, based on data from the All-Japan Utstein Registry. We included pediatric patients who experienced OHCA and received bystander CPR. The primary outcome was a favorable neurological state one month after OHCA defined as a Glasgow-Pittsburgh cerebral performance category (CPC) score of 1-2 (corresponding to a Pediatric CPC score of 1-3). The secondary outcomes included a neurologically favorable survival with a CPC score of 1 (corresponding to a Pediatric CPC score of 1), one-month survival, and prehospital return of spontaneous circulation (ROSC). Results: A total of 1,193 patients were included in the final cohort; 57 received PAD and 1,136 did not. Among 1,193 patients, 188 (15.8%) survived with a favorable neurological status one month after OHCA. The odds of neurologically favorable survival were significantly higher for patients receiving PAD after adjusting for potential confounders: propensity score matching, OR 3.17 (95%CI 1.40-7.17), and multivariable logistic regression modeling, OR 5.10 (95% CI 2.01-13.70). Similar findings were observed for the secondary outcomes. In subgroup analyses, there were no significant differences in neurologically favorable survival between PAD group and no PAD group in unwitnessed cohort (OR 7.76 [0.75-81.90]) and non-cardiac etiology cohort (OR6.65 [0.64-66.24]). Conclusions: In conclusion, PAD was associated with an increased chance of neurologically favorable survival after pediatric OHCA, except for unwitnessed cases and non-cardiac etiology cases.