Abstract 276: Prehospital Advanced Airway Management Without Intravenous Access May Negatively Affect Favorable Neurological Outcome in Children With Out-of-Hospital Cardiac Arrest

Abstract

Background: Although advanced airway management and intravenous (IV) access for patients with out-of-hospital cardiac arrest (OHCA) are thought to be lifesaving procedures at prehospital settings, recent data suggested that these procedures might lead to poorer neurological outcome for adult population. This association needs to be studied further for pediatric population as well. Methods: Data were collected through a Japanese nationwide, population-based registration form for OHCA from 2005 to 2011 involving 13,159 consecutive children aged less than 18 years old. Data regarding OHCA patients such as age, etiology, bystander CPR, and others were collected. Main outcome measure was favorable neurological outcome at one month from OHCA event, which was defined as cerebral performance category 1 or 2. OHCA patients who did not receive any resuscitative intervention by prehospital personnel were excluded from the analysis. Results: 12,510 OHCA pediatric patients were eligible to the analysis. Among these, 465 (3.7%) patients had both IV access and advanced airway (IV+/AA+), 328 (2.6%) patients had only IV access (IV+/AA-), 1,685 (13.5%) patients had only advanced airway (IV-/AA+), and 10,032 (80.2%) patients had neither of them (IV-/AA-). Devices of advanced airway management were esophageal obturator airway (60%), laryngeal mask (30%), and endotracheal tube (10%). Favorable neurological outcome at one month from OHCA event for IV-/AA- group (4.2% [412/10,032]) was compared with other groups. IV-/AA+ group had the worst outcome (1.9% [32/1685]; OR 0.45, 95% CI; 0.31 - 0.64) followed by IV+/AA+ group (3.4% [16/465]; OR 0.82, 95%CI; 0.49 - 1.37) and IV+/AA- group (3.7% [12/328]; OR 0.88, 95% CI; 0.49 - 1.57). Baseline characteristics for these groups were not significantly different except for age distribution as IV-/AA- group were younger than others. There was no statistical difference in neurological outcome between IV-/AA+ group and IV+/AA+ group. Conclusion: Advanced airway management without IV access seems to negatively affect pediatric OHCA patients. Obtaining IV access and further intervention by prehosital personnel may compensate this effect.