Abstract 405: Characteristics and Care of Pediatric Out-of-Hospital Cardiac Arrest in the National Emergency Medical Services Information System

Abstract

Background: Pediatric out-of-hospital cardiac arrest (OHCA) is an infrequent event with variations in clinical performance in the United States. Recent data on national incidence and treatments provided by Emergency Medical Services (EMS) clinicians during these events is unclear. We sought to characterize the incidence, medications, and procedures performed on children presenting with OHCA. Methods: We evaluated EMS responses in the US using 2021 National Emergency Medical Services Information System (NEMSIS) data. We included children (age ≥1 day - 17 years) with 9-1-1 responses. We identified OHCA events by those with reported: 1) cardiac arrest, 2) EMS resuscitation attempt, 3) EMS CPR performance, or 4) EMS defibrillation. We determined the incidence of pediatric out-of-hospital cardiac arrest among EMS responses and evaluated patient demographics (age, sex, race, location, urbanicity) and clinical interventions (medications, airway procedures). Results: Among 1.74 million pediatric 9-1-1 responses in 2021, we observed 13,040 OHCA events and an overall incidence of 7.6 per 1,000 pediatric 9-1-1 responses. For OHCA events, the median age was 3 years (IQR 0.33,14); 33% of events occurred in children less than one-year-old and 30% in adolescents aged 13-17. Most patients were male (58%) and events occurred mainly in urban settings (79%) and homes (63%). Of this population, 12% received defibrillation, 41% epinephrine, and 27% an advanced airway (endotracheal intubation or supraglottic airway). Conclusions: Pediatric OHCA incidence was low and followed a biphasic pattern by age. As expected in the pediatric population, defibrillation rates were low. One-quarter of patients received an advanced airway. Epinephrine, recommended for all cardiac arrests, was found to be administered in less than half of these events. Further studies are needed to evaluate barriers to optimal OHCA management in pediatric patients in prehospital settings.