Abstract
Background: Since 2005, the American Heart Association has recommended that children in cardiopulmonary arrest (CA), greater than 1 year of age, receive an attempt at automated external defibrillator (AED) application and shock. However, little is known about whether these guidelines have reached the bystander response in the U.S. Objective: 1) To characterize survival and neurologically intact (NI) outcomes of pediatric out of hospital CA events 2) To determine the prevalence of bystander cardiopulmonary resuscitation (CPR) and AED, particularly in those victims under 8 years of age. Methods: We conducted a secondary analysis of prospectively collected data from 29 U.S. cities that participate in the Cardiac Arrest Registry to Enhance Survival (CARES). Patients were included if they were less than 18 years of age and had a documented resuscitation attempt from October 1, 2005 through December 31, 2009. Chi-squared tests were used to test for differences in AED and bystander CPR provision between age groups. Results: A total of 481 cases comprised our cohort. The overall survival was 5.6 % (95% CI: 3.7-8.1), and NI survival was 3.5% (95% CI: 2.0- 5.6). Across all age strata, asystole was the most common initial rhythm. Sixty-six (13.7 % (95% CI: 10.8-17.1) patients had a shockable rhythm with increasing percentages of shockable rhythms at older ages (<30 days: 3.2% (n=2); 30 days-1 year old: 3.4% (n=7); 1-5 years old: 10.1% (n=7); 5-12 years old: 22.1% (n=13); 12-18 years old: 31.8% (n=27), p<0.05). Bystander CPR and AED rates are shown in the table. Overall AED use for the sample was 70/481; 14.6% (95% CI: 11.5-18.0) while the provision of bystander CPR was 160/481; 33.3% (95% CI: 29.1-37.7). Conclusions: Despite a similar rate of bystander CPR and higher rate of AED use, pediatric CA have lower overall and NI survival as compared to the adult population. Future research will need to be conducted to determine the barriers to children receiving bystander CPR and having AEDs applied
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