Epidemiology of pediatric out-of-hospital cardiac arrest compared with adults

Abstract

Out-of-hospital cardiac arrest (OHCA) is associated with approximately 90% mortality rate. In the pediatric population, this would equate to a large number of years of life lost, posing a heavy medical and economic burden to society. Outline characteristics and causes of pediatric OHCA (pOHCA) and associations with survival until discharge in patients enrolled in the End Unexplained Cardiac Death (EndUCD) registry. A prospective state-wide multi-source registry identified all pOHCA in patients aged 1-18 years old in Victoria, Australia (population 6.5 million), from April 2019 to April 2021. Cases were adjudicated using ambulance, hospital and forensic records, clinic assessments and interviews of survivors and family members. The analysis included 106 cases after adjudication (58.5% male), 45 (42.5%) of which were cardiac causes of OHCA, with unascertained (n = 33, 31.1%) being the most common cardiac cause reported. Respiratory events (n = 28, 26.4%) were the most common non-cardiac cause of pOHCA. Non-cardiac causes were more likely to present with asystole or pulseless electrical activity (p=0.007). The overall survival to hospital discharge rate was 11.3% and associated with increasing age, witnessed cardiac arrest and initial ventricular arrhythmias (p<0.05). The incidence of pOHCA in the study population was 3.69 per 100 000 child-years. In contrast to young adults with OHCA, the most common aetiology was non-cardiac. Prognostic factors associated with survival to discharge included increasing age, witnessed arrest and initial ventricular arrhythmias. Rates of cardiopulmonary resuscitation and defibrillation were sub-optimal.