Pre-hospital Prognostic Factors of Out-of-Hospital Cardiac Arrest: The Difference Between Pediatric and Adult.

Shih-Chiang Hung,Ming-Ta Tsai,Yu-Ni Ho,Kuan-Han Wu,Fu-Jen Cheng,I-Min Chiu,Wei-Ting Wu

doi:10.3389/fped.2021.723327

Shih-Chiang Hung, Ming-Ta Tsai + Show 5 more

Open Access

https://doi.org/10.3389/fped.2021.723327

Copy DOI

Abstract

The prognosis of out-of-hospital cardiac arrest (OHCA) is very poor. Although several pre-hospital factors are associated with survival, the different association of pre-hospital factors with OHCA outcomes in pediatric and adult groups remain unclear. To assess the association of pre-hospital factors with OHCA outcomes among pediatric and adult groups, a retrospective observational study was conducted using the emergency medical service (EMS) database in Kaohsiung from January 2015 to December 2019. Pre-hospital factors, underlying diseases, and OHCA outcomes were collected for the pediatric (Age ≤ 20) and adult groups. Kaplan-Meier type plots and multivariable logistic regression were used to analyze the association between pre-hospital factors and outcomes. In total, 7,461 OHCAs were analyzed. After adjusting for EMS response time, bystander CPR, attended by EMT-P, witness, and pre-hospital defibrillation, we found that age [odds ratio (OR) = 0.877, 95% confidence interval (CI): 0.764–0.990, p = 0.033], public location (OR = 7.681, 95% CI: 1.975–33.428, p = 0.003), and advanced airway management (AAM) (OR = 8.952; 95% CI, 1.414–66.081; p = 0.02) were significantly associated with survival till hospital discharge in pediatric OHCAs. The results of Kaplan-Meier type plots with log-rank test showed a significant difference between the pediatric and adult groups in survival for 2 h (p < 0.001), 24 h (p < 0.001), hospital discharge (p < 0.001), and favorable neurologic outcome (p < 0.001). AAM was associated with improved survival for 2 h (p = 0.015), 24 h (p = 0.023), and neurologic outcome (p = 0.018) only in the pediatric group. There were variations in prognostic factors between pediatric and adult patients with OHCA. The prognosis of the pediatric group was better than that of the adult group. Furthermore, AAM was independently associated with outcomes in pediatric patients, but not in adult patients. Age and public location of OHCA were independently associated with survival till hospital discharge in both pediatric and adult patients.

Highlights

The prognosis of out-of-hospital cardiac arrest (OHCA) is very poor; only 2–20% of patients can survive till hospital discharge [1,2,3,4]
Deaths due to trauma or drowning (n = 1,661), resuscitation not started due to preprescribed do not resuscitate” (DNR) order (n = 703), and incomplete data (n = 1,108) were excluded; 7,461 OHCAs were analyzed in this study
Pediatric OHCA patients had a higher ratio of public location of cardiac arrest (p < 0.001), bystander cardiopulmonary resuscitation (CPR) (p = 0.014), and survival till hospital discharge (p < 0.001), as well as a lower ratio of pre-hospital defibrillation by automated external defibrillator (AED) (p = 0.009), laryngeal mask use (p < 0.001), diabetes (p < 0.001), and malignancy (p = 0.011)

Summary

Introduction

The prognosis of out-of-hospital cardiac arrest (OHCA) is very poor; only 2–20% of patients can survive till hospital discharge [1,2,3,4]. The prevalence of pediatric OHCA varies among countries, ranging from 5.4 to 18 per 100,000 person-years [5,6,7]. Patient level characteristics, such as age, sex, and comorbidities might influence OHCA outcome [8,9,10]. The prognosis of OHCA is relatively better than that of adult patients, and the rate of survival till hospital discharge ranges from 10 to 20% [6, 7, 11].

Objectives

Methods

Results

Conclusion