Retrospective population-based study of emergency medical services-attended out-of-hospital cardiac arrests in children in Belgium.

Abstract

This study presents an analysis of clinical data of the circumstances and outcome of paediatric (0-16 years) out-of-hospital cardiac arrests (p-OHCA) in Belgium. This was a retrospective study of a prospective population-based registration of physician-attended [mobile emergency group (MUG)] emergency medical services (EMS) interventions of p-OHCA in Belgium between 2010 and 2012. We identified 365 OHCA in 18 295 paediatric MUG interventions (2%). Cardiopulmonary resuscitation was performed in 260 (71.2%) cases. In 59.2%, a medical problem was presumed to be underlying. In 106 (40.7%) cases, an 'external' cause (e.g. trauma) was the reason for the OHCA. Eventually, 133 children were transported to the emergency department, with return-of-spontaneous-circulation (ROSC) in 42 cases. In the group with initial shockable rhythm (n=13), sustained ROSC was obtained in 69.2%. For those with an initial nonshockable rhythm, the prognosis was much more reserved (13.4% sustained ROSC). This number is in contrast to the high number of children who are transported from scene (51.2%). Importantly, 40.6% of the latter were proclaimed 'dead' during transport. p-OHCA remains rare. Typically, Belgian MUGs each encounter less than two p-OHCA yearly, thus inducing a risk of being insufficiently prepared. Compared with other countries, cardiopulmonary resuscitation was not started in more cases. Even so, in many other cases, children were transported from scene to be proclaimed 'dead' very soon after, pointing to a practice of 'slow code'. This study provides 'real-life' data on p-OHCA in Belgium. As it is based on an administrative registry, it lacks information on individual cases. Large population-based registries are needed to further guide our decision making.