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Pediatric prehospital evaluation of NYC respiratory arrest survival (PHENYCS)
Michael G Tunik1, Neal Richmond, Marsha Treiber
1Department of Emergency Medicine and Pediatrics, NYU School of Medicine, New York, NY, USA.
Insights
Most pediatric out-of-hospital respiratory arrests (OOHRA) occurred at home, with a high survival rate of 79%. Bystander cardiopulmonary resuscitation (CPR) was infrequent, highlighting a need for increased family CPR efforts in pediatric emergencies.
Area of Science:
- Pediatric Emergency Medicine
- Resuscitation Science
- Public Health
Background:
- Out-of-hospital respiratory arrest (OOHRA) in children is a critical medical event.
- Understanding the demographics and outcomes of pediatric OOHRA is essential for improving emergency care.
- Previous research has focused on cardiac arrest, with less emphasis on respiratory arrest in children.
Purpose of the Study:
- To describe the demographics, epidemiology, and survival characteristics of children under 18 experiencing OOHRA.
- To analyze factors associated with survival in pediatric OOHRA cases within a large urban setting.
- To inform strategies for improving outcomes in pediatric out-of-hospital emergencies.
Main Methods:
- Prospective observational cohort study of pediatric OOHRA cases in New York City (April 2002-March 2003).
- Data collected by trained paramedics via telephone interviews, including Pediatric Utstein core measures and prehospital time intervals.
- Descriptive statistics and bivariate analyses were used to assess associations with survival.
Main Results:
- 109 pediatric OOHRAs were analyzed; median age was 7 years, 52% male.
- Most OOHRAs occurred at home (77%), with lay bystander witness in 56% and bystander CPR in 31%.
- Overall survival to hospital discharge was 79%; no significant association found between response time, witnessed arrest, bystander CPR, or ventilation method and survival.
Conclusions:
- The majority of pediatric out-of-hospital respiratory arrests occur at home, with a high overall survival rate.
- Bystander CPR, particularly by family members, was infrequently performed, indicating a need for increased public awareness and training.
- Out-of-hospital respiratory arrests represent a significant proportion of pediatric arrests, necessitating their inclusion in future research alongside cardiac arrests.
Objective:
The objective of this study was to describe the demographics, epidemiology, and characteristics associated with survival of children younger than 18 years who had an out-of-hospital respiratory arrest (OOHRA) during a 1-year period in a large urban area.
Methods:
A prospective observational cohort of consecutive children younger than 18 years with OOHRA cared for by the New York City 911 emergency medical services (EMS) system from April 12, 2002, to March 31, 2003. Following resuscitative efforts, data were collected from prehospital providers by trained paramedics using a previously validated telephone interview process. Data included Pediatric Utstein core measures and critical prehospital time intervals. Analyses used descriptive statistics and bivariate association with survival.
Results:
Resuscitation was attempted on 109 OOHRAs during the study period. The median age was 7 years, 52% were male. Lay bystanders witnessed 56%. Most occurred at home (77%). Witnesses were family members in 59%. Bystander cardiopulmonary resuscitation (CPR) was performed in 31% of all respiratory arrests (RAs). A chronic medical condition existed in 28%. Median EMS response time was 4.4 minutes (range, 0-12 min). Overall survival was 79% to hospital discharge. Time interval to EMS arrival, witnessed arrest, bystander CPR, and ventilation method were not associated with survival.
Conclusions:
Most OOHRAs occurred at home, and bystander CPR occurred infrequently. The majority of children in OOHRA survived. Strategies to increase the rate of bystander CPR, especially by family members, are needed. Out-of-hospital RAs are a large proportion of all arrests in children. Future studies of pediatric arrest should include RA as well as cardiac arrest.
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