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Neurological outcomes in children dead on hospital arrival
Yoshikazu Goto1, Akira Funada2, Yumiko Nakatsu-Goto3
1Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, 920-8641, Japan. gotoyosh@med.kanazawa-u.ac.jp.
Insights
Favorable neurological outcomes in pediatric out-of-hospital cardiac arrest (OHCA) survivors without prehospital return of spontaneous circulation (ROSC) are linked to initial non-asystole rhythms and bystander-witnessed arrests. These factors significantly improve survival chances in children.
Area of Science:
- Pediatric Emergency Medicine
- Cardiology
- Neurology
Background:
- Achieving favorable neurological outcomes in pediatric out-of-hospital cardiac arrest (OHCA) survivors without prehospital return of spontaneous circulation (ROSC) is challenging.
- Key prehospital factors influencing outcomes in this specific pediatric OHCA cohort remain poorly understood.
- This study investigates prehospital predictors of survival with good neurological function (Cerebral Performance Category 1-2) in children experiencing OHCA without prehospital ROSC.
Purpose of the Study:
- To identify critical prehospital factors associated with favorable neurological outcomes (CPC 1-2) in children who experienced OHCA without prehospital ROSC.
- To analyze the impact of initial cardiac rhythm, bystander intervention, and other prehospital variables on neurological recovery.
- To provide evidence-based insights for improving resuscitation strategies in pediatric OHCA.
Main Methods:
- Analysis of a prospectively recorded Japanese national database (Utstein-style) from 2008-2012.
- Inclusion of 7332 children (<18 years) with OHCA and no prehospital ROSC.
- Primary endpoint: 1-month Cerebral Performance Category (CPC) 1-2.
Main Results:
- The 1-month survival rate was 6.92% and favorable neurological outcome (CPC 1-2) rate was 0.99%.
- Factors significantly associated with favorable neurological outcomes included older age, bystander-witnessed arrest, initial non-asystole rhythms (Ventricular Fibrillation/Pulseless Ventricular Tachycardia, Pulseless Electrical Activity), and presumed cardiac causes.
- Multivariate analysis identified initial non-asystole rhythm (aOR 16.0 for VF/VT, aOR 5.19 for PEA) and bystander-witnessed arrest (aOR 3.22) as independent predictors of 1-month CPC 1-2.
Conclusions:
- Initial non-asystole rhythm and bystander-witnessed arrest are crucial prehospital factors for achieving favorable neurological outcomes in pediatric OHCA patients without prehospital ROSC.
- Early recognition and intervention by bystanders, along with prompt defibrillation for shockable rhythms, are vital for improving neurological recovery in this population.
- These findings underscore the importance of optimizing prehospital care to enhance survival and neurological function in critically ill children.
Introduction:
Obtaining favorable neurological outcomes is extremely difficult in children transported to a hospital without a prehospital return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA). However, the crucial prehospital factors affecting outcomes in this cohort remain unclear. We aimed to determine the prehospital factors for survival with favorable neurological outcomes (Cerebral Performance Category 1 or 2 (CPC 1-2)) in children without a prehospital ROSC after OHCA.
Methods:
Of 9093 OHCA children, 7332 children (age <18 years) without a prehospital ROSC after attempting resuscitation were eligible for enrollment. Data were obtained from a prospectively recorded Japanese national Utstein-style database from 2008 to 2012. The primary endpoint was 1-month CPC 1-2 after OHCA.
Results:
The 1-month survival and 1-month CPC 1-2 rates were 6.92 % (n = 508) and 0.99 % (n = 73), respectively. The proportions of the following prehospital variables were significantly higher in the 1-month CPC 1-2 cohort than in the 1-month CPC 3-5 cohort: age (median, 3 years (interquartile range (IQR), 0-14) versus 1 year (IQR, 0-11), p <0.05), bystander-witnessed arrest (52/73 (71.2 %) versus 1830/7259 (25.2 %), p <0.001), initial ventricular fibrillation (VF)/pulseless ventricular tachycardia (VT) rhythm (28/73 (38.3 %) versus 241/7259 (3.3 %), p <0.001), presumed cardiac causes (42/73 (57.5 %) versus 2385/7259 (32.8 %), p <0.001), and actual shock delivery (25/73 (34.2 %) versus 314/7259 (4.3 %), p <0.0001). Multivariate logistic regression analysis indicated that 2 prehospital factors were associated with 1-month CPC 1-2: initial non-asystole rhythm (VF/pulseless VT: adjusted odds ratio ( aOR), 16.0; 95 % confidence interval (CI), 8.05-32.0; pulseless electrical activity (PEA): aOR, 5.19; 95 % CI, 2.77-9.82) and bystander-witnessed arrest (aOR, 3.22; 95 % CI, 1.84-5.79). The rate of 1-month CPC 1-2 in witnessed-arrest children with an initial VF/pulseless VT was significantly higher than that in those with other initial cardiac rhythms (15.6 % versus 2.3 % for PEA and 1.2 % for asystole, p for trend <0.001).
Conclusions:
The crucial prehospital factors for 1-month survival with favorable neurological outcomes after OHCA were initial non-asystole rhythm and bystander-witnessed arrest in children transported to hospitals without a prehospital ROSC.