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Association between shockable rhythms and long-term outcome after pediatric out-of-hospital cardiac arrest in
M Albrecht1, R C J de Jonge1, V M Nadkarni2
1Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Insights
Pediatric out-of-hospital cardiac arrest (pOHCA) with a shockable rhythm significantly improves long-term survival and favorable neurologic outcomes. Early recognition and treatment of shockable pOHCA are crucial for better outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Cardiology
- Neurology
Background:
- Pediatric out-of-hospital cardiac arrest (pOHCA) survival is linked to initial rhythm, but long-term outcomes remain understudied.
- Understanding the association between initial rhythm and long-term neurologic recovery is vital for improving pediatric cardiac arrest care.
Purpose of the Study:
- To investigate the association between the first documented rhythm and long-term neurologic outcomes in children experiencing pOHCA.
- To analyze survival rates and neurologic performance over an 18-year period in a pOHCA cohort.
Main Methods:
- Retrospective analysis of pediatric patients (1 day-18 years) with non-traumatic pOHCA admitted between 2002-2019.
- Long-term neurologic outcome assessed using Pediatric Cerebral Performance Category (PCPC) scores; multivariable regression used to determine associations.
Main Results:
- A shockable rhythm was documented in 14% of cases, significantly higher in adolescents (39%).
- Hospital survival was 39%; 81% of survivors achieved favorable long-term neurologic outcome (PCPC 1-2) at a median of 25 months.
- A shockable rhythm was strongly associated with favorable long-term neurologic outcome (OR 8.9).
Conclusions:
- Children with pOHCA and a shockable rhythm have significantly better odds of long-term survival with favorable neurologic outcome.
- Focusing on early recognition and on-scene treatment of shockable pOHCA is essential for improving overall outcomes.
Introduction:
Shockable rhythm following pediatric out-of-hospital cardiac arrest (pOHCA) is consistently associated with hospital and short-term survival. Little is known about the relationship between shockable rhythm and long-term outcomes (>1 year) after pOHCA. The aim was to investigate the association between first documented rhythm and long-term outcomes in a pOHCA cohort over 18 years.
Methods:
All children aged 1 day-18 years who experienced non-traumatic pOHCA between 2002-2019 and were subsequently admitted to the emergency department (ED) or pediatric intensive care unit (PICU) of Erasmus MC-Sophia Children's Hospital were included. Data was abstracted retrospectively from patient files, (ground) ambulance and Helicopter Emergency Medical Service (HEMS) records, and follow-up clinics. Long-term outcome was determined using a Pediatric Cerebral Performance Category (PCPC) score at the longest available follow-up interval through august 2020. The primary outcome measure was survival with favorable neurologic outcome, defined as PCPC 1-2 or no difference between pre- and post-arrest PCPC. The association between first documented rhythm and the primary outcome was calculated in a multivariable regression model.
Results:
369 children were admitted, nine children were lost to follow-up. Median age at arrest was age 3.4 (IQR 0.8-9.9) years, 63% were male and 14% had a shockable rhythm (66% non-shockable, 20% unknown or return of spontaneous circulation (ROSC) before emergency medical service (EMS) arrival). In adolescents (aged 12-18 years), 39% had shockable rhythm. 142 (39%) of children survived to hospital discharge. On median follow-up interval of 25 months (IQR 5.1-49.6), 115/142 (81%) of hospital survivors had favorable neurologic outcome. In multivariable analysis, shockable rhythm was associated with survival with favorable long-term neurologic outcome (OR 8.9 [95%CI 3.1-25.9]).
Conclusion:
In children with pOHCA admitted to ED or PICU shockable rhythm had significantly higher odds of survival with long-term favorable neurologic outcome compared to non-shockable rhythm. Survival to hospital discharge after pOHCA was 39% over the 18-year study period. Of survivors to discharge, 81% had favorable long-term (median 25 months, IQR 5.1-49.6) neurologic outcome. Efforts for improving outcome of pOHCA should focus on early recognition and treatment of shockable pOHCA at scene.
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