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Pediatric out-of-hospital cardiac arrest in Denmark
Mathias Geldermann Holgersen1,2,3, Theo W Jensen2,4, Niklas Breindahl2,4,5
1Copenhagen Emergency Medical Services, Telegrafvej 5, 2750, Ballerup, The Capital Region of Denmark, Denmark.
Insights
Pediatric out-of-hospital cardiac arrest (POHCA) is rare but serious, particularly in infants. Hypoxia is the main cause, and prompt defibrillator use improves survival rates in children.
Area of Science:
- Pediatric Emergency Medicine
- Cardiology
- Public Health
Background:
- Pediatric out-of-hospital cardiac arrest (POHCA) is an understudied critical event in children.
- Understanding POHCA's incidence, causes, and outcomes is crucial for improving pediatric resuscitation efforts.
Purpose of the Study:
- To determine the incidence, identify reversible causes, and analyze survival rates of POHCA in Denmark.
- To investigate factors influencing survival, including age and defibrillator use.
Main Methods:
- A nationwide registry-based cohort study in Denmark covering 2016-2019.
- Manual review of prehospital medical records by independent raters to identify presumed reversible causes of POHCA.
Main Results:
- 173 POHCA cases identified; incidence was 4.2 per 100,000 children.
- Hypoxia was the predominant reversible cause (42.2%); 48.6% of cases had a presumed reversible cause.
- Thirty-day survival was 40%, with lower rates in infants. Defibrillator use was higher in survivors.
Conclusions:
- POHCA is a rare event with higher incidence and mortality in infants.
- Hypoxia is the most common cause, and defibrillator use is associated with better survival outcomes.
- Targeted interventions for hypoxia and early defibrillation are critical for pediatric cardiac arrest survival.
Background:
Pediatric out-of-hospital cardiac arrest (POHCA) has received limited attention. All causes of POHCA and outcomes were examined during a 4-year period in a Danish nationwide register and prehospital medical records. The aim was to describe the incidence, reversible causes, and survival rates for POHCA in Denmark.
Methods:
This is a registry-based follow-up cohort study. All POHCA for a 4-year period (2016-2019) in Denmark were included. All prehospital medical records for the included subjects were reviewed manually by five independent raters establishing whether a presumed reversible cause could be assigned.
Results:
We identified 173 cases within the study period. The median incidence of POHCA in the population below 17 years of age was 4.2 per 100,000 persons at risk. We found a presumed reversible cause in 48.6% of cases, with hypoxia being the predominant cause of POHCA (42.2%). The thirty-day survival was 40%. Variations were seen across age groups, with the lowest survival rate in cases below 1 year of age. Defibrillators were used more frequently among survivors, with 16% of survivors defibrillated bystanders as opposed to 1.9% in non-survivors and 24% by EMS personnel as opposed to 7.8% in non-survivors. The differences in initial rhythm being shockable was 34% for survivors and 16% for non-survivors.
Conclusion:
We found pediatric out-of-hospital cardiac arrests was a rare event, with higher incidence and mortality in infants compared to other age groups of children. Use of defibrillators was disproportionally higher among survivors. Hypoxia was the most common presumed cause among all age groups.
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