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Trends in community response and long-term outcomes from pediatric cardiac arrest: A retrospective observational
M Albrecht1, R C J de Jonge1, K Dulfer1
1Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands.
Insights
Improved survival rates in pediatric out-of-hospital cardiac arrest (pOHCA) were observed, linked to increased automated external defibrillator (AED) use. Long-term cognitive outcomes like total IQ scores did not significantly change over time.
Area of Science:
- Pediatric Emergency Medicine
- Cardiology
- Neurology
Background:
- Pediatric out-of-hospital cardiac arrest (pOHCA) outcomes and pre-hospital factors require further large-scale population studies.
- Long-term neurological and neuropsychological outcomes post-pOHCA are critical but under-described.
Purpose of the Study:
- To investigate temporal trends in pre-hospital factors for pOHCA.
- To analyze trends in long-term neurological and neuropsychological outcomes following pOHCA.
- To identify factors associated with improved outcomes in pediatric cardiac arrest.
Main Methods:
- Retrospective analysis of non-traumatic arrest patients aged 1 day to 17 years (2002-2020).
- Inclusion criteria: Patients presenting to Sophia Children's Hospital.
- Statistical analysis: Multivariable logistic and linear regression models to assess trends over time, with year of event as the independent variable. Favorable neurological outcome defined as Pediatric Cerebral Performance Categories (PCPC) 1-2.
Main Results:
- A significant increase in long-term favorable neurological outcome (PCPC 1-2) was observed over the 19-year study period (OR 1.10).
- Annual automated external defibrillator (AED) use significantly increased (OR 1.21).
- Among adolescents, initial shockable rhythm also increased significantly (OR 1.15), while bystander basic life support (BLS) rates and total IQ scores did not change significantly over time.
Conclusions:
- Long-term favorable neurological outcomes following pediatric out-of-hospital cardiac arrest have improved over time.
- Increased automated external defibrillator (AED) use and a higher incidence of shockable rhythms in adolescents are concurrent trends.
- While neurological function has improved, overall cognitive scores (total IQ) remained stable, indicating a need for further research into comprehensive long-term recovery.
Aim:
This study aimed to investigate trends over time in pre-hospital factors for pediatric out-of-hospital cardiac arrest (pOHCA) and long-term neurological and neuropsychological outcomes. These have not been described before in large populations.
Methods:
Non-traumatic arrest patients, 1 day-17 years old, presented to the Sophia Children's Hospital from January 2002 to December 2020, were eligible for inclusion. Favorable neurological outcome was defined as Pediatric Cerebral Performance Categories (PCPC) 1-2 or no difference with pre-arrest baseline. The trend over time was tested with multivariable logistic and linear regression models with year of event as independent variable.
Findings:
Over a nineteen-year study period, the annual rate of long-term favorable neurological outcome, assessed at a median 2.5 years follow-up, increased significantly (OR 1.10, 95%-CI 1.03-1.19), adjusted for confounders. Concurrently, annual automated external defibrillator (AED) use and, among adolescents, initial shockable rhythm increased significantly (OR 1.21, 95% CI 1.10-1.33 and OR 1.15, 95% CI 1.02-1.29, respectively), adjusted for confounders. For generalizability purposes, only the total intelligence quotient (IQ) was considered for trend analysis of all tested domains. Total IQ scores and bystander basic life support (BLS) rate did not change significantly over time.
Interpretation:
Long-term favorable neurological outcome, assessed at a median 2.5 years follow-up, improved significantly over the study period. Total IQ scores did not significantly change over time. Furthermore, AED use (OR 1.21, 95%CI 1.10-1.33) and shockable rhythms among adolescents (OR1.15, 95%CI 1.02-1.29) increased over time.
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