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Adverse Safety Events in Emergency Medical Services Care of Children With Out-of-Hospital Cardiac Arrest
Carl O Eriksson1, Nathan Bahr2, Garth Meckler3,4
1Department of Pediatrics, Oregon Health and Science University, Portland.
Insights
Sixty percent of pediatric out-of-hospital cardiac arrest patients experienced severe adverse safety events (ASEs), with neonates most affected. These findings highlight an urgent need to improve emergency medical services for critically ill children.
Area of Science:
- Pediatric Emergency Medicine
- Cardiovascular Research
- Patient Safety
Background:
- Survival rates for pediatric out-of-hospital cardiac arrest (OHCA) remain suboptimal.
- Improvements in adult OHCA survival have not translated to pediatric populations.
Purpose of the Study:
- To determine the frequency of adverse safety events (ASEs) in pediatric OHCA.
- To identify factors associated with ASEs in pediatric OHCA patients.
Main Methods:
- A retrospective cohort study analyzed patient care reports from 51 emergency medical services (EMS) agencies across multiple US states.
- The study included children younger than 18 years with OHCA between 2013 and 2019.
- Data analysis focused on severe ASEs during EMS encounters.
Main Results:
- Of 1019 pediatric OHCA encounters, 60% had at least one severe ASE.
- Neonates experienced the highest frequency of ASEs, particularly involving epinephrine administration, vascular access, and ventilation.
- Young age was the only factor associated with severe ASEs; neonates had significantly higher odds.
Conclusions:
- A high proportion (60%) of pediatric OHCA patients treated by EMS experience severe adverse safety events.
- Neonates, especially those with birth-related OHCA, face the greatest risk of ASEs.
- Urgent improvements in care delivery and training are needed for pediatric OHCA management.
Importance:
Survival for children with out-of-hospital cardiac arrest (OHCA) remains poor despite improvements in adult OHCA survival.
Objective:
To characterize the frequency of and factors associated with adverse safety events (ASEs) in pediatric OHCA.
Design, Setting, And Participants:
This population-based retrospective cohort study examined patient care reports from 51 emergency medical services (EMS) agencies in California, Georgia, Oregon, Pennsylvania, Texas, and Wisconsin for children younger than 18 years with an OHCA in which resuscitation was attempted by EMS personnel between 2013 and 2019. Medical record review was conducted from January 2019 to April 2022 and data analysis from October 2022 to February 2023.
Main Outcomes And Measure:
Severe ASEs during the patient encounter (eg, failure to give an indicated medication, 10-fold medication overdose).
Results:
A total of 1019 encounters of EMS-treated pediatric OHCA were evaluated; 465 patients (46%) were younger than 12 months. At least 1 severe ASE occurred in 610 patients (60%), and 310 patients (30%) had 2 or more. Neonates had the highest frequency of ASEs. The most common severe ASEs involved epinephrine administration (332 [30%]), vascular access (212 [19%]), and ventilation (160 [14%]). In multivariable logistic regression, the only factor associated with severe ASEs was young age. Neonates with birth-related and non-birth-related OHCA had greater odds of a severe ASE compared with adolescents (birth-related: odds ratio [OR], 7.0; 95% CI, 3.1-16.1; non-birth-related: OR, 3.4; 95% CI, 1.2-9.6).
Conclusions And Relevance:
In this large geographically diverse cohort of children with EMS-treated OHCA, 60% of all patients experienced at least 1 severe ASE. The odds of a severe ASE were higher for neonates than adolescents and even higher when the cardiac arrest was birth related. Given the national increase in out-of-hospital births and ongoing poor outcomes of OHCA in young children, these findings represent an urgent call to action to improve care delivery and training for this population.
