Epidemiology, Process of Care, and Associated Outcomes of Pediatric Out-of-Hospital Cardiac Arrest in China: Results From a Prospective, Multicenter, Population-Based Registry
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Published on: November 3, 2023
Xiangkai Zhao1,2,3, Wen Zheng1,2,3, Yu Ma4
1Department of Emergency Medicine, Chest Pain Center, Shandong Provincial Clinical Research Center for Emergency and Critical Care Medicine, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital of Shandong University, Jinan, China.
Insights
Pediatric out-of-hospital cardiac arrest (OHCA) in China is rare, with low survival rates. Nonmedical causes like trauma and asphyxia are common, highlighting the need for accident prevention and improved emergency care for children.
Area of Science:
- Pediatric Emergency Medicine
- Public Health
- Epidemiology
Background:
- Out-of-hospital cardiac arrest (OHCA) in children presents unique challenges.
- Understanding the epidemiology of pediatric OHCA is crucial for developing targeted interventions.
- China's large pediatric population necessitates a national registry to capture comprehensive data.
Purpose of the Study:
- To determine the incidence, care processes, and outcomes of pediatric OHCA in China.
- To analyze variations in pediatric OHCA across different age groups.
- To identify areas for improvement in the chain of survival for pediatric OHCA.
Main Methods:
- Prospective, multicenter, population-based registry (BASIC-OHCA).
- Inclusion of 25 monitoring sites across seven geographical regions in China.
- Enrollment of pediatric patients (age ≤ 19) with EMS-assessed OHCA from August 2019 to December 2020.
Main Results:
- 1493 pediatric OHCA cases identified; resuscitation attempted in 43.6%.
- Crude incidence of EMS-assessed OHCA was 5.5 per 100,000.
- High proportion (54.2%) of nonmedical causes; survival to discharge or 30 days was 3.5% with favorable neurologic prognosis in 3.1%.
Conclusions:
- This is the first national study on pediatric OHCA in China.
- The high rate of nonmedical causes emphasizes the need for child accident prevention strategies.
- Gaps in the chain of survival and poor outcomes highlight opportunities for improving pediatric OHCA treatment in China and other developing nations.
Objectives:
To comprehensively describe the incidence, process of care, outcomes, and variation among different age groups of pediatric out-of-hospital cardiac arrest (OHCA) in China.
Design:
The Baseline Investigation of Out-of-Hospital Cardiac Arrest (BASIC-OHCA) is a prospective, multicenter, population-based registry of emergency medical services (EMS)-assessed OHCA in China.
Setting:
A total of 25 monitoring sites of all seven geographical regions were included, covering a pediatric population (age ≤ 19) of around 22.3 million in China.
Patients:
Pediatric patients enrolled in BASIC-OHCA from August 2019 to December 2020 were included.
Interventions:
None.
Measurements And Main Results:
A total of 1493 pediatric patients with EMS-assessed OHCA were enrolled, and resuscitation was attempted in 651 cases (43.6%). The crude incidence of EMS-assessed and EMS-treated OHCA was 5.5 (95% CI, 5.2-5.9) and 2.4 (95% CI, 2.2-2.6) per 100,000 pediatric population. Among 651 EMS-treated OHCA cases, 434 patients (66.7%) were male, and 353 (54.2%) had nonmedical causes (trauma, asphyxia, and drowning being the most common). There were 396 patients (60.8%) who collapsed at home, and the proportion of cases that occurred in public places such as streets and schools increased with age. There were 26 patients (4.0%) who had an initial shockable rhythm. For 626 non-EMS-witnessed patients, 152 patients (24.3%) received bystander cardiopulmonary resuscitation (CPR), 68 (10.9%) received dispatcher-assisted CPR, and 3 (0.5%) had automated external defibrillator applied. The survival to discharge or 30 days was 3.5% (23/651), and the favorable neurologic prognosis was 3.1% (20/651), with no differences among age groups.
Conclusions:
This study provides the first national exploration of pediatric OHCA in China. The high proportion of nonmedical causes underscores the importance of preventing accidents in children. Gaps in the chain of survival and patient outcomes provide a focus for improving the treatment of pediatric OHCA in China and other developing countries.
