Scene Time and Outcome in Pediatric Out-of-Hospital Cardiac Arrest: Findings From NEMSIS Data

Pediatric out-of-hospital cardiac arrest (P-OHCA) has a low incidence rate with a survival rate ranging from 2% to 11%. While national guidelines exist for P-OHCA management, they do not clearly address how long EMS providers should treat on-scene and when to initiate transportation.

This study aims to explore the factors influencing scene time and its correlation with the return of spontaneous circulation (ROSC) in pediatric cases using the National Emergency Medical Services Information System (NEMSIS).

This retrospective cohort study analyzed NEMSIS data from 2019 to 2020. P-OHCA cases who received EMS treatment and were transported to the ED were included. We examined demographic and scene-related factors influencing EMS scene time and categorized interventions by scene time groups (<10, 10 to 30, >30 min). Using multivariable logistic regression, the study explored the relationship between scene time and ROSC, adjusting for various clinical and demographic predictors, and validated the model with calibration plots and sensitivity analyses.

A total of 8467 cardiac arrest cases met the inclusion criteria for analysis. The most common EMS scene time was 10 to 30 minutes, and longer scene times were significantly associated with ROSC. ROSC was more likely with older age, public or health care arrest locations, and defibrillation use, while airway interventions and medications were associated with lower odds of ROSC.

We found that younger children had shorter EMS scene times, while those who achieved ROSC had longer scene times. Further investigation is needed to clarify the underlying factors and their impact on survival and neurological outcomes.