Post-cardiac arrest care during transport from referral centers to a tertiary children's hospital

Pediatric out-of-hospital cardiac arrest (POHCA) is rare but is associated with poor survival and unfavorable neurological outcomes. There is limited literature on post-cardiac arrest care during inter-facility transport of patients from referral centers to tertiary pediatric hospitals. This study aims to investigate if PCAC best practices are prioritized during inter-facility transport of POHCA patients and to describe PCAC prioritization and complications by survival status.

A retrospective cohort study was conducted on POHCA patients transported to Children's Hospital - London Health Sciences Center (CH-LHSC) by a critical care transport team between January 2006 and June 2022. PCAC prioritization was defined based on post-resuscitation guidelines and CH-LHSC transport team protocols.

Among the 46 POHCA patients included in descriptive analysis, 12 patients (26.1%) survived to hospital discharge with 10 survivors (83.3%) demonstrating favourable neurological outcomes at discharge. Hypotension was the most common complication during transport (n = 16, 34.8%). Of these, 15 POHCA patients (93.8%) were non-survivors, while only one patient (6.3%) survived to discharge.

The study identified that PCAC in the hemodynamic and temperature management categories was not optimally prioritized during transport. Hypotension was the most common complication and more frequently observed in patients who did not survive to discharge. The small sample size and few survivors limited the ability to perform formal statistical comparisons. Further studies should combine data with other centers to improve the sample size, which will allow exploration of barriers to PCAC prioritization to pave way for areas of quality improvement in pediatric out-of-hospital post cardiac arrest care.