Paediatric out-of-hospital cardiac arrests: epidemiology and outcome

LP Tham, I Chan
Correspondence: Dr Tham Lai Peng, sharonlp@kkh.com.sg

ABSTRACT
Introduction Little information is available regarding the outcome of children in our local population who sustained pre-hospital cardiac arrest. This study was performed to determine the survival rate among children after out-of-hospital cardiac arrest, to describe the epidemiology, and to identify predictors of survival.
Methods The records of 85 children who presented to a paediatric emergency department in cardiac arrest, between 1 June 1997 and 31 September 2001, were reviewed. The characteristics of the patients, cardiac arrest circumstances, and the outcomes of arrest were analysed.
Results 85 children presented to the emergency department in cardiac arrest during the 52-month study period. 26 out of 85 children (30.6 percent) with cardiac arrest had return of spontaneous circulation (ROSC) after resuscitation efforts at the emergency department. Only four (4.7 percent) survived to be discharged from hospital and three of them survived beyond one year. Two of the cardiac arrest survivors had no change in the neurological status, with the remaining two sustaining severe neurological deficits. Emergency medical service was activated in only 63.7 percent of the patients. 34 percent of the arrests were witnessed, and only 22.9 percent of the children received bystander cardiopulmonary resuscitation (CPR). The positive predictors for survival to hospital discharge in a bivariate analysis were witnessed arrest (p-value is equal to 0.012), presence of bystander CPR (p-value is equal to 0.003), and duration of resuscitation (p-value is equal to 0.028). None who had more than 30 minutes of resuscitation in the emergency department survived. In a multivariate analysis with a logistic regression model, the only two independent predictors of ROSC were witnessed arrest (odds ratio is 3.049; 95% confidence interval [CI] is 1.101-8.444; p-value is equal to 0.032) and duration of resuscitation (odds ratio is 0.353; 95% CI is 0.146 - 0.854; p-value is equal to 0.021).
Conclusion Out-of-hospital cardiac arrest in children has a poor prognosis and prolonged resuscitation at the emergency department beyond 30 minutes does not improve survival.

Keywords: cardiac arrest, cardiopulmonary resuscitation, emergency medical service, paediatric cardiac arrest
Singapore Med J 2005; 46(6): 289-296