Unchanged pediatric out-of-hospital cardiac arrest incidence and survival rates with regional variation in North America

• Published in: Resuscitation Vol. 107; pp. 121 - 128
• Main Authors: Fink, Ericka L, Prince, David K, Kaltman, Jonathan R, Atkins, Dianne L, Austin, Michael, Warden, Craig, Hutchison, Jamie, Daya, Mohamud, Goldberg, Scott, Herren, Heather, Tijssen, Janice A, Christenson, James, Vaillancourt, Christian, Miller, Ronna, Schmicker, Robert H, Callaway, Clifton W
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.10.2016
• Subjects: Adolescent; Cardiac arrest; Cardiopulmonary Resuscitation - methods; Child; Child, Preschool; Emergency; Emergency Medical Services - statistics & numerical data; Epidemiology; Female; Hospital Mortality - trends; Humans; Incidence; Infant; Infant, Newborn; Male; North America - epidemiology; Out-of-Hospital Cardiac Arrest - mortality; Out-of-Hospital Cardiac Arrest - therapy; Outcomes; Pediatric; Registries; Resuscitation; Survival Analysis; Pediatric; Epidemiology; Resuscitation; Outcomes; Cardiac arrest
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2016.07.244

Abstract Aim Outcomes for pediatric out-of-hospital cardiac arrest (OHCA) are poor. Our objective was to determine temporal trends in incidence and mortality for pediatric OHCA. Methods Adjusted incidence and hospital mortality rates of pediatric non-traumatic OHCA patients from 2007–2012 were analyzed using the 9 region Resuscitation Outcomes Consortium—Epidemiological Registry (ROC-Epistry) database. Children were divided into 4 age groups: perinatal (<3 days), infants (3 days–1 year), children (1–11 years), and adolescents (12–19 years). ROC regions were analyzed post-hoc. Results We studied 1738 children with OHCA. The age- and sex-adjusted incidence rate of OHCA was 8.3 per 100,000 person-years (75.3 for infants vs. 3.7 for children and 6.3 for adolescents, per 100,000 person-years, p < 0.001). Incidence rates differed by year ( p < 0.001) without overall linear trend. Annual survival rates ranged from 6.7–10.2%. Survival was highest in the perinatal (25%) and adolescent (17.3%) groups. Stratified by age group, survival rates over time were unchanged (all p > 0.05) but there was a non-significant linear trend (1.3% increase) in infants. In the multivariable logistic regression analysis, infants, unwitnessed event, initial rhythm of asystole, and region were associated with worse survival, all p < 0.001. Survival by region ranged from 2.6–14.7%. Regions with the highest survival had more cases of EMS-witnessed OHCA, bystander CPR, and increased EMS-defibrillation (all p < 0.05). Conclusions Overall incidence and survival of children with OHCA in ROC regions did not significantly change over a recent 5 year period. Regional variation represents an opportunity for further study to improve outcomes.