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Time on the scene and interventions are associated with improved survival in pediatric out-of-hospital cardiac arrest

  • Janice A. Tijssen
    Correspondence
    Corresponding authors at: Children's Hospital, London Health Sciences Centre, 800 Commissioners Road East, London, ON, Canada, N6A5W9. Fax: +1 519 685 8766 and Hospital for Sick Children, Department of Critical Care Medicine, 555 University Avenue, Toronto, ON, Canada M5G1X8. Fax: +1 416 813 7299.
    Affiliations
    Division of Pediatric Critical Care Medicine, Department of Pediatrics, London Health Sciences Centre, University of Western Ontario, London, ON, Canada

    The Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
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  • David K. Prince
    Affiliations
    Data Coordinating Center, Resuscitation Outcomes Consortium, University of Washington, Seattle, WA, United States
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  • Laurie J. Morrison
    Affiliations
    Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada

    Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
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  • Dianne L. Atkins
    Affiliations
    Stead Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
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  • Michael A. Austin
    Affiliations
    Department of Emergency Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada
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  • Robert Berg
    Affiliations
    Departments of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, United States
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  • Siobhan P. Brown
    Affiliations
    Data Coordinating Center, Resuscitation Outcomes Consortium, University of Washington, Seattle, WA, United States
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  • Jim Christenson
    Affiliations
    Department of Emergency Medicine, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada
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  • Debra Egan
    Affiliations
    Division of Cardiovascular Sciences, Heart Failure and Arrhythmias Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States
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  • Preston J. Fedor
    Affiliations
    Division of Emergency Medicine, Department of Surgery, University of Texas Southwestern, Dallas, TX, United States
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  • Ericka L. Fink
    Affiliations
    Department of Critical Care Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Centre, Pittsburgh, PA, United States
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  • Garth D. Meckler
    Affiliations
    Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada

    British Columbia Children's Hospital, Vancouver, BC, Canada
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  • Martin H. Osmond
    Affiliations
    Division of Emergency Medicine, Department of Pediatrics, The University of Ottawa, Ottawa, ON, Canada

    Children's Hospital of Eastern Ontario, The University of Ottawa, Ottawa, ON, Canada
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  • Kathryn A. Sims
    Affiliations
    Data Coordinating Center, Resuscitation Outcomes Consortium, University of Washington, Seattle, WA, United States
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  • James S. Hutchison
    Correspondence
    Corresponding authors at: Children's Hospital, London Health Sciences Centre, 800 Commissioners Road East, London, ON, Canada, N6A5W9. Fax: +1 519 685 8766 and Hospital for Sick Children, Department of Critical Care Medicine, 555 University Avenue, Toronto, ON, Canada M5G1X8. Fax: +1 416 813 7299.
    Affiliations
    Department of Critical Care and Neuroscience and Mental Health Research Program, The Hospital for Sick Children, Toronto, ON, Canada

    Interdepartmental Division of Critical Care Medicine, Faculty of Medicine and Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada
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  • on behalf of the Resuscitation Outcomes Consortium

      Abstract

      Background

      Survival is less than 10% for pediatric patients following out-of-hospital cardiac arrest. It is not known if more time on the scene of the cardiac arrest and advanced life support interventions by emergency services personnel are associated with improved survival.

      Aim

      This study was performed to determine which times on the scene and which prehospital interventions were associated with improved survival.

      Methods

      We studied patients aged 3 days to 19 years old with out-of-hospital cardiac arrest, using the Resuscitation Outcomes Consortium cardiac arrest database from 11 North American regions, from 2005 to 2012. We evaluated survival to hospital discharge according to on-scene times (<10, 10 to 35 and >35 min).

      Results

      Data were available for 2244 patients (1017 infants, 594 children and 633 adolescents). Infants had the lowest rate of survival (3.7%) compared to children (9.8%) and adolescents (16.3%). Survival improved over the 7 year study period especially among adolescents. Survival was highest in the 10 to 35 min on-scene time group (10.2%) compared to the > 35 min. group (6.9%) and the <10 min. group (5.3%, p = 0.01). Intravenous or intra-osseous access attempts and fluid administration were associated with improved survival, whereas advanced airway attempts were not associated with survival and resuscitation drugs were associated with worse survival.

      Conclusions

      In this observational study, a scene time of 10 to 35 min was associated with the highest survival, especially among adolescents. Access for fluid resuscitation was associated with increased survival but advanced airway and resuscitation drugs were not.

      Keywords

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