Abstract
Background
Automated external defibrillators (AEDs) are critical in the chain of survival following
out-of-hospital cardiac arrest (OHCA), yet few studies have reported on AED use and
outcomes among pediatric OHCA. This study describes the association between bystander
AED use, neighborhood characteristics and survival outcomes following public pediatric
OHCA.
Methods
Non-traumatic OHCAs among children less than18 years of age in a public setting between
from January 1, 2013 through December 31, 2017 were identified in the CARES database.
A neighborhood characteristic index was created from the addition of dichotomous values
of 4 American Community Survey neighborhood characteristics at the Census tract level:
median household income, percent high school graduates, percent unemployment, and
percent African American. Multivariable logistic regression models assessed the association
of OHCA characteristics, the neighborhood characteristic index and outcomes.
Results
Of 971 pediatric OHCA, AEDs were used by bystanders in 10.3% of OHCAs. AEDs were used
on 2.3% of children ≤1 year (infants), 8.3% of 2–5 year-olds, 12.4% of 6−11 year-olds,
and 18.2% of 12–18 year-olds (p < 0.001). AED use was more common in neighborhoods
with a median household income of >$50,000 per year (12.3%; p = 0.016), <10% unemployment
(12.1%; p = 0.002), and >80% high school education (11.8%; p = 0.002). Greater survival
to hospital discharge and neurologically favorable survival were among arrests with
bystander AED use, varying by neighborhood characteristics.
Conclusions
Bystander AED use is uncommon in pediatric OHCA, particularly in high-risk neighborhoods,
but improves survival. Further study is needed to understand disparities in AED use
and outcomes.
Keywords
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Article info
Publication history
Published online: November 27, 2019
Accepted:
September 9,
2019
Received in revised form:
August 27,
2019
Received:
February 1,
2019
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2019 Elsevier B.V. All rights reserved.