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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References
- Incidence, causes, and outcomes of out-of-hospital cardiac arrest in children: a comprehensive, prospective, population-based study in the Netherlands.J Am Coll Cardiol. 2011; 57: 1822-1828
- Survival after out-of-hospital cardiac arrest in children.J Am Heart Assoc. 2015; 4e002122
- Unchanged pediatric out-of-hospital cardiac arrest incidence and survival rates with regional variation in North America.Resuscitation. 2015; : 121-128
- A prospective, population-based study of the demographics, epidemiology, management, and outcome of out-of-hospital pediatric cardiopulmonary arrest.Annals Emerg Med. 1999; 33: 174-184
- Characteristics of bystander cardiopulmonary resuscitation for paediatric out-of-hospital cardiac arrests: a national observational study from 2012 to 2014.Resuscitation. 2017; : 26-33
- Automated external defibrillator application before EMS arrival in pediatric cardiac arrests.Pediatrics. 2018; 142
- AED use in businesses, public facilities and homes by minimally trained first responders.Resuscitation. 2003; 59: 225-233
- The use of automated external defibrillators in infants: a report from the American Red Cross Scientific Advisory Council.Pediatr Emerg Care. 2015; 31: 526-530
- Demographics, bystander CPR, and AED use in out-of-hospital pediatric arrests.Resuscitation. 2014; 85: 920-926
- Out-of-hospital cardiac arrest: probability of bystander defibrillation relative to distance to nearest automated external defibrillator.Resuscitation. 2018; 124: 138-144
- Bystander defibrillation for out-of-hospital cardiac arrest in public vs residential locations.JAMA Cardiol. 2017; 2: 507-514
- Restart a heart day: a strategy by the European Resuscitation Council to raise cardiac arrest awareness.Resuscitation. 2013; 84: 1157-1158
- Employment and residential characteristics in relation to automated external defibrillator locations.Am Heart J. 2016; 172: 185-191
- Neighborhoods matter: a population-based study of provision of cardiopulmonary resuscitation.Annals Emerg Med. 1999; 34: 459-468
- Association of neighborhood characteristics with bystander-initiated CPR.N Engl J Med. 2012; 367: 1607-1615
- Socioeconomic factors associated with outcome after cardiac arrest in patients under the age of 65.Resuscitation. 2015; 93: 14-19
- Interaction effects between highly-educated neighborhoods and dispatcher-provided instructions on provision of bystander cardiopulmonary resuscitation.Resuscitation. 2016; 99: 84-91
- Bystander CPR is associated with improved neurologically favourable survival in cardiac arrest following drowning.Resuscitation. 2017; 115: 39-43
- Impact of bystander automated external defibrillator use on survival and functional outcomes in shockable observed public cardiac arrests.Circulation. 2018; 137: 2104-2113
- Pay it forward: high school video-based instruction can disseminate cpr knowledge in priority neighborhoods.West J Emerg Med. 2018; 19: 423-429
- A crowdsourcing innovation challenge to locate and map automated external defibrillators.Circulation. 2013; 6: 229-236
- The PulsePoint respond mobile device application to crowdsource basic life support for patients with out-of-hospital cardiac arrest: challenges for optimal implementation.Resuscitation. 2015; 98: 20-26
- Locating AED enabled medical drones to enhance cardiac arrest response times.Prehospital Emergency Care. 2016; 20: 378-389
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.
