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. 2016 Oct:107:121-8.
doi: 10.1016/j.resuscitation.2016.07.244. Epub 2016 Aug 24.

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

Ericka L Fink  1 , David K Prince  2 , Jonathan R Kaltman  3 , Dianne L Atkins  4 , Michael Austin  5 , Craig Warden  6 , Jamie Hutchison  7 , Mohamud Daya  8 , Scott Goldberg  9 , Heather Herren  2 , Janice A Tijssen  10 , James Christenson  11 , Christian Vaillancourt  12 , Ronna Miller  9 , Robert H Schmicker  2 , Clifton W Callaway  13 ; Resuscitation Outcomes Consortium
Affiliations

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

Ericka L Fink et al. Resuscitation. 2016 Oct.

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 (3days-1year), 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 5year period. Regional variation represents an opportunity for further study to improve outcomes.

Keywords: Cardiac arrest; Epidemiology; Outcomes; Pediatric; Resuscitation.

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Figures

Figure 1
Figure 1
CONSORT Diagram.
Figure 2
Figure 2
Incidence Rates by Year and Age Group with Estimated Linear Differences. Shaded areas represent 95% confidence intervals.
Figure 3
Figure 3
Survival to Hospital Discharge for Cardiac Arrest by Year and Age Group with Estimated Linear Differences. Vertical bars represent standard error.
See this image and copyright information in PMC

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