| BackgroundOut-of-hospital cardiac arrest(OHCA)is one of the most important public health problems worldwide.The pediatric population is a particularly vulnerable portion of OHCA patients,with a higher health burden and relatively more severe outcomes due to the greater number of years of life lost per individual.Several studies focused on pediatric OHCA patients around the world,aiming to provide guidance on the situation and opportunities for improvement for this particularly population.The reported annual incidence of Emergency Medical Service-assessed(EMS-assessed)pediatric OHCA has ranged from 1.8 to 37.9 per 100,000 globally.Previous reports suggested that pediatric OHCA was more common in boys and occurred most frequently in the home.The first rhythm monitoring was typically dominated by non-shockable rhythms such as asystole and pulseless electrical activity.Compared to adult OHCA,the prognosis for pediatric OHCA with appropriate treatment might be better.Studies showed that the Return of Spontaneous Circulation(ROSC)rate for pediatric OHCA ranged from 8.6%to 42%,the survival rate at 30 days/survival to discharge ranged from 4.7%to 17.4%,and the prognosis for good neurological function at 30 days/discharge ranged from 2.4%to 14.5%.Pre-hospital emergency care for children with OHCA mainly involves activating emergency response systems and high-quality CPR implementation.Factors such as age,gender,location of arrest,first monitored rhythm,etiology,CPR delivery and type,airway management,and medication use have been identified as potentially influencing the outcomes of pediatric OHCA.However,recent studies exploring these factors have produced controversial findings,greatly limiting the medical community’s understanding of pediatric OHCA and potential treatment improvements.Current studies on Chinese pediatric OHCA are restricted to selected cities or regions.A previous study reported an age-adjusted incidence of EMS-assessed OHCA in Beijing of 3.8/100,000 for pediatric patients,however,the quality of care and outcomes have not been explored.The incidence of pediatric OHCA in Hong Kong and Taiwan was 5.4/100,000 and 1.8/100,000,respectively.Currently,there are no national data-based estimates of pediatric OHCA in China.The unavailability of national data constrains in-depth understanding of the epidemiological characteristics and current state of care for Chinese pediatric OHCA.Therefore,this study was initiated to analyze the epidemiological characteristics and treatment of pediatric OHCA in China using data from The BASeline Investigation of Cardiac Arrest-OHCA(BASIC-OHCA).Aims1.To identify the epidemiological characteristics of Chinese pediatric OHCA,including age,sex,location,etiology,initial monitored rhythm,CPR,defibrillation,airway management and epinephrine application.2.To analyze the implications of the epidemiological features and the current state of care for patient prognosis and identify current weaknesses in the treatment of Chinese pediatric OHCA,and propose targeted improvements to improve the quality of pediatric OHCA.MethodsThe BASeline Investigation of Cardiac Arrest OHCA(BASIC-OHCA)study is a nationwide,prospective cohort study in China.The registry utilizes the Utstein style of OHCA reporting and includes variables from prehospital care through hospital discharge.This study will use the BASIC-OHCA project data for the research analysis.Inclusion criteria for the BASIC-OHCA study are all OHCA patients confirmed via EMS,including patients declared dead at the scene by EMS personnel for any reason.For this study,we will include only patients with OHCA enrolled in the BASIC program and who are ≤19 years of age."Exclusion criteria for this study were patients who did not receive CPR were excluded.The detailed extracted data are as follows:1)Baseline characteristics:age,gender,time and location of arrest,cause of arrest,initial rhythm,etc.2)Characteristics of care:EMS response characteristics:Elapsed EMS response time(interval between unit notified by dispatch and unit arrival at the scene),scene time(interval between unit arrival at the scene and unit departure from the scene),and transport time(interval between unit departure from the scene and arrival at the destination),witnessed status,bystander CPR,dispatcher-guided CPR,airway management,medication administrations,etc.3)Outcomes:the primary outcomes were defined as survived discharge or survived 30 days post-discharge and the secondary outcomes included the rate of return of spontaneous circulation(ROSC)or good neurological outcome at hospital discharge or 30 days post-discharge.Descriptive statistics were reported as means±standard deviation(SD),medians with interquartile range(IQR),or number(percent)as indicated.Chi square was calculated for categorical variables.Student’s t-test and analysis of variance(ANOVA)were done for comparison of continuous variables.Baseline characteristics,process of care and outcomes are described and stratified by age groups(age<1 years,age 1 to 4 years,age 5 to 9 years,age 10 to 14 years and age 15 to 19 years).Multivariate logistic regression was conducted to assess the correlation between clinical characteristics and prognosis.A 2-tailed P value<0.05 was considered statistically significant for all tests.Results142927 patients with OHCA were accessed by EMS from August 2019 to December 2020,and 651 EMS-treated pediatric OHCA patients were included in the final analysis after excluding patients who did not meet the inclusion criteria.Of 651 EMS-treated pediatric OHCA,the number and percentage of pediatric OHCA in the<1,1-4,5-9,10-14 and 15-19 age groups were 78(12.0%),102(15.7%),102(15.7%),144(22.1%)and 225(34.6%)respectively.The percentage of males was higher than females(66.7%vs 33.3%),home was the most common place of occurrence(60.8%),non-medical etiologies were the most common cause of pediatric OHCA,accounting for 52.4%of cases,while cardiac and traumatic causes accounted for 34.6%and 26.0%respectively.Asystole was the most common initial rhythm(79.4%),while shockable rhythm accounted for only 4.0%.The rate of witnessed pediatric OHCA in China was relatively high at approximately 50.2%,but the rate of bystander CPR was low at 24.3%.The median EMS response time was 12 min across all age groups.The median scene time was 9 min and transport time was 8 min.Epinephrine was the most commonly applied drug for prehospital treatment of pediatric OHCA,with epinephrine applied with 52.7%of patients.After treatment,5.5%of patients achieved ROSC on site,10.8%of patients achieved any ROSC,3.6%survived at discharge or survived 30 days and 3.1%had good neurological function at discharge or at 30 days.After comparing with the whole population of OHCA patients,it was postulated that the outcomes of any ROSC,survival and good prognosis of neurological function of pediatric OHCA in China are better than those of adult patients.However,there is still a large gap in discharge or 30-day survival rates for pediatric OHCA in China compared to developed countries.Multifactorial logistic regression showed that age 10-14 years(OR=3.017,95%CI:0.957-9.513,P=0.009),and shockable rhythm(OR=9.802,95%CI:3.848-24.965,P<0.001)were independent protective factors for patients’ ROSC.Bystander witness status(OR=6.1 16,95%CI:1.572-23.785,P=0.009)was beneficial for patient survival.Female(OR=0.159,95%Cl:0.029-0.880,P=0.035),epinephrine application(OR=0.153,95%Cl:0.038-0.616,P=0.008)were unfavorable factors for patient survival.Bystander witness status(OR=4.757,95%CI:1.204-18.786,P=0.026)was a protective factor for good neurological function in pediatric OHCA patients,while epinephrine application(OR=0.159,95%CI:0.036-0.708,P=0.016)was detrimental to neurological recovery.Conclusions1.The most common location for pediatric OHCA in China is the home,the most common etiology is non-medical causes.There are differences in the etiologies and location of pediatric OHCA among different age groups,and targeted resuscitation education and training based on age stratification may help to improve the quality of treatment for pediatric OHCA.2.There are deficiencies in the pre-hospital treatment of Chinese pediatric OHCA,the application rate of bystander CPR and AED is still lower than that of foreign countries,and the response time of EMS is longer than that of developed countries.Developing CPR,AED training and education,and optimizing the EMS dispatch system are some of the critical aspects for improving the pre-hospital treatment of Chinese pediatric OHCA in the future.3.The prognosis for pediatric OHCA patients in China is better than that of adult OHCA patients,but still lower than that of pediatric OHCA patients in developed countries.An initial rhythm with a shockable rhythm can increase the chance of ROSC.Female,epinephrine application is unfavorable for survival,while bystander witnessing is favorable for survival and epinephrine application is unfavorable for patient neurological recovery. |
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