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  • Title: Outcomes differ by first documented rhythm after witnessed out-of-hospital cardiac arrest in children: an observational study with prospective nationwide population-based cohort database in Japan.
    Author: Hara M, Hayashi K, Kitamura T.
    Journal: Eur Heart J Qual Care Clin Outcomes; 2017 Jan 01; 3(1):83-92. PubMed ID: 28927190.
    Abstract:
    AIMS: To evaluate and compare outcomes and impacts of delay of time to cardiopulmonary resuscitation (CPR) by type of first documented rhythm in paediatric patients with out-of-hospital cardiac arrest (OHCA). METHODS AND RESULTS: We enrolled 3968 paediatric (aged <18 years) OHCA patients whose events were witnessed between 2005 and 2012 from a prospective nationwide population-based cohort database in Japan. We assessed and compared their neurologically favourable 1-month survival according to first documented rhythm: pulseless ventricular tachycardia/ventricular fibrillation (pVT/VF), pulseless electrical activity (PEA), or asystole. Out-of-hospital cardiac arrest patients with pVT/VF, PEA, and asystole totalled 556 (14.0%), 1249 (31.5%), and 2163 (54.5%), respectively. The proportion of overall neurologically favourable 1-month survival in patients with pVT/VF, PEA, and asystole was 36.5, 5.0, and 1.8%, respectively, in the entire study population, and 73.8, 27.7, and 13.8%, respectively, in patients who achieved pre-hospital return of spontaneous circulation (ROSC). As the time from collapse to CPR lengthened, the number of patients with asystole increased, whereas those of pVT/VF and PEA decreased (P < 0.001). After paediatric OHCA, earlier initiation of CPR resulted in higher rates of pre-hospital ROSC (adjusted odds ratio 0.97, 95% confidence interval 0.95-0.99, P = 0.018), which led to much better patient outcomes than in the total study population. CONCLUSION: We confirmed that pVT/VF and early ROSC in general were associated with better outcomes in patients with witnessed paediatric OHCA.
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