Incidence, Causes and Outcome of Out-of-Hospital Cardiac Arrest in Children
A Comprehensive, Prospective, Population-Based Study in The Netherlands
Abdennasser Bardai, MD,* Jocelyn Berdowski, MSc, MSE,* Christian van der Werf, MD,* Marieke T. Blom, MA,
Manon Ceelen, PhD, Irene M. van Langen, MD, PhD, Jan G.P. Tijssen, PhD, Arthur A.M. Wilde, MD, PhD,
Rudolph W. Koster, MD, PhD, Hanno L. Tan, MD, PhD
Amsterdam and Groningen, The NetherlandsAmsterdam and Groningen, The Netherlands* These authors contributed equally
Background
There is a paucity of complete studies on incidence, causes and outcome of pediatric out-of-hospital cardiac arrest (OHCA) Previous large studies only included OHCA
cases that involved emergency medical services (EMS)
Few studies reported the single (groups of) causes of pediatric OHCA
J Am Coll Cardiol 2011;57:1822-8
Objective
To comprehensively determine: The incidence of pediatric OHCA The contribution of OHCA to total pediatric
mortality, The causes of pediatric OHCAThe outcome of resuscitation of pediatric
OHCA patients
J Am Coll Cardiol 2011;57:1822-8
Prospective population-based study of children suffering OHCA between October 1, 2005 and February 1, 2010 in the North-Holland province of The Netherlands
Population: 2.4 million people, including 588,389 aged <21 years
J Am Coll Cardiol 2011;57:1822-8
OHCA was non-cardiac when EMS rescuers, hospital physicians or coroners identified a natural, non-cardiac cause or non-natural cause
All other cases had a (presumed) cardiac cause and were termed cardiac OHCA
J Am Coll Cardiol 2011;57:1822-8
Death certificate data
We retrieved death certificate data from Statistics Netherlands, a Dutch governmental institution that collects age/gender-specific statistics of all deaths in The Netherlands to: Establish the contribution of OHCA to total
mortality in pediatric age groupsGain insight into the completeness of our data
collection
J Am Coll Cardiol 2011;57:1822-8
Survival analysis
We analyzed only truly resuscitatable OHCA cases by excluding OHCA victims who were found dead by EMS personnel upon arrival
Survival status at hospital discharge obtained by contacting the designated hospital
The pediatric Cerebral Performance Category (CPC) of each patient was estimated by reviewing the hospital charts
J Am Coll Cardiol 2011;57:1822-8
Patient characteristics
233 pediatric OHCA cases83 EMS-only, 100 coroners-only cases, 50
cases registered by both sources
24% of total pediatric mortalityWe registered 90 (87%) of the 103
potential pediatric cardiac OHCA cases according to the death certificate data, and 143 (99%) of the 144 potential pediatric non-cardiac OHCA cases
J Am Coll Cardiol 2011;57:1822-8
Incidences of pediatric OHCA
All causes
(n=233)
Cardiac causes
(n=90)
Non-cardiac causes
(n=143)
Overall 9.0 (7.8-10.3) 3.2 (2.5-3.9) 5.8 (4.9-6.8)
Age <1 years 33.8 (23.1-44.5) 25.8 (16.4-35.2) 8.0 (2.8-13.2)
Age 1-11 years 4.8 (3.6-6.0) 1.6 (0.9-2.3) 3.2 (2.2-4.2)
Age 12-20 years 11.7 (9.5-13.8) 2.7 (1.7-3.7) 9.0 (7.1-10.8)
Data are expressed as number per 100,000 pediatric person-years (95% confidence interval). Data are expressed as number per 100,000 pediatric person-years (95% confidence interval). Adjusted by age/sex to the European Union populationAdjusted by age/sex to the European Union population
J Am Coll Cardiol 2011;57:1822-8
Survival and neurologic outcome
CPR was initiated in 69 OHCA victims, but only 51 were truly resuscitatable
Of 51 resuscitated patients, 12 (24%) survived29% [4/14] in infants, 12% [2/17] in children, 30%
[6/20] in adolescents (NS)10/12 (83%) had a neurologically-intact
outcome83% (75% [3/4] in infants, 100% [2/2] in children,
83% [5/6] in adolescents
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Operational characteristics of resuscitated victims of OHCA from cardiac causes
All Age <1 year
Age 1-11 years
Age 12-20 years
P-value
Variable (n=69) (n=29) (n=18) (n=22)
Witnessed collapse, n (%) 41 (59) 11 (38) 14 (78) 16 (73) 0.03
Bystander CPR, n (%) 52 (75) 19 (66) 14 (78) 19 (86) 0.53
Collapse at home, n (%) 48 (70) 28 (97) 11 (61) 9 (41) <0.001
AED connected, n (%) 9 (13) 1 (3) 1 (6) 7 (32) 0.02
Time between emergency call and arrival, min, median (25th to 75th percentile)
12.1 (8.8-14.8)
12.2 (9.8-13.9)
11.1 (8.4-15.3)
12.0 (9.0-15.6)
0.99
Shockable initial rhythm, n (%) 25 (36) 1 (3) 6 (33) 18 (82) <0.001
J Am Coll Cardiol 2011;57:1822-8
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