Age-specific differences in outcomes after out-of-hospital cardiac arrests

Masahiko Nitta, Taku Iwami, Tetsuhisa Kitamura, Vinay M Nadkarni, Robert A Berg, Naoki Shimizu, Kunio Ohta, Tatsuya Nishiuchi, Yasuyuki Hayashi, Atsushi Hiraide, Hiroshi Tamai, Masanao Kobayashi, Hiroshi Morita
Pediatrics 2011, 128 (4): e812-20

OBJECTIVE: We assessed out-of-hospital cardiac arrests (OHCAs) for various pediatric age groups.

METHODS: This prospective, population-based, observational study included all emergency medical service-treated OHCAs in Osaka, Japan, between 1999 and 2006 (excluding 2004). Patients were grouped as adults (>17 years), infants (<1 year), younger children (1-4 years), older children (5-12 years), and adolescents (13-17 years). The primary outcome measure was 1-month survival with favorable neurologic outcome.

RESULTS: Of 950 pediatric OHCAs, resuscitations were attempted for 875 patients (92%; 347 infants, 203 younger children, 135 older children, and 190 adolescents). The overall incidence of nontraumatic pediatric OHCAs was 7.3 cases per 100 000 person-years, compared with 64.7 cases per 100 000 person-years for adults and 65.5 cases per 100 000 person-years for infants. Most infant OHCAs occurred in homes (93%) and were not witnessed (90%). Adolescent OHCAs often occurred outside the home (45%), were witnessed by bystanders (37%), and had shockable rhythms (18%). One-month survival was more common after nontraumatic pediatric OHCAs than adult OHCAs (8% [56 of 740 patients] vs 5% [1677 of 33 091 patients]; adjusted odds ratio: 2.26 [95% confidence interval: 1.63-3.13]). One-month survival with favorable neurologic outcome was more common among children than adults (3% [21 of 740 patients] vs 2% [648 of 33 091 patients]; adjusted odds ratio: 2.46 [95% confidence interval: 1.45-4.18]). Rates of 1-month survival with favorable neurologic outcome were 1% for infants, 2% for younger children, 2% for older children, and 11% for adolescents.

CONCLUSION: Survival and favorable neurologic outcome at 1 month were more common after pediatric OHCAs than adult OHCAs.

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