Out-of-hospital cardiac arrest due to drowning among children and adults from the Utstein Osaka Project

Masahiko Nitta, Tetsuhisa Kitamura, Taku Iwami, Vinay M Nadkarni, Robert A Berg, Alexis A Topjian, Yoshio Okamoto, Chika Nishiyama, Tatsuya Nishiuchi, Yasuyuki Hayashi, Yasuhisa Nishimoto, Akira Takasu
Resuscitation 2013, 84 (11): 1568-73

BACKGROUND: Children have better outcomes after out-of-hospital cardiac arrest (OHCA) than adults. However, little is known about the difference in outcomes between children and adults after OHCA due to drowning.

OBJECTIVES: The aim of this study is to assess the outcome after OHCA due to drowning between children and adults. Our hypothesis is that outcomes after OHCA due to drowning would be in better among children (<18 years old) compared with adults (≥18 years old).

METHOD: This prospective population-based, observational study included all emergency medical service-treated OHCA due to drowning in Osaka, Japan, between 1999 and 2010 (excluding 2004). Outcomes were evaluated between younger children (0-4 years old), older children (5-17 years old), and adults (≥18 years old). Major outcome measures were one-month survival and neurologically favorable one-month survival defined as cerebral performance category 1 or 2. Multivariate logistic regression analyses were used to account for potential confounders.

RESULTS: During the study period, 66,716 OHCAs were documented, and resuscitation was attempted for 62,048 patients (1300 children [2%] and 60,748 adults [98%]). Among these OHCAs, 1737 (3% of OHCAs) were due to drowning (36 younger children [2%], 32 older children [2%], and 1669 adults [96%]). The odds of one-month survival were significantly higher for younger children (28% [10/36]; adjusted odds ratio [AOR], 20.20 [95% confidence interval {CI} 7.45-54.78]) and older children (9% [3/32]; AOR, 4.47 [95% CI 1.04-19.27]) when compared with adults (2% [28/1669]). However, younger children (6% [2/36]; AOR, 5.23 [95% CI 0.52-51.73]) and older children (3% [1/32]; AOR, 2.53 [95% CI 0.19-34.07]) did not have a higher odds of neurologically favorable outcome than adults (1% [11/1669]).

CONCLUSION: In this large OHCA registry, children had better one-month survival rates after OHCA due to drowning compared with adults. Most survivors in all groups had unfavorable neurological outcomes.

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