Time on the scene and interventions are associated with improved survival in pediatric out-of-hospital cardiac arrest

Janice A Tijssen, David K Prince, Laurie J Morrison, Dianne L Atkins, Michael A Austin, Robert Berg, Siobhan P Brown, Jim Christenson, Debra Egan, Preston J Fedor, Ericka L Fink, Garth D Meckler, Martin H Osmond, Kathryn A Sims, James S Hutchison
Resuscitation 2015, 94: 1-7

BACKGROUND: Survival is less than 10% for pediatric patients following out-of-hospital cardiac arrest. It is not known if more time on the scene of the cardiac arrest and advanced life support interventions by emergency services personnel are associated with improved survival.

AIM: This study was performed to determine which times on the scene and which prehospital interventions were associated with improved survival.

METHODS: We studied patients aged 3 days to 19 years old with out-of-hospital cardiac arrest, using the Resuscitation Outcomes Consortium cardiac arrest database from 11 North American regions, from 2005 to 2012. We evaluated survival to hospital discharge according to on-scene times (<10, 10 to 35 and >35 min).

RESULTS: Data were available for 2244 patients (1017 infants, 594 children and 633 adolescents). Infants had the lowest rate of survival (3.7%) compared to children (9.8%) and adolescents (16.3%). Survival improved over the 7 year study period especially among adolescents. Survival was highest in the 10 to 35 min on-scene time group (10.2%) compared to the >35 min. group (6.9%) and the <10 min. group (5.3%, p=0.01). Intravenous or intra-osseous access attempts and fluid administration were associated with improved survival, whereas advanced airway attempts were not associated with survival and resuscitation drugs were associated with worse survival.

CONCLUSIONS: In this observational study, a scene time of 10 to 35 min was associated with the highest survival, especially among adolescents. Access for fluid resuscitation was associated with increased survival but advanced airway and resuscitation drugs were not.

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