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

Masahiko Hara, Kenichi Hayashi, Tetsuhisa Kitamura

Research output: Contribution to journalArticle

4 Citations (Scopus)

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 ¼ 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.

Original languageEnglish
Pages (from-to)83-92
Number of pages10
JournalEuropean Heart Journal - Quality of Care and Clinical Outcomes
Volume3
Issue number1
DOIs
Publication statusPublished - 2017 Jan 1

Fingerprint

Out-of-Hospital Cardiac Arrest
Observational Studies
Japan
Databases
Ventricular Fibrillation
Ventricular Tachycardia
Heart Arrest
Population
Cardiopulmonary Resuscitation
Pediatric Hospitals
Pediatrics
Survival
Odds Ratio
Confidence Intervals

Keywords

  • Asystole
  • Out-of-hospital cardiac arrest
  • Paediatric
  • Pulseless electrical activity
  • Ventricular fibrillation

ASJC Scopus subject areas

  • Health Policy
  • Cardiology and Cardiovascular Medicine

Cite this

@article{7828f2675adf4028be7b247c4954da6d,
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",
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 ¼ 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.",
keywords = "Asystole, Out-of-hospital cardiac arrest, Paediatric, Pulseless electrical activity, Ventricular fibrillation",
author = "Masahiko Hara and Kenichi Hayashi and Tetsuhisa Kitamura",
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doi = "10.1093/ehjqcco/qcw040",
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T1 - Outcomes differ by first documented rhythm after witnessed out-of-hospital cardiac arrest in children

T2 - An observational study with prospective nationwide population-based cohort database in Japan

AU - Hara, Masahiko

AU - Hayashi, Kenichi

AU - Kitamura, Tetsuhisa

PY - 2017/1/1

Y1 - 2017/1/1

N2 - 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 ¼ 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.

AB - 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 ¼ 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.

KW - Asystole

KW - Out-of-hospital cardiac arrest

KW - Paediatric

KW - Pulseless electrical activity

KW - Ventricular fibrillation

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U2 - 10.1093/ehjqcco/qcw040

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