WakeMed Health & Hospitals, Clinical Research Unit, Emergency Services Institute, Raleigh, North Carolina 27610, USA.
Prehosp Emerg Care. 2012 Apr-Jun;16(2):230-6. doi: 10.3109/10903127.2011.640419. Epub 2012 Jan 11.
To determine the epidemiology and survival of pediatric out-of-hospital cardiac arrest (OHCA) secondary to trauma.
The CanAm Pediatric Cardiac Arrest Study Group is a collaboration of researchers in the United States and Canada sharing a common goal to improve survival outcomes for pediatric cardiac arrest. This was a prospective, multicenter, observational study. Twelve months of consecutive data were collected from emergency medical services (EMS), fire, and inpatient records from 2000 to 2003 for all OHCAs secondary to trauma in patients aged ≤18 years in 36 urban and suburban communities supporting advanced life support (ALS) programs. Eligible patients were apneic and pulseless and received chest compressions in the field. The primary outcome was survival to discharge. Secondary measures included return of spontaneous circulation (ROSC), survival to hospital admission, and 24-hour survival.
The study included 123 patients. The median patient age was 7.3 years (interquartile range [IQR] 6.0-17.0). The patient population was 78.1% male and 59.0% African American, 20.5% Hispanic, and 15.7% white. Most cardiac arrests occurred in residential (47.1%) or street/highway (37.2%) locations. Initial recorded rhythms were asystole (59.3%), pulseless electrical activity (29.1%), and ventricular fibrillation/tachycardia (3.5%). The majority of cardiac arrests were unwitnessed (49.5%), and less than 20% of patients received chest compressions by bystanders. The median (IQR) call-to-arrival interval was 4.9 (3.1-6.5) minutes and the on-scene interval was 12.3 (8.4-18.3) minutes. Blunt and penetrating traumas were the most common mechanisms (34.2% and 25.2%, respectively) and were associated with poor survival to discharge (2.4% and 6.5%, respectively). For all OHCA patients, 19.5% experienced ROSC in the field, 9.8% survived the first 24 hours, and 5.7% survived to discharge. Survivors had triple the rate of bystander cardiopulmonary resuscitation (CPR) than nonsurvivors (42.9% vs. 15.2%). Unlike patients sustaining blunt trauma or strangulation/hanging, most post-cardiac arrest patients who survived the first 24 hours after penetrating trauma or drowning were discharged alive. Drowning (17.1% of cardiac arrests) had the highest survival-to-discharge rate (19.1%).
The overall survival rate for OHCA in children after trauma was low, but some trauma mechanisms are associated with better survival rates than others. Most OHCA in children is preventable, and education and prevention strategies should focus on those overrepresented populations and high-risk mechanisms to improve mortality.
确定创伤性儿童院外心脏骤停（OHCA）的流行病学和生存情况。
CanAm 儿科心脏骤停研究小组是一个由美国和加拿大的研究人员组成的合作组织，共同目标是改善儿科心脏骤停患者的生存结果。这是一项前瞻性、多中心、观察性研究。2000 年至 2003 年，在 36 个支持高级生命支持（ALS）计划的城市和郊区社区，从紧急医疗服务（EMS）、消防和住院记录中连续收集了 12 个月的所有创伤性 OHCA 患者的数据，这些患者的年龄均≤18 岁。符合条件的患者是呼吸暂停和无脉搏，并在现场接受了胸部按压。主要结局是出院时的存活。次要措施包括自主循环恢复（ROSC）、住院时存活和 24 小时存活。
研究纳入 123 例患者。中位患者年龄为 7.3 岁（四分位距 [IQR] 6.0-17.0）。患者人群中 78.1%为男性，59.0%为非裔美国人，20.5%为西班牙裔，15.7%为白人。大多数心脏骤停发生在住宅（47.1%）或街道/高速公路（37.2%）。初始记录的节律为停搏（59.3%）、无脉电活动（29.1%）和室颤/心动过速（3.5%）。大多数心脏骤停是无人见证的（49.5%），不到 20%的患者接受了旁观者的胸部按压。中位数（IQR）从呼叫到到达的时间为 4.9（3.1-6.5）分钟，现场时间为 12.3（8.4-18.3）分钟。钝器和穿透性创伤是最常见的机制（分别为 34.2%和 25.2%），与出院时的不良生存相关（分别为 2.4%和 6.5%）。对于所有 OHCA 患者，19.5%在现场出现 ROSC，9.8%在 24 小时内存活，5.7%存活至出院。幸存者接受旁观者心肺复苏（CPR）的比例是未幸存者的三倍（42.9%比 15.2%）。与钝器创伤或勒死/绞死的患者不同，大多数穿透性创伤或溺水后存活至 24 小时后的心脏骤停后患者均存活出院。溺水（占心脏骤停的 17.1%）的出院生存率最高（19.1%）。
创伤后儿童 OHCA 的总体生存率较低，但某些创伤机制的生存率高于其他机制。大多数儿童 OHCA 是可以预防的，教育和预防策略应侧重于那些代表性过高的人群和高风险的机制，以提高死亡率。
