Division of Cardiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California.
Division of Cardiology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California.
Heart Rhythm. 2018 Jan;15(1):116-121. doi: 10.1016/j.hrthm.2017.08.014. Epub 2017 Aug 18.
In general, the prognosis is poor for pediatric patients who experience out-of-hospital (OOH) cardiac arrest, with survival rates of 12% to 29%.
The purpose of this study was to describe the causes and outcomes of pediatric patients with documented ventricular fibrillation (VF) at resuscitation from OOH cardiac arrest with sustained return of spontaneous circulation after defibrillation and survival to hospital admission.
Retrospective analysis of OOH-VF patients <19 years of age evaluated between 2004 and 2016 was performed. Primary outcome measures included demographics, arrest and resuscitation parameters, cardiac diagnoses, survival, and neurologic outcome.
Forty-five patients fulfilled study criteria (median age 12 years; range 2 months to 18 years). Cardiac arrest occurred in public in 68% of cases, with bystander cardiopulmonary resuscitation in 42% before arrival of emergency medical services. All patients underwent defibrillation (1-6 shocks) with return of spontaneous circulation and survival to hospital admission. Underlying etiologies were primary electrical disease (33%), cardiomyopathy (27%), congenital heart disease (11%), other (13%), and unknown (16%). Before arrest, 40% of patients had a cardiac diagnosis and 26% had symptoms. Ultimately, 40 of 45 patients (89%) survived resuscitation to hospital discharge. During 72 ± 37 months of follow-up, 38% of survivors had a normal neurologic outcome, whereas 32% had mild neurologic impairment and 30% had moderate-to-severe neurologic impairment.
In pediatric patients resuscitated from OOH-VF, a cardiovascular cause was identified in >80%. Regardless of cause, survival and neurologic prognosis appear improved compared to patients with asystole or pulseless electrical activity. These findings support early rhythm assessment and advanced cardiopulmonary resuscitation protocols in pediatric cardiac arrest victims.
一般来说，院外（OOH）心脏骤停的儿科患者预后较差，存活率为 12%至 29%。
本研究旨在描述经复苏后证实为室颤（VF）的儿科患者的病因和结局，这些患者在除颤后自主循环持续恢复并存活至入院。
对 2004 年至 2016 年间评估的 OOH-VF 患者（年龄<19 岁）进行回顾性分析。主要结局指标包括人口统计学、心跳骤停和复苏参数、心脏诊断、存活率和神经结局。
45 名患者符合研究标准（中位年龄 12 岁；年龄范围 2 个月至 18 岁）。68%的心脏骤停发生在公共场所，在紧急医疗服务人员到达之前，有 42%的患者有旁观者心肺复苏。所有患者均接受除颤（1-6 次电击），自主循环恢复并存活至入院。潜在病因是原发性电疾病（33%）、心肌病（27%）、先天性心脏病（11%）、其他（13%）和未知（16%）。在心跳骤停之前，40%的患者有心脏诊断，26%的患者有症状。最终，45 名患者中有 40 名（89%）在复苏后存活至出院。在 72±37 个月的随访期间，38%的幸存者神经功能正常，32%有轻度神经功能障碍，30%有中重度神经功能障碍。
在从 OOH-VF 中复苏的儿科患者中，>80%的患者确定了心血管病因。无论病因如何，与心搏骤停或无脉电活动患者相比，存活和神经预后似乎都有所改善。这些发现支持在儿科心脏骤停患者中早期进行节律评估和高级心肺复苏方案。
