Healthcare Analytics Unit, The Children's Hospital of Philadelphia, United States; Department of Biomedical Health Informatics, The Children's Hospital of Philadelphia, United States; Cardiac Center Research Core, The Children's Hospital of Philadelphia, United States.
The Children's Hospital of Philadelphia, United States.
Resuscitation. 2020 Jan 1;146:126-131. doi: 10.1016/j.resuscitation.2019.09.038. Epub 2019 Nov 27.
Automated external defibrillators (AEDs) are critical in the chain of survival following out-of-hospital cardiac arrest (OHCA), yet few studies have reported on AED use and outcomes among pediatric OHCA. This study describes the association between bystander AED use, neighborhood characteristics and survival outcomes following public pediatric OHCA.
Non-traumatic OHCAs among children less than18 years of age in a public setting between from January 1, 2013 through December 31, 2017 were identified in the CARES database. A neighborhood characteristic index was created from the addition of dichotomous values of 4 American Community Survey neighborhood characteristics at the Census tract level: median household income, percent high school graduates, percent unemployment, and percent African American. Multivariable logistic regression models assessed the association of OHCA characteristics, the neighborhood characteristic index and outcomes.
Of 971 pediatric OHCA, AEDs were used by bystanders in 10.3% of OHCAs. AEDs were used on 2.3% of children ≤1 year (infants), 8.3% of 2-5 year-olds, 12.4% of 6-11 year-olds, and 18.2% of 12-18 year-olds (p < 0.001). AED use was more common in neighborhoods with a median household income of >$50,000 per year (12.3%; p = 0.016), <10% unemployment (12.1%; p = 0.002), and >80% high school education (11.8%; p = 0.002). Greater survival to hospital discharge and neurologically favorable survival were among arrests with bystander AED use, varying by neighborhood characteristics.
Bystander AED use is uncommon in pediatric OHCA, particularly in high-risk neighborhoods, but improves survival. Further study is needed to understand disparities in AED use and outcomes.
在院外心脏骤停（OHCA）后，自动体外除颤器（AED）在生存链中至关重要，但很少有研究报告儿科 OHCA 中的 AED 使用情况和结果。本研究描述了旁观者 AED 使用、邻里特征与公共儿科 OHCA 后生存结果之间的关联。
从 2013 年 1 月 1 日至 2017 年 12 月 31 日，CARES 数据库中确定了公共环境中年龄小于 18 岁的非创伤性 OHCA。创建了一个邻里特征指数，该指数由 4 个美国社区调查邻里特征的二分值相加而成：家庭收入中位数、高中毕业生比例、失业率和非裔美国人比例。多变量逻辑回归模型评估了 OHCA 特征、邻里特征指数与结局之间的关系。
在 971 例儿科 OHCA 中，旁观者在 10.3%的 OHCA 中使用了 AED。AED 在 2.3%的 1 岁以下（婴儿）、8.3%的 2-5 岁、12.4%的 6-11 岁和 18.2%的 12-18 岁儿童中使用（p<0.001）。在家庭收入中位数>50000 美元/年（12.3%；p=0.016）、失业率<10%（12.1%；p=0.002）和高中教育程度>80%（11.8%；p=0.002）的邻里中，AED 使用更为常见。旁观者使用 AED 的情况下，存活率和神经功能良好的存活率更高，这取决于邻里特征。
旁观者 AED 使用在儿科 OHCA 中并不常见，尤其是在高风险的邻里中，但可以提高存活率。需要进一步研究以了解 AED 使用和结局方面的差异。
