Alqudah Zainab, Nehme Ziad, Alrawashdeh Ahmad, Williams Brett, Oteir Alaa, Smith Karen
Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Department of Allied Medical Sciences, Applied Medical Sciences College, Jordan University of Science and Technology, Irbid, Jordan.
Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia.
Resuscitation. 2020 Apr;149:65-73. doi: 10.1016/j.resuscitation.2020.01.037. Epub 2020 Feb 15.
In this study, we sought to quantitatively describe the survival outcomes, incidence rates, and predictors of survival after paediatric traumatic out-of-hospital cardiac arrest (OHCA).
We systematically searched MEDLINE, EMBASE, EMCARE, and CINAHL to identify observational or interventional studies reporting relevant data for paediatric traumatic OHCA. The Joanna Briggs Institute critical appraisal tool for prognostic studies was used to assess study quality. We analysed the survival outcomes and pooled incidence rates per 100,000 person-years using random-effect models.
Nineteen articles met the eligibility criteria involving 705 Emergency Medical Service (EMS)-attended and 973 EMS-treated traumatic paediatric OHCAs across an estimated serviceable population of 15.2 million. Four studies were conducted in the Asia-pacific region, seven in Europe, and eight in North America. Nine studies were assessed as low quality. Overall pooled survival to hospital discharge or 30-day survival for the EMS-treated cases was 1.2% (n = 6 studies; 95% confidence interval (CI): 0.1%, 3.1%; I = 26.1%). The pooled rate of return of spontaneous circulation in four studies was 22.1% (95% CI: 18.4%, 26.1%; I = 0.0%), and the pooled rate of event survival was 18.8% (n = 3 studies; 95% CI: 15.2%, 22.7%; I = 0.0%). The pooled incidence of EMS-treated paediatric traumatic OHCA was 1.6 cases per 100,000 person-years (n = 10 studies; 95% CI: 1.1, 2.2; I = 98.1%). No study reported on the impact of epidemiological or clinical factors on survival.
Survival outcomes of paediatric traumatic OHCA are poor and existing studies report varying incidence rates. The absence of large prospective and international registry data hinders the development of novel strategies to improve survival rates.
在本研究中，我们试图定量描述小儿创伤性院外心脏骤停（OHCA）后的生存结果、发病率及生存预测因素。
我们系统检索了MEDLINE、EMBASE、EMCARE和CINAHL，以确定报告小儿创伤性OHCA相关数据的观察性或干预性研究。采用乔安娜·布里格斯研究所预后研究的批判性评价工具来评估研究质量。我们使用随机效应模型分析了生存结果及每10万人年的合并发病率。
19篇文章符合纳入标准，涉及705例接受紧急医疗服务（EMS）的小儿创伤性OHCA以及973例接受EMS治疗的病例，估计适用人群为1520万。4项研究在亚太地区开展，7项在欧洲，8项在北美。9项研究被评估为低质量。对于接受EMS治疗的病例，总体出院生存率或30天生存率为1.2%（n = 6项研究；95%置信区间（CI）：0.1%，3.1%；I² = 26.1%）。4项研究中自主循环恢复的合并率为22.1%（95%CI：18.4%，26.1%；I² = 0.0%），事件生存率的合并率为18.8%（n = 3项研究；95%CI：15.2%，22.7%；I² = 0.0%）。接受EMS治疗的小儿创伤性OHCA的合并发病率为每10万人年1.6例（n = 10项研究；95%CI：1.1，2.2；I² = 98.1%）。没有研究报告流行病学或临床因素对生存的影响。
小儿创伤性OHCA的生存结果较差，现有研究报告的发病率各不相同。缺乏大型前瞻性和国际注册数据阻碍了提高生存率新策略的开发。
