Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States.
Resuscitation. 2021 Sep;166:110-120. doi: 10.1016/j.resuscitation.2021.05.015. Epub 2021 May 31.
Shockable rhythm following pediatric out-of-hospital cardiac arrest (pOHCA) is consistently associated with hospital and short-term survival. Little is known about the relationship between shockable rhythm and long-term outcomes (>1 year) after pOHCA. The aim was to investigate the association between first documented rhythm and long-term outcomes in a pOHCA cohort over 18 years.
All children aged 1 day-18 years who experienced non-traumatic pOHCA between 2002-2019 and were subsequently admitted to the emergency department (ED) or pediatric intensive care unit (PICU) of Erasmus MC-Sophia Children's Hospital were included. Data was abstracted retrospectively from patient files, (ground) ambulance and Helicopter Emergency Medical Service (HEMS) records, and follow-up clinics. Long-term outcome was determined using a Pediatric Cerebral Performance Category (PCPC) score at the longest available follow-up interval through august 2020. The primary outcome measure was survival with favorable neurologic outcome, defined as PCPC 1-2 or no difference between pre- and post-arrest PCPC. The association between first documented rhythm and the primary outcome was calculated in a multivariable regression model.
369 children were admitted, nine children were lost to follow-up. Median age at arrest was age 3.4 (IQR 0.8-9.9) years, 63% were male and 14% had a shockable rhythm (66% non-shockable, 20% unknown or return of spontaneous circulation (ROSC) before emergency medical service (EMS) arrival). In adolescents (aged 12-18 years), 39% had shockable rhythm. 142 (39%) of children survived to hospital discharge. On median follow-up interval of 25 months (IQR 5.1-49.6), 115/142 (81%) of hospital survivors had favorable neurologic outcome. In multivariable analysis, shockable rhythm was associated with survival with favorable long-term neurologic outcome (OR 8.9 [95%CI 3.1-25.9]).
In children with pOHCA admitted to ED or PICU shockable rhythm had significantly higher odds of survival with long-term favorable neurologic outcome compared to non-shockable rhythm. Survival to hospital discharge after pOHCA was 39% over the 18-year study period. Of survivors to discharge, 81% had favorable long-term (median 25 months, IQR 5.1-49.6) neurologic outcome. Efforts for improving outcome of pOHCA should focus on early recognition and treatment of shockable pOHCA at scene.
儿科院外心脏骤停（pOHCA）后出现可电击节律与医院和短期存活率始终相关。关于 pOHCA 后可电击节律与长期结局（>1 年）之间的关系知之甚少。本研究旨在调查 pOHCA 队列中 18 年以上首次记录的节律与长期结局之间的关系。
纳入 2002-2019 年期间经历非创伤性 pOHCA 且随后入住 Erasmus MC-Sophia 儿童医院急诊室（ED）或儿科重症监护病房（PICU）的 1 天至 18 岁的所有儿童。数据通过回顾性地从患者档案、（地面）救护车和直升机紧急医疗服务（HEMS）记录以及随访诊所中提取。通过截至 2020 年 8 月的最长随访间隔，使用最长可用随访间隔的儿童脑功能预后评分（PCPC）来确定长期结局。主要结局测量指标为存活且神经功能结局良好，定义为 PCPC 1-2 或在发病前和发病后 PCPC 之间无差异。在多变量回归模型中计算了首次记录的节律与主要结局之间的关联。
共纳入 369 名患儿，其中 9 名患儿失访。发病时的中位年龄为 3.4 岁（IQR 0.8-9.9 岁），63%为男性，14%存在可电击节律（66%为非可电击节律，20%为未知或在 EMS 到达前恢复自主循环（ROSC））。在青少年（12-18 岁）中，39%存在可电击节律。142 名（39%）患儿存活至出院。在中位随访间隔 25 个月（IQR 5.1-49.6）时，142 名存活至出院的患儿中有 115 名（81%）具有良好的神经功能结局。在多变量分析中，可电击节律与长期神经功能结局良好的存活相关（OR 8.9 [95%CI 3.1-25.9]）。
在因 pOHCA 而入住 ED 或 PICU 的儿童中，与非可电击节律相比，可电击节律具有更高的长期神经功能结局良好的存活几率。在 18 年的研究期间，pOHCA 后患儿的出院存活率为 39%。出院后存活的患儿中，81%具有良好的长期（中位 25 个月，IQR 5.1-49.6）神经功能结局。改善 pOHCA 结局的努力应侧重于现场识别和治疗可电击的 pOHCA。
