Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore.
Prehospital Emergency & Research Centre, Duke-NUS Medical School, Singapore, Singapore.
Resuscitation. 2022 Jul;176:9-18. doi: 10.1016/j.resuscitation.2022.04.018. Epub 2022 Apr 26.
Paediatric out-of-hospital cardiac arrest (OHCA) results in high mortality and poor neurological outcomes. We conducted this study to describe and compare the effects of pre-hospital airway management on survival outcomes for paediatric OHCA in the Asia-pacific region.
We performed a retrospective analysis of the Pan Asian Resuscitation Outcomes Study (PAROS) data from January 2009 to June 2018. PAROS is a prospective, observational, multi-centre cohort study from eleven countries. The primary outcomes were one-month survival and survival with favourable neurological status, defined as Cerebral Performance Category1 or 2. We performed multivariate analyses of the unmatched and propensity matched cohort.
We included 3131 patients less than 18 years in the study. 2679 (85.6%) children received bag-valve-mask (BVM) ventilations, 81 (2.6%) endotracheal intubations (ETI) and 371 (11.8%) supraglottic airways (SGA). 792 patients underwent propensity score matching. In the matched cohort, advanced airway management (AAM: SGA and ETI) when compared with BVM group was associated with decreased one-month survival [AAM: 28/396 (7.1%) versus BVM: 55/396 (13.9%); adjusted odds ratio (aOR), 0.46 (95% CI, 0.29 - 0.75); p = 0.002] and survival with favourable neurological status [AAM: 8/396 (2.0%) versus BVM: 31/396 (7.8%); aOR, 0.22 (95% CI, 0.10 - 0.50); p < 0.001]. For SGA group, we observed less 1-month survival [SGA: 24/337 (7.1%) versus BVM: 52/337 (15.4%); aOR, 0.41 (95 %CI, 0.25-0.69), p = 0.001] and survival with favourable neurological status.
In children with OHCA in the Asia-Pacific region, pre-hospital AAM was associated with decreased one-month survival and less favourable neurological status.
儿科院外心脏骤停（OHCA）导致高死亡率和较差的神经预后。我们进行这项研究，旨在描述和比较亚太地区儿科 OHCA 院前气道管理对生存结果的影响。
我们对 2009 年 1 月至 2018 年 6 月期间的泛亚复苏结果研究（PAROS）数据进行了回顾性分析。PAROS 是一项来自 11 个国家的前瞻性、观察性、多中心队列研究。主要结局是一个月的生存率和具有良好神经状态的生存率，定义为脑功能分类 1 或 2。我们对未匹配和倾向评分匹配队列进行了多变量分析。
我们纳入了研究中年龄小于 18 岁的 3131 名患者。2679 名（85.6%）儿童接受了球囊面罩通气（BVM），81 名（2.6%）接受了气管插管（ETI），371 名（11.8%）接受了喉上气道（SGA）。792 名患者进行了倾向评分匹配。在匹配队列中，与 BVM 组相比，高级气道管理（AAM：SGA 和 ETI）与一个月生存率降低相关 [AAM：396 例中的 28 例（7.1%）与 BVM：396 例中的 55 例（13.9%）；调整后的优势比（aOR），0.46（95%CI，0.29-0.75）；p=0.002] 和具有良好神经状态的生存率 [AAM：396 例中的 8 例（2.0%）与 BVM：396 例中的 31 例（7.8%）；aOR，0.22（95%CI，0.10-0.50）；p<0.001]。对于 SGA 组，我们观察到一个月生存率较低 [SGA：337 例中的 24 例（7.1%）与 BVM：337 例中的 52 例（15.4%）；aOR，0.41（95%CI，0.25-0.69），p=0.001] 和具有良好神经状态的生存率。
在亚太地区 OHCA 的儿童中，院前 AAM 与一个月生存率降低和神经预后不良有关。
