Gupte Dhruv, Assaf Maysaa, Miller Michael R, McKenzie Kate, Loosley Jay, Tijssen Janice A
Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada.
Department of Paediatrics, London Health Sciences Centre, 800 Commissioners Rd. E., London, ON N6A 5W9, Canada.
Resusc Plus. 2023 Jul 27;15:100433. doi: 10.1016/j.resplu.2023.100433. eCollection 2023 Sep.
Pediatric out of hospital cardiac arrest (POHCA) is rare, with high mortality and neurological morbidity. Adherence to Pediatric Advanced Life Support guidelines standardizes in-hospital care and improves outcomes. We hypothesized that in-hospital care of POHCA patients was variable and deviations from guidelines were associated with higher mortality.
POHCA patients in the London-Middlesex region between January 2012 and June 2020 were included. The care of children with ongoing arrest (intra-arrest) and post-arrest outcomes were reviewed using the Children's Hospital, London Health Sciences Centre (LHSC) patient database and the Adverse Event Management System.
50 POHCA patients arrived to hospital, with 15 (30%) patients admitted and 2 (4.0%) surviving to discharge, both with poor neurological outcomes and no improvement at 90 days. Deviations occurred at every event with intra-arrest care deviations occurring mostly in medication delivery and defibrillation (98%). Post-arrest deviations occurred mostly in temperature monitoring (60%). Data missingness was 15.9% in the intra-arrest and 1.7% in the post-arrest group.
Deviations commonly occurred in both in-hospital arrest and post-arrest care. The study was under-powered to identify associations between DEVs and outcomes. Future work includes addressing specific deviations in intra-arrest and post-arrest care of POHCA patients and standardizing electronic documentation.
儿童院外心脏骤停（POHCA）较为罕见，死亡率和神经功能障碍发生率较高。遵循儿童高级生命支持指南可使院内治疗标准化并改善治疗结果。我们推测，POHCA患者的院内治疗存在差异，而偏离指南与较高的死亡率相关。
纳入2012年1月至2020年6月期间伦敦-米德尔塞克斯地区的POHCA患者。使用伦敦卫生科学中心儿童医院（LHSC）患者数据库和不良事件管理系统对持续心脏骤停（心脏骤停期间）儿童的治疗及心脏骤停后结局进行回顾。
50例POHCA患者被送至医院，其中15例（30%）患者入院，2例（4.0%）存活至出院，二者神经功能结局均较差，且90天时无改善。在每个环节均出现了偏差，心脏骤停期间的治疗偏差主要发生在药物输送和除颤方面（98%）。心脏骤停后的偏差主要发生在体温监测方面（60%）。心脏骤停期间的数据缺失率为15.9%，心脏骤停后组为1.7%。
院内心脏骤停和心脏骤停后护理中均普遍存在偏差。该研究的效能不足以确定偏差与结局之间的关联。未来的工作包括解决POHCA患者心脏骤停期间和心脏骤停后护理中的特定偏差，并使电子文档标准化。
