Matsui Satoshi, Kurosawa Hiroshi, Hayashi Takuro, Takei Hirokazu, Tanizawa Naoko, Ohnishi Yasuhiro, Murata Satoshi, Ohnishi Masahumi, Henry Yoshii Takuma, Miyawaki Kosuke, Matsumoto Taisuke, Tanaka Ryojiro, Kiyohara Kosuke, Zha Ling, Kitamura Tetsuhisa, Sobue Tomotaka, Nitta Masahiko
Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan; Division of Emergency Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan.
Division of Pediatric Critical Care Medicine, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan.
Resuscitation. 2023 Oct;191:109942. doi: 10.1016/j.resuscitation.2023.109942. Epub 2023 Aug 23.
Out-of-hospital cardiac arrest (OHCA) has a poor prognosis in children; however, the annual patterns of prognosis and treatment have not been fully investigated.
From the Japanese Association for Acute Medicine OHCA registry, a multicenter prospective observational registry in Japan, we identified pediatric patients (zero to 17 years old) between June 2014 and December 2019. The primary outcome was one-month survival. We investigated the annual patterns in patient characteristics, treatment, and one-month prognosis.
During the study period, 1188 patients were eligible for analysis. For all years, the zero-year-old group accounted for a large percentage of the total population (between 30% and 40%). There were significant increases in the rates of bystander-initiated cardiopulmonary resuscitation (CPR; from 50.6% to 62.3%, p = 0.003), dispatcher instructions (from 44.7% to 65.7%, p = 0.001), and adrenaline administration (from 2.4% to 6.9%, p = 0.014) over time, whereas the rate of advanced airway management decreased significantly (from 17.7% to 8.8%, p = 0.003). The odds ratios for one-month survival adjusted for potential resuscitation factors also did not change significantly (from 7.1% to 10.3%, adjusted odds ratio for one-year increment = 0.98, confidence interval: 0.86-1.11).
Despite an increase in the rate of bystander-initiated CPR and pre-hospital adrenaline administration, there was no significant change in one-month survival.
院外心脏骤停（OHCA）患儿的预后较差；然而，其预后和治疗的年度模式尚未得到充分研究。
从日本急性医学协会的院外心脏骤停登记处（日本的一个多中心前瞻性观察登记处），我们确定了2014年6月至2019年12月期间的儿科患者（0至17岁）。主要结局是1个月生存率。我们调查了患者特征、治疗和1个月预后的年度模式。
在研究期间，1188例患者符合分析条件。各年份中，0岁组在总人口中所占比例较大（30%至40%）。随着时间的推移，旁观者实施心肺复苏（CPR）的比例（从50.6%增至62.3%，p = 0.003）、调度员指导比例（从44.7%增至65.7%，p = 0.001）和肾上腺素使用比例（从2.4%增至6.9%，p = 0.014）均显著增加，而高级气道管理比例显著下降（从17.7%降至8.8%，p = 0.003）。经潜在复苏因素调整后的1个月生存比值比也无显著变化（从7.1%至10.3%，每年增加的调整后比值比 = 0.98，置信区间：0.86 - 1.11）。
尽管旁观者实施CPR和院前使用肾上腺素的比例有所增加，但1个月生存率并无显著变化。
