Impact of emergency medical services transport on non-traumatic out-of-hospital cardiac arrest in pediatric and young adult: 25-year single-center experience.

BACKGROUND

The role of emergency medical services (EMS) in out-of-hospital cardiac arrest (OHCA) among children and young adults remains understudied. This study evaluated EMS utilization and its association with outcomes in non-traumatic pediatric and young adult OHCA.

METHODS

Patients aged <35 years with non-traumatic OHCA treated at a tertiary center between 1995 and 2019 were analyzed. Exclusion criteria included referrals and newborns <24 hours old. EMS use was defined as public-ambulance transport to the emergency department. The primary outcome was return of spontaneous circulation (ROSC).

RESULTS

Of 195 OHCAs, 109 (55.9%) were pediatric. EMS use increased with age, from 38.0% (0-5 years) to 82.6% (18 to <35 years). EMS was associated with higher ROSC and survival to hospital discharge (41.7% vs. 24.6%, p = 0.06, and 25.0% vs. 6.6%, p = 0.007, respectively) in pediatric group but not in the young adult group. However, EMS improved the ROSC rate in young adults from 30.8% during 1995-2002 to 65.7% during 2011-2019. The impact of EMS was not significant after multivariable adjustment.

CONCLUSION

EMS utilization and clinical outcomes in pediatric and young adults OHCA remained suboptimal over the 25-year study period. Targeted advocacy and education are essential to strengthen the chain of survival in these population.

IMPACT

Pediatric OHCA patients had significantly lower EMS use than young adults. EMS was associated with higher ROSC and survival to hospital discharge in the pediatric group but not in the young adult group. While EMS-transported young adults showed improved outcomes over time, pediatric outcomes remained unchanged. Pediatric OHCA patients transported by EMS had shorter scene times and received fewer prehospital interventions than young adults. Educating caregivers on the importance of EMS activation is crucial. Emergency departments must be prepared for unannounced pediatric cases. There is an urgent need for protocols specifically tailored to pediatric OHCA care.