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Critical Care
Published in: Critical Care 1/2015

Open Access 01-12-2015 | Research

Neurological outcomes in children dead on hospital arrival

Authors: Yoshikazu Goto, Akira Funada, Yumiko Nakatsu-Goto

Published in: Critical Care | Issue 1/2015

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Abstract

Introduction

Obtaining favorable neurological outcomes is extremely difficult in children transported to a hospital without a prehospital return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA). However, the crucial prehospital factors affecting outcomes in this cohort remain unclear. We aimed to determine the prehospital factors for survival with favorable neurological outcomes (Cerebral Performance Category 1 or 2 (CPC 1–2)) in children without a prehospital ROSC after OHCA.

Methods

Of 9093 OHCA children, 7332 children (age <18 years) without a prehospital ROSC after attempting resuscitation were eligible for enrollment. Data were obtained from a prospectively recorded Japanese national Utstein-style database from 2008 to 2012. The primary endpoint was 1-month CPC 1–2 after OHCA.

Results

The 1-month survival and 1-month CPC 1–2 rates were 6.92 % (n = 508) and 0.99 % (n = 73), respectively. The proportions of the following prehospital variables were significantly higher in the 1-month CPC 1–2 cohort than in the 1-month CPC 3–5 cohort: age (median, 3 years (interquartile range (IQR), 0–14) versus 1 year (IQR, 0–11), p <0.05), bystander-witnessed arrest (52/73 (71.2 %) versus 1830/7259 (25.2 %), p <0.001), initial ventricular fibrillation (VF)/pulseless ventricular tachycardia (VT) rhythm (28/73 (38.3 %) versus 241/7259 (3.3 %), p <0.001), presumed cardiac causes (42/73 (57.5 %) versus 2385/7259 (32.8 %), p <0.001), and actual shock delivery (25/73 (34.2 %) versus 314/7259 (4.3 %), p <0.0001). Multivariate logistic regression analysis indicated that 2 prehospital factors were associated with 1-month CPC 1–2: initial non-asystole rhythm (VF/pulseless VT: adjusted odds ratio ( aOR), 16.0; 95 % confidence interval (CI), 8.05–32.0; pulseless electrical activity (PEA): aOR, 5.19; 95 % CI, 2.77–9.82) and bystander-witnessed arrest (aOR, 3.22; 95 % CI, 1.84–5.79). The rate of 1-month CPC 1–2 in witnessed-arrest children with an initial VF/pulseless VT was significantly higher than that in those with other initial cardiac rhythms (15.6 % versus 2.3 % for PEA and 1.2 % for asystole, p for trend <0.001).

Conclusions

The crucial prehospital factors for 1-month survival with favorable neurological outcomes after OHCA were initial non-asystole rhythm and bystander-witnessed arrest in children transported to hospitals without a prehospital ROSC.
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Metadata
Title
Neurological outcomes in children dead on hospital arrival
Authors
Yoshikazu Goto
Akira Funada
Yumiko Nakatsu-Goto
Publication date
01-12-2015
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2015
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-015-1132-1

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