Incidence, characteristics and survival outcomes of out-of-hospital cardiac arrest in children and adolescents between 1997 and 2014 in Perth, Western Australia

Abstract

Objective: The present study was to describe the trends in the incidence, characteristics and survival of paediatric out-of-hospital cardiac arrest (OHCA) over an 18 year period.

Methods: We conducted a population-based retrospective cohort study using prospectively collected data from all OHCA patients aged <18 years who were attended by St John Ambulance Western Australia paramedics in the Perth metropolitan area, WA, between 1997 and 2014. The incidence, characteristics and survival were compared across 4 year periods (1997-2000, 2001-2005, 2006-2010 and 2011-2014). The Paediatric Cerebral Performance Category at hospital discharge was determined by medical record review. Incidence per 100 000 population was calculated for four age groups (<1, 1-4, 5-12 and 13-17).

Results: In total, 723 OHCAs were identified, and 451 (62.4%) had resuscitation commenced by paramedics. The patients were predominantly male (61.6%) with a median age of 2 years (IQR 0-14 years). Bystander CPR increased over time from 35.0% (1997-2000) to 63.0% (2011-2014) (P < 0.001). Any return of spontaneous circulation was 39/451 (8.6%), and survival to hospital discharge was 21/451 (5.0%). Of the 20 survivors assessed, 11 had good neurological status at hospital discharge (Paediatric Cerebral Performance Category 1 or 2). The overall incidence decreased from 14.1 (1997-2000) to 8.7 (2011-2014) per 100 000 population (P < 0.001). This was almost halved in children aged <1 year group (P < 0.001).

Conclusion: The incidence of paediatric OHCA decreased over time, but survival remained poor. Strategies to strengthen the chain of survival for paediatric OHCA need to be considered.

Keywords: cohort studies; incidence; out-of-hospital cardiac arrest; paediatrics; survival rate.