Public access defibrillation and outcomes after pediatric out-of-hospital cardiac arrest

Tatsuma Fukuda; Naoko Ohashi-Fukuda; Hiroaki Kobayashi; Masataka Gunshin; Toshiki Sera; Yutaka Kondo; Naoki Yahagi

doi:10.1016/j.resuscitation.2016.11.010

Public access defibrillation and outcomes after pediatric out-of-hospital cardiac arrest

Resuscitation. 2017 Feb:111:1-7. doi: 10.1016/j.resuscitation.2016.11.010. Epub 2016 Nov 27.

Authors

Tatsuma Fukuda¹, Naoko Ohashi-Fukuda², Hiroaki Kobayashi³, Masataka Gunshin⁴, Toshiki Sera⁵, Yutaka Kondo⁶, Naoki Yahagi²

Affiliations

¹ Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan. Electronic address: tatsumafukuda-jpn@umin.ac.jp.
² Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
³ Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; Stephen M. Ross School of Business at the University of Michigan, 701 Tappan Street, Ann Arbor, MI 48109-1234, USA.
⁴ Department of Disaster Medical Management, The University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-8655, Japan; The Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
⁵ Department of Acute Critical Care and Disaster Medicine, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo 113-8519, Japan.
⁶ Department of Emergency Medicine, Graduate School of Medicine, University of Ryukyus, 207, Uehara, Nishihara-cho, Okinawa 903-0215, Japan; Division of Acute Care Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.

PMID: 27899017
DOI: 10.1016/j.resuscitation.2016.11.010

Abstract

Background: Use of automated external defibrillators (AEDs) has been recommended for pediatric out-of-hospital cardiac arrest (OHCA). However, there are no conclusive studies that elucidated the effectiveness of public-access defibrillation (PAD) in children.

Methods: This was a nationwide, population-based, propensity score-matched study of pediatric OHCA in Japan from 2011 to 2012, based on data from the All-Japan Utstein Registry. We included pediatric OHCA patients (aged 1-17 years) who received bystander cardiopulmonary resuscitation. The primary outcome was a favorable neurological state 1 month after OHCA (defined as a CPC score of 1-2).

Results: A total of 1193 patients were included in the final cohort; 57 received PAD and 1136 did not. Among 1193 patients, 188 (15.8%) survived with a favorable neurological status 1 month after OHCA. The odds of neurologically favorable survival were significantly higher for patients receiving PAD after adjusting for potential confounders: propensity score matching, OR 3.17 (95% CI 1.40-7.17), and multivariable logistic regression modeling, OR_adjusted 5.10 (95% CI 2.01-13.70). Similar findings were observed for the secondary outcomes (i.e., neurologically favorable survival with a CPC score of 1, one-month survival, and prehospital return of spontaneous circulation). In subgroup analyses, there were no significant differences in neurologically favorable survival between the PAD group and non-PAD group in the unwitnessed cohort (OR_adjusted 7.76 [0.75-81.90]) or the non-cardiac etiology cohort (OR_adjusted 6.65 [0.64-66.24]).

Conclusions: PAD was associated with an increased chance of neurologically favorable survival in pediatric OHCA (aged 1-17 years) who received bystander CPR, except for in cases of unwitnessed or non-cardiac etiology.

Keywords: Cardiopulmonary resuscitation; Children; Epidemiology; Out-of-hospital cardiac arrest; Pediatrics.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Child
Child, Preschool
Defibrillators*
Electric Countershock / instrumentation
Female
Humans
Infant
Male
Out-of-Hospital Cardiac Arrest / therapy*
Propensity Score
Treatment Outcome