Pediatric Cardiac Arrest Resuscitation by EMS (CARE)

Introduction: Epidemiology of pediatric out-of-hospital cardiac arrest (pOHCA) and return of spontaneous circulation (ROSC) rates varies greatly. A paucity of literature exists concerning pOHCA and the factors that affect field ROSC and thus potential survivability. 

Objective: To examine factors influencing the likelihood of achieving field ROSC in pOHCA.
Methods: We conducted a retrospective analysis of field ROSC using electronic patient care records from the 2017 ESO research database. The database contains prehospital patient care records for over five million EMS responses from more than 900 agencies across the United States and encompasses a broad range of practice settings from urban to rural. Inclusion criteria consisted of pOHCA patients aged 18 years or less for whom resuscitation was attempted. Patients with traumatic or “other” OHCA etiologies were excluded. Data were analyzed using univariate tests and logistic regression with p≤0.05 indicating significance. Patients were stratified by age (newborn: 0–1 year and child: 2–18 years) for analysis. 

Results: A total of 656 pOHCA patients met inclusion criteria. The mean (+SD) age was 4.8 (+6.5) years, of which most were 1 year of age or less (59.5%); 55.9% were Caucasian, 59.5% were male, and 24.7% attained ROSC. Compared to unwitnessed arrests, patients were more likely to achieve ROSC when arrests were witnessed by a healthcare provider (OR 6.53, p=0.003), bystander (OR 2.94, p=0.001), or family member (OR 2.77, p=0.016). Field ROSC was also associated with Caucasian race (OR 2.39, p=0.004), use of CPR feedback device (OR 2.21, p=0.007), and quicker epinephrine administration (OR 0.98, p=0.042 per minute from 9-1-1 call received time to first epinephrine administration). The child age group (2–18 years) also exhibited improved odds of ROSC (OR 2.11, p=0.008). Factors that did not influence the likelihood of ROSC included gender, shockable presenting rhythm, and layperson CPR.

Conclusions: In this retrospective analysis of pOHCA, witnessed arrests and those receiving CPR feedback-guided resuscitations were more likely to achieve ROSC. Caucasian pOHCA and early epinephrine administration also increased the likelihood of ROSC. Additional prospective investigation is needed to elucidate determinants of ROSC in pOHCA.