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  • Duration of prehospital and in-hospital cardiopulmonary resuscitation and neurological outcome in paediatric out-of-hospital cardiac arrest

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Original research
Duration of prehospital and in-hospital cardiopulmonary resuscitation and neurological outcome in paediatric out-of-hospital cardiac arrest
  1. Masato Yasuda1,2,
  2. Shunsuke Amagasa1,
  3. Masahiro Kashiura3,
  4. Hideto Yasuda3,
  5. Satoko Uematsu1
  1. 1 Department of Emergency and Transport Medicine, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
  2. 2 Division of Pediatric Emergency Medicine, Aichi Children's Health and Medical Center, Obu, Aichi, Japan
  3. 3 Department of Emergency and Critical Care Medicine, Jichi Ika University Saitama Medical Center, Saitama, Saitama, Japan
  1. Correspondence to Dr Masato Yasuda; masato_yasuda{at}sk00106.achmc.pref.aichi.jp

Abstract

Background Because of their young age and lack of known comorbidities, paediatric patients with out-of-hospital cardiac arrest (OHCA) often undergo prolonged cardiopulmonary resuscitation (CPR). We aimed to determine the association between prehospital and in-hospital CPR duration and neurological outcomes.

Methods We conducted a retrospective analysis of data from the Japanese Association for Acute Medicine-OHCA Registry for patients <18 years of age with OHCA between June 2014 and December 2019. All patients received prehospital CPR by emergency medical service (EMS). The aetiologies of arrest included traumatic and atraumatic causes. The primary outcome measure was a 1-month neurological outcome of moderate disability or better (Pediatric Cerebral Performance Category 1–3). We calculated the dynamic probability and cumulative proportion of 1-month moderate disability or better neurological outcomes. Dynamic probability calculates patient outcomes during CPR per min. We performed multivariate logistic regression analysis to explore the association between longer CPR duration (as an ordinal variable) and 1-month poorer neurological outcomes.

Results Among 1007 eligible children, 252 achieved return of spontaneous circulation and 53 had a 1-month moderate disability or better neurological outcome. The dynamic probability of a 1-month moderate disability or better neurological outcome dropped below 0.01 at 64 min (0.005, 95% CI 0.001 to 0.017). The cumulative proportion of a 1-month moderate disability or better neurological outcome exceeded 0.99 at 68 min (1, 95% CI 1 to 1). With increasing CPR time from CPR initiation by EMS, both crude and adjusted ORs for 1-month neurological outcomes gradually decreased.

Conclusion Using a large Japanese database of paediatric OHCA patients, we found that longer CPR duration was associated with a lower likelihood of a 1-month moderate disability or better neurological outcome. Less than 1% of paediatric patients exhibited 1-month moderate disability or better neurological outcomes when total CPR duration is more than 64 min.

  • Cardiopulmonary Resuscitation
  • heart arrest
  • pediatric emergency medicine
  • emergency ambulance systems

Data availability statement

Data may be obtained from a third party and are not publicly available.

https://doi.org/10.1136/emermed-2023-213730

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    Data availability statement

    Data may be obtained from a third party and are not publicly available.

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    Footnotes

    • Handling editor Shammi L Ramlakhan

    • Contributors MY and SA conceived the idea of the study. SA, MK and HY developed the statistical analysis plan and conducted statistical analyses. SA, MK and HY contributed to the interpretation of the results. MY drafted the original manuscript. SU supervised the conduct of this study. All authors reviewed the manuscript draft and revised it critically on intellectual content. All authors approved the final version of the manuscript to be published. Guarantor: MY—is responsible for the overall content as guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; internally peer-reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.