Elsevier

Resuscitation

Volume 64, Issue 1, January 2005, Pages 37-40
Resuscitation

Characteristics and outcome among children suffering from out of hospital cardiac arrest in Sweden

https://doi.org/10.1016/j.resuscitation.2004.06.019Get rights and content

Abstract

Aim:

To evaluate the characteristics, outcome and prognostic factors among children suffering from out of hospital cardiac arrest in Sweden.

Methods:

Patients aged below 18 years suffering from out of hospital cardiac arrest which were not crew witnessed and included in the Swedish cardiac arrest registry were included in the survey. This survey included the period 1990–2001 and 60 ambulance organisations covering 85% of the Swedish population (8 million inhabitants).

Results:

In all 457 children participated in the survey of which 32% were bystander witnessed and 68% received bystander CPR. Ventricular fibrillation was found in 6% of the cases. The overall survival to 1 month was 4%. The aetiology was sudden infant death syndrome in 34% and cardiac in 11%. When in a multivariate analysis considering age, sex, witnessed status, bystander CPR, initial rhythm, aetiology and the interval between call for, and arrival of, the ambulance and place of arrest only one appeared as an independent predictor of an increased chance of surviving cardiac arrest occurring outside home (adjusted odds ratio 8.7; 95% CL 2.2–58.1).

Conclusion:

Among children suffering from out of hospital cardiac arrest in Sweden that were not crew witnessed, the overall survival is low (4%). The chance of survival appears to be markedly increased if the arrest occurs outside the patients home compared with at home. No other strong predictors for an increased chance of survival could be demonstrated.

Introduction

Among patients who suffer from out of hospital cardiac arrest a minor fraction are children. They differ in many aspects from adults in their characteristics and outcome when suffering from out of hospital cardiac arrest [1], [2]. Most previous reports dealing with children who suffer from out of hospital cardiac arrest come from urban areas.

Since 1990 there has been an ongoing registry in Sweden reporting on the majority of patients suffering from out of hospital cardiac arrest in whom cardiopulmonary resuscitation (CPR) was started. This report aims at describing factors associated with an increased chance of survival among children who suffer from out of hospital cardiac arrest. Our hypothesis was that factors that have been shown to be associated with an increased chance of survival among adults also are associated with an increased chance of survival among children.

Section snippets

Patients

Patients with cardiac arrest to whom the ambulance was called were included in the registry, with one exception. Patients who had obviously been dead for a long time and whose bodies were not brought to hospital by the ambulance crew were excluded. For the others, the standardised form was completed by the ambulance crew. In this survey, crew witnessed cases, patients aged <18 years and patients in whom CPR was not started were excluded. Patients who suffered from cardiac arrest within the

Results

In all there were 38,750 patients reported to the registry during the time of the survey. Among them no resuscitation attempts was provided by the ambulance crew in 8111 (21%). Among the remaining 30,639 patients, 3374 were excluded since they were crew witnessed. Among the remaining 27,265 patients information on age was available in 26,177 cases (96%). Among them 457 (2%) were below 18 years of age. Thus, this study concerns 457 children suffering from out of hospital cardiac arrest in Sweden

Discussion

This is one of the largest patient cohorts evaluating the characteristics and outcome among patients aged less than 18 years suffering from out of hospital cardiac arrest. The study cohort has the advantage of representing almost the entire nation and not only a city ambulance organization. The major weakness was a substantial number of patients with missing information particularly with regard to the initial rhythm.

Only one-third of the patients had a witnessed cardiac arrest. Previous studies

Conclusion

Among children suffering from out of hospital cardiac arrest in Sweden which were not crew witnessed, the overall survival is low (4%). The chance of survival appears to be markedly increased if the arrest occurs outside the patients home compared with at home. No other strong predictors for an increased chance of survival could be demonstrated.

References (7)

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    Accordingly, the occurrence of shockable ventricular dysrhythmia such as VF or pVT is lower than during adult cardiac arrest and the frequency is age-dependant. VF is the first recorded rhythm in 5–24% of all paediatric cardiac arrests9,11–17 but up to 65% may experience VF or pVT during the resuscitation.13–17 In a large cohort study, 12% of cardiac arrests that occurred in the ICU had defibrillation performed.7

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A Spanish and Portuguese translated version of the Abstract and Keywords of this article appears at doi:10.1016/j.resuscitation.2004.06.019.

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