Clinical paperPost-resuscitative clinical features in the first hour after achieving sustained ROSC predict the duration of survival in children with non-traumatic out-of-hospital cardiac arrest☆
Introduction
Pediatric out-of-hospital cardiac arrest (OHCA) is rare and the rate of survival is very low.1, 2, 3, 4, 5, 6 Although sustained return of spontaneous circulation (ROSC) can be initially established after resuscitation from non-traumatic OHCA in up to 35% of children, the rate of survival to hospital discharge is only 6–12%, and only 2–4% of those children have good neurologic outcome.1, 2 Some studies have shown that survival of children with OHCA is associated with factors in the pre-hospital resuscitation period, such as whether the arrest was witnessed, initial cardiac rhythm, and bystander resuscitation.7, 8, 9 The post-resuscitative clinical features that may be predictive of survival and duration of survival in children, however, have not been well addressed.
The aim of this study was to determine the clinical features during the first hour after ROSC that may predict survival in children with non-traumatic OHCA.
Section snippets
Study design
Children aged ≤ 18 years who presented to the emergency department (ED) of either the Chang Gung Memorial Hospital or the Changhua Christian Hospital with OHCA of non-traumatic origin during the period January 1996–December 2008 were included in this study. Patient characteristics and post-resuscitative clinical features that may be associated with the outcomes of children with OHCA were analyzed retrospectively. The study protocol was approved by the Institutional Review Boards of both hospitals.
Patient characteristics and factors related to sustained ROSC
Data on 228 children with OHCA of non-traumatic origin were analyzed. Patient characteristics are presented in Table 1. Among the 228 patients, sustained ROSC was achieved in 80 children. The overall mortality rate was 87.8%. A total of 28 patients survived to discharge. Among them, 6 had good neurologic outcomes and 17 had poor neurologic outcomes (Fig. 1). The factors that were positively associated with achieving sustained ROSC in the ED are also shown in Table 1.
Clinical features during the first hour after achieving sustained ROSC
Among the 80 children who
Discussion
Although sustained ROSC can be initially established after resuscitation from non-traumatic OHCA in some children, many of the children lose spontaneous circulation during hospital stay and do not survive to discharge.2 It remains challenging for ED physicians to predict the survival after OHCA in children, especially in children with unstable signs in the post-resuscitative period. In this study, we have analyzed the post-resuscitative clinical features that may predict the chances of survival
Conclusions
The post-resuscitative clinical features of non-traumatic OHCA children in the first hour after achieving sustained ROSC that can predict survival include sinus rhythm, a normal heart rate, normal blood pressure, and an initial urine output > 1 ml/kg/h.
Conflict of interest statement
There is no conflict of interest related to this study.
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A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2010.01.006.