Association of subsequent treated shockable rhythm with outcomes after paediatric out-of-hospital cardiac arrests: A nationwide, population-based observational study
Aim: Among patients with paediatric out-of-hospital cardiac arrests (OHCAs), most have an initial non-shockable rhythm with poor outcomes. There is a subset who developed shockable rhythms. This study aimed to investigate the association between subsequent shock delivery and outcomes after paediatri...
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2021
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oai:doaj.org-article:7d2d3ad984dc436e8b8810afb37041bb2021-11-12T04:48:16ZAssociation of subsequent treated shockable rhythm with outcomes after paediatric out-of-hospital cardiac arrests: A nationwide, population-based observational study2666-520410.1016/j.resplu.2021.100181https://doaj.org/article/7d2d3ad984dc436e8b8810afb37041bb2021-12-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2666520421001065https://doaj.org/toc/2666-5204Aim: Among patients with paediatric out-of-hospital cardiac arrests (OHCAs), most have an initial non-shockable rhythm with poor outcomes. There is a subset who developed shockable rhythms. This study aimed to investigate the association between subsequent shock delivery and outcomes after paediatric OHCAs. Methods: We analysed records of 19,095 children (aged <18 years) with OHCA and initial non-shockable rhythm. Data were obtained from a Japanese nationwide database for 13 years (2005–2017). The primary outcome measure was 1-month neurologically intact survival, defined as cerebral performance category 1–2. Results: Among patients with pulseless electrical activity (PEA, n = 3,326), there was no significant difference between those with subsequent treated shockable rhythm (10.0% [11/109]) and those with sustained non-shockable rhythm (6.0% [192/3,217], p = 0.10) with respect to the neurologically intact survival rate. Among asystole patients (n = 15,769), the neurologically intact survival rate was significantly higher in the subsequent treated shockable rhythm group (4.4% [10/227]) than in the sustained non-shockable rhythm group (0.7% [106/15,542], p < 0.0001). Subsequent treated shockable rhythm with a shock delivery time (time from emergency medical services [EMS]-initiated cardiopulmonary resuscitation [CPR] to shock delivery) ≤9 min was associated with increased odds of neurologically intact survival compared with sustained non-shockable rhythm (PEA, adjusted odds ratio, 2.45 [95% confidence interval, 1.16–5.16], p = 0.018; asystole, 9.77 [4.2–22.5], p < 0.0001). Conclusion: After paediatric OHCAs, subsequent treated shockable rhythm was associated with increased odds of 1-month neurologically intact survival regardless of whether the initial rhythm was PEA or asystole, only when the shock was delivered ≤9 min of EMS-initiated CPR.Yoshikazu GotoAkira FunadaTetsuo MaedaYumiko GotoElsevierarticleOut-of-hospital cardiac arrestResuscitationChildrenOutcomesNon-shockable rhythmRhythm conversionSpecialties of internal medicineRC581-951ENResuscitation Plus, Vol 8, Iss , Pp 100181- (2021) |
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Out-of-hospital cardiac arrest Resuscitation Children Outcomes Non-shockable rhythm Rhythm conversion Specialties of internal medicine RC581-951 |
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Out-of-hospital cardiac arrest Resuscitation Children Outcomes Non-shockable rhythm Rhythm conversion Specialties of internal medicine RC581-951 Yoshikazu Goto Akira Funada Tetsuo Maeda Yumiko Goto Association of subsequent treated shockable rhythm with outcomes after paediatric out-of-hospital cardiac arrests: A nationwide, population-based observational study |
description |
Aim: Among patients with paediatric out-of-hospital cardiac arrests (OHCAs), most have an initial non-shockable rhythm with poor outcomes. There is a subset who developed shockable rhythms. This study aimed to investigate the association between subsequent shock delivery and outcomes after paediatric OHCAs. Methods: We analysed records of 19,095 children (aged <18 years) with OHCA and initial non-shockable rhythm. Data were obtained from a Japanese nationwide database for 13 years (2005–2017). The primary outcome measure was 1-month neurologically intact survival, defined as cerebral performance category 1–2. Results: Among patients with pulseless electrical activity (PEA, n = 3,326), there was no significant difference between those with subsequent treated shockable rhythm (10.0% [11/109]) and those with sustained non-shockable rhythm (6.0% [192/3,217], p = 0.10) with respect to the neurologically intact survival rate. Among asystole patients (n = 15,769), the neurologically intact survival rate was significantly higher in the subsequent treated shockable rhythm group (4.4% [10/227]) than in the sustained non-shockable rhythm group (0.7% [106/15,542], p < 0.0001). Subsequent treated shockable rhythm with a shock delivery time (time from emergency medical services [EMS]-initiated cardiopulmonary resuscitation [CPR] to shock delivery) ≤9 min was associated with increased odds of neurologically intact survival compared with sustained non-shockable rhythm (PEA, adjusted odds ratio, 2.45 [95% confidence interval, 1.16–5.16], p = 0.018; asystole, 9.77 [4.2–22.5], p < 0.0001). Conclusion: After paediatric OHCAs, subsequent treated shockable rhythm was associated with increased odds of 1-month neurologically intact survival regardless of whether the initial rhythm was PEA or asystole, only when the shock was delivered ≤9 min of EMS-initiated CPR. |
format |
article |
author |
Yoshikazu Goto Akira Funada Tetsuo Maeda Yumiko Goto |
author_facet |
Yoshikazu Goto Akira Funada Tetsuo Maeda Yumiko Goto |
author_sort |
Yoshikazu Goto |
title |
Association of subsequent treated shockable rhythm with outcomes after paediatric out-of-hospital cardiac arrests: A nationwide, population-based observational study |
title_short |
Association of subsequent treated shockable rhythm with outcomes after paediatric out-of-hospital cardiac arrests: A nationwide, population-based observational study |
title_full |
Association of subsequent treated shockable rhythm with outcomes after paediatric out-of-hospital cardiac arrests: A nationwide, population-based observational study |
title_fullStr |
Association of subsequent treated shockable rhythm with outcomes after paediatric out-of-hospital cardiac arrests: A nationwide, population-based observational study |
title_full_unstemmed |
Association of subsequent treated shockable rhythm with outcomes after paediatric out-of-hospital cardiac arrests: A nationwide, population-based observational study |
title_sort |
association of subsequent treated shockable rhythm with outcomes after paediatric out-of-hospital cardiac arrests: a nationwide, population-based observational study |
publisher |
Elsevier |
publishDate |
2021 |
url |
https://doaj.org/article/7d2d3ad984dc436e8b8810afb37041bb |
work_keys_str_mv |
AT yoshikazugoto associationofsubsequenttreatedshockablerhythmwithoutcomesafterpaediatricoutofhospitalcardiacarrestsanationwidepopulationbasedobservationalstudy AT akirafunada associationofsubsequenttreatedshockablerhythmwithoutcomesafterpaediatricoutofhospitalcardiacarrestsanationwidepopulationbasedobservationalstudy AT tetsuomaeda associationofsubsequenttreatedshockablerhythmwithoutcomesafterpaediatricoutofhospitalcardiacarrestsanationwidepopulationbasedobservationalstudy AT yumikogoto associationofsubsequenttreatedshockablerhythmwithoutcomesafterpaediatricoutofhospitalcardiacarrestsanationwidepopulationbasedobservationalstudy |
_version_ |
1718431238671302656 |