Incidence, characteristics and survival outcomes of out-of-hospital cardiac arrest in children and adolescents between 1997 and 2014 in Perth, Western Australia.

Abstract

Objective: The present study was to describe the trends in the incidence, characteristics and survival of paediatric out-of-hospital cardiac arrest (OHCA) over an 18 year period. Methods: We conducted a population-based retrospective cohort study using prospectively collected data from all OHCA patients aged <18 years who were attended by St John Ambulance Western Australia paramedics in the Perth metropolitan area, WA, between 1997 and 2014. The incidence, characteristics and survival were compared across 4 year periods (1997–2000, 2001–2005, 2006–2010 and 2011–2014). The Paediatric Cerebral Performance Category at hospital discharge was determined by medical record review. Incidence per 100 000 population was calculated for four age groups (<1, 1–4, 5–12 and 13–17). Results: In total, 723 OHCAs were identified, and 451 (62.4%) had resuscitation commenced by paramedics. The patients were predominantly male (61.6%) with a median age of 2 years (IQR 0–14 years). Bystander CPR increased over time from 35.0% (1997–2000) to 63.0% (2011–2014) (P < 0.001). Any return of spontaneous circulation was 39/451 (8.6%), and survival to hospital discharge was 21/451 (5.0%). Of the 20 survivors assessed, 11 had good neurological status at hospital discharge (Paediatric Cerebral Performance Category 1 or 2). The overall incidence decreased from 14.1 (1997–2000) to 8.7 (2011–2014) per 100 000 population (P < 0.001). This was almost halved in children aged <1 year group (P < 0.001). Conclusion: The incidence of paediatric OHCA decreased over time, but survival remained poor. Strategies to strengthen the chain of survival for paediatric OHCA need to be considered.