Children, Teens Have Higher Non-Traumatic Cardiac Arrest Survival Rates
Children and adolescents are twice as likely as infants or adults to survive a non-traumatic, out-of-hospital cardiac arrest (OHCA), researchers report in Circulation: Journal of the American Heart Association. However, they found the OHCA survival rate for infants younger than one-year-old was lower than the survival rate for adults.
OHCA is uncommon among children and has generally been noted to have poor outcomes.
However, the new findings challenge the idea that resuscitating children with OHCA is unwarranted because they have an extremely low survival rate and are often left with severe neurological damage.
“Previously, if you talked to most emergency medicine doctors and emergency medicine technicians, they would say that children almost never survive a cardiac arrest,” said Dianne L. Atkins, M.D., lead author of the study and professor of pediatrics at the University of Iowa’s Carver College of Medicine and Children’s Hospital in Iowa City. “What we showed is that children and teenagers, in fact, do better than adults.”
Researchers discovered the findings after analyzing data from 11 geographic areas (eight in the United States, three in Canada) participating in the Resuscitation Outcomes Consortium (ROC), a group that conducts clinical trials and other outcome research involving cardiopulmonary arrest and severe traumatic injury.
Most of the previous studies of pediatric OHCA have covered a single geographic region, usually a large metropolitan area. Because OHCA is uncommon in children, a single-site study often required many years to accrue sufficient numbers of cases for statistically significant assessment.
“The advantages of this study were that we collected a very large number of out-of-hospital cardiac arrests in children from geographically diverse sites, over a very short time,” Atkins said.
Using ROC’s Epistry-Cardiac Arrest database, she and her colleagues looked at the incidence, characteristics and outcomes of OHCA among three pediatric age groups (infants – under one year old; children – ages 1 to 11 years; and adolescents – ages 12 to 19 years) .
They examined all cardiac arrest cases that were not caused by respiratory arrest or traumatic injury that occurred outside of hospitals in the 11 ROC locales from Dec. 1, 2005 through March 31, 2007.
The cases totaled 25,405 adults and 624 people younger than age 20, including 277 infants (under one year old), 154 children (ages 1 to 11) and 193 adolescents (ages 12 to 19). The researchers tracked survivors through treatment and discharge from the hospital.
Among the 624 pediatric patients, 44 percent were infants and 62 percent were males. The median ages of the pediatric patients were: infants, 0.2 years; children, 3.0 years; and adolescents, 17.0 years.
Among the study’s key findings were:
• The incidence of pediatric cardiac arrest per 100,000 person-years was: 72.71 for infants, 3.73 for children and 6.37 for adolescents, compared to 126.52 for adults.
• Overall, 6.4 percent of pediatric patients versus 4.5 percent of adults survived to be discharged from the hospital, a statistically significant difference.
• Survival rates varied significantly between infants and the older pediatric patients — infants, 3.3 percent; children, 9.1 percent; and adolescents, 8.9 percent.
• Among pediatric patients treated by emergency medical service personnel, eight of 230 infants (3.5 percent), 14 of 135 children (10.4 percent) and 17 of 135 adolescents (12.6 percent) survived to discharge.
Atkins noted that many previous reports of low pediatric OHCA survival lumped infants together with older pediatric patients. In the future, researchers should separate infants from older pediatric patients in epidemiologic studies, and more aggressively address their treatment, she said.
“We put a lot of effort into developing better therapies and better ways to resuscitate adults,” Atkins said. “We also need to put that same effort into children because they actually do have a slightly higher survival.”