This Article Free upon publication Full Text Full Text (PDF) CME: Take the course for this article: Circulation: March 24, 2009, Volume 119, Number 11 All Versions of this Article: 119/11/1484    most recent CIRCULATIONAHA.108.802678v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Atkins, D. L. Search for Related Content PubMed PubMed Citation Articles by Atkins, D. L. Pubmed/NCBI databases Medline Plus Health Information CPR Emergency Medical Services Related Collections CPR and emergency cardiac care Epidemiology Related Article

(Circulation. 2009;119:1484-1491.)
© 2009 American Heart Association, Inc.

Pediatric Cardiology

Epidemiology and Outcomes From Out-of-Hospital Cardiac Arrest in Children

The Resuscitation Outcomes Consortium Epistry–Cardiac Arrest

Dianne L. Atkins, MD; Siobhan Everson-Stewart, MS; Gena K. Sears, BSN; Mohamud Daya, MD, MS; Martin H. Osmond, MD, CM, FRCPC; Craig R. Warden, MD, MPH; Robert A. Berg, MD; the Resuscitation Outcomes Consortium Investigators

From the University of Iowa Carver College of Medicine, University of Iowa Children’s Hospital, Iowa City (D.L.A.); Department of Biostatistics, University of Washington, Seattle (S.E.-S., G.K.S.); Center for Policy and Research in Emergency Medicine (M.D.) and Departments of Emergency Medicine and Pediatrics (C.R.W.), Oregon Health and Science University, Portland; Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada (M.H.O); and Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Department of Anesthesiology and Critical Care Medicine, Philadelphia (R.A.B.).

Correspondence to Dianne L. Atkins, MD, Division of Pediatric Cardiology, University of Iowa, 200 Hawkins Dr, Iowa City, IA 52242-1083. E-mail dianne-atkins{at}uiowa.edu

Received July 7, 2008; accepted December 10, 2008.

Background— Population-based data for pediatric cardiac arrest are scant and largely from urban areas. The Resuscitation Outcomes Consortium (ROC) Epistry–Cardiac Arrest is a population-based emergency medical services registry of out-of-hospital nontraumatic cardiac arrest (OHCA). This study examined age-stratified incidence and outcomes of pediatric OHCA. We hypothesized that survival to hospital discharge is less frequent from pediatric OHCA than adult OHCA.

Methods and Results— This prospective population-based cohort study in 11 US and Canadian ROC sites included persons <20 years of age who received cardiopulmonary resuscitation or defibrillation by emergency medical service providers and/or received bystander automatic external defibrillator shock or who were pulseless but received no resuscitation by emergency medical services between December 2005 and March 2007. Patients were stratified a priori into 3 age groups: <1 year (infants; n=277), 1 to 11 years (children; n=154), and 12 to 19 years (adolescents; n=193). The incidence of pediatric OHCA was 8.04 per 100 000 person-years (72.71 in infants, 3.73 in children, and 6.37 in adolescents) versus 126.52 per 100 000 person-years for adults. Survival for all pediatric OHCA was 6.4% (3.3% for infants, 9.1% for children, and 8.9% for adolescents) versus 4.5% for adults (P=0.03). Unadjusted odds ratio for pediatric survival to discharge compared with adults was 0.71 (95% confidence interval, 0.37 to 1.39) for infants, 2.11 (95% confidence interval, 1.21 to 3.66) for children, and 2.04 (95% confidence interval, 1.24 to 3.38) for adolescents.

Conclusions— This study demonstrates that the incidence of OHCA in infants approaches that observed in adults but is lower among children and adolescents. Survival to discharge was more common among children and adolescents than infants or adults.

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