Abstract 18594: Can Emergency Physician in Non-Pediatric-Specialty Hospitals Resuscitate Children With Out-of-Cardiac Arrest?
Introduction: The concept of “pediatric readiness” has recently been advocated in the United States(US) recently. As in the US and other countries, most pediatric patients are received emergency treatment in non-pediatric-specialty hospitals in Japan and many children with out-of-hospital cardiac arrest (OHCA) are also resuscitated in general emergency departments (EDs).
Hypothesis: We tested the hypothesis that emergency physician in general EDs may face a peculiar problem when resuscitating pediatric patients with OHCA.
Methods: This study was a retrospective analysis of pediatric patients (age < 15 years) with OHCA who were brought to an urban tertiary ED of a non-pediatric-specialty hospital in Japan between 1999 and 2015.The primary outcome was the emergency physicians’ experience with pediatric patients with OHCA.Additional outcomes were causes of OHCAs, total mortality, survival status,neurological outcome at hospital discharge, and predictors of survival after OHCA.
Results: Of all patients with OHCA (n=4361), 86 (1.9 %) were pediatric patients. Emergency physicians resuscitated an average of 0.49 pediatric patients with OHCA per year. The cause of OHCA was of cardiac origin in 8 (9.3%), of non-cardiac origin in 40 (46.5%), and traumatic injury in 32 (37.2%)patients.Overall, 16 patients (18.6 %) survived to hospital discharge and 6 (6.9 %) had favorable neurologic outcomes.In univariate analysis, initial cardiac rhythm, bystander cardiopulmonary resuscitation and post-period of Pediatric Advanced Life Support course implemented in our institution were favorable predictors and being an infant was a poor predictor of survival to hospital discharge.After multivariate analysis, first monitored rhythm of ventricular fibrillation (odds ratio: 16.7; 95% CI: 1.65-169) and bystander cardiopulmonary resuscitation (odds ratio: 5.60; 95% CI: 1.06-29.4) retained statistical significance.
Conclusions: Pediatric OHCAs were rare events and emergency physicians are at significant risk of skill deterioration due to lack of experience with pediatric patients in the general ED. The role of off-the-job training seems to be of great importance to maintain the performance of pediatric cardiopulmonary resuscitation.
Author Disclosures: N. Hata: None. Y. Matsuoka: None. D. Mizu: None. K. Ariyoshi: None.
- © 2016 by American Heart Association, Inc.