Abstract 20612: Predicting Survival From Pediatric Out-of-Hospital Cardiac Arrest
Introduction: Pediatric out-of-hospital cardiac arrest (OHCA) is unique in terms of epidemiology, treatment, and outcomes. There is a paucity of literature examining predictors of survival to help guide resuscitation in this population.
Objective: The primary objective was to determine the probability of ROSC over the duration of resuscitation. The secondary objective was to examine predictors of survival to discharge.
Methods: A retrospective cohort study of non-traumatic OHCA (<18 years) treated by EMS from the Toronto Regional RescuNET Epistry-Cardiac Arrest database from 2006 to 2015. We used competing risk analysis to calculate the probability of ROSC over the duration of resuscitation. We then used multivariable logistic regression to examine the role of Utstein factors and duration of resuscitation in predicting survival to hospital discharge. Candidate variables were limited to Utstein factors and duration of resuscitation due to the number of events.
Results: A total of 658 patients met inclusion criteria. Survival to discharge was 10.2% with 70.1% of those children having a good neurologic outcome. The median time to ROSC was 23.9 min. (IQR 15.0,36.7). Figure 1 shows the probability of ROSC over resuscitation duration while adjusting for the probability of terminating resuscitation. Older age (OR 0.9, 95% CI 0.86,0.99), and longer duration of resuscitation (OR 0.9, 95% CI 0.88,0.93) were associated with worse outcome while initial shockable rhythm (OR 5.8, 95% CI 2.0,16.5), and witnessed arrests (OR 2.4, 95% CI 1.10,5.30) were associated with improved patient outcome. The Area under the curve (AUC) for the Utstein factors was fair (0.77). Including duration of resuscitation improved the discrimination of the model to 0.84.
Conclusion: Inclusion of duration of resuscitation improved the performance of our model compared to Utstein factors alone. However, our results suggest there are a number of other important factors for predicting patient outcome.
Author Disclosures: I.R. Drennan: Other Research Support; Significant; Personal Scholarship: Canadian Institute of Health Research Banting and Best Doctoral Research Award. K.E. Thorpe: None. S. Cheskes: Research Grant; Significant; Operating Grant Canadian Institute of Health Research for the Resuscitation Outcomes Consortium. Honoraria; Modest; Zoll Medical and PhysioControl for talks related to CPR Quality. M. Mamdani: None. D.C. Scales: None. A. Guerguerian: None. L.J. Morrison: Research Grant; Modest; Operating Grant from Heart and Stroke Foundation of Canada and Canadian Institute of Health Research. Other Research Support; Significant; Robert and Dorothy Pitts Chair in Emergency Medicine and Acute Care, Salary Support from National Institute of Health for Resuscitation Outcomes Consortium.
- © 2016 by American Heart Association, Inc.