Objectives: There is a paucity of data examining nationwide population-based incidences and outcomes of pediatric out-of-hospital cardiac arrest. The objective of this study is to describe the detailed characteristics of pediatric out-of-hospital cardiac arrest by scholastic age category and to evaluate the impact of bystander cardiopulmonary resuscitation and public access–automated external defibrillators on the 1-month survival and favorable neurological status of pediatric out-of-hospital cardiac arrest patients.
Design: A nationwide, population-based, observational study.
Setting: Nationwide emergency medical system in Japan.
Patients: Out-of-hospital cardiac arrest patients aged ≤ 18 yr.
Measurements and Main Results: We identified 7,624 pediatric out-of-hospital cardiac arrest patients (≤ 18 yr old) from a nationwide population-based out-of-hospital cardiac arrest database in Japan from 2005 to 2008 and stratified them into five categories by scholastic age. The overall rates of 1-month survival and favorable neurological outcomes were 11.0% and 5.1%, respectively. Bystander cardiopulmonary resuscitation resulted in a significant improvement in both 1-month survival (odds ratio 2.81; 95% confidence interval 2.30–3.44) and favorable neurological outcomes (odds ratio 4.55; 95% confidence interval 3.35–6.18). Performing public access–automated external defibrillators had a significant effect on the 1-month survival rate (odds ratio 3.51; 95% confidence interval 1.81–6.81) and favorable neurological outcomes (odds ratio 5.13; 95% confidence interval 2.64–9.96).
Conclusions: This study demonstrated that bystander cardiopulmonary resuscitation and public access–automated external defibrillators had a significant impact on the outcomes of pediatric out-of-hospital cardiac arrest. The improved survival associated with bystander cardiopulmonary resuscitation and public access–automated external defibrillators are clinically important and are of major public health importance for school-aged out-of-hospital card-iac arrest patients.
1 Department of Public Health, Health Management and Policy, Nara Medical University School of Medicine Nara, Japan.
2 Foundation for Ambulance Service Development, Emergency Life-Saving Technique Academy of Tokyo Tokyo, Japan.
3 Department of Planning, Information and Management, The University of Tokyo Hospital Tokyo, Japan.
4 Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo Tokyo, Japan.
*See also p. 223.
Drs. Akahane and Imamura designed this study and conducted data analysis. Dr. Ogawa conducted data cleaning. Drs. Ogawa, Tanabe, Koike, Horiguchi, and Yasunaga jointly interpreted the results. All authors have approved the manuscript for submission.
Supported, in part, by the Ministry of Health, Labour and Welfare, Japan (Grant-in-Aid for scientific research), who had no influence on the study design, analysis, interpretation of data, the writing of the report, and the decision to submit the paper for publication.
The authors have not disclosed any potential conflicts of interest.
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