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Long-Term Outcomes Following Pediatric Out-of-Hospital Cardiac Arrest*

Michiels, Erica A. MD1,2,3; Dumas, Florence MD, PhD4; Quan, Linda MD1,3; Selby, Leah MD1; Copass, Michael MD1; Rea, Thomas MD, MPH1

Pediatric Critical Care Medicine: October 2013 - Volume 14 - Issue 8 - p 755–760
doi: 10.1097/PCC.0b013e31829763e2
Feature Articles

Objectives: Pediatric out-of-hospital cardiac arrest is an uncommon event with measurable short-term survival to hospital discharge. For those who survive to hospital discharge, little is known regarding duration of survival. We sought to evaluate the arrest circumstances and long-term survival of pediatric patients who experienced an out-of-hospital cardiac arrest and survived to hospital discharge.

Design: Retrospective cohort study

Setting: King County, WA Emergency Medical Service Catchment and Quaternary Care Children’s Hospital

Patients: Persons less than 19 years old who had an out-of-hospital cardiac arrest and were discharged alive from the hospital between 1976 and 2007.

Intervention: None.

Measurements and Main Results: During the study period, 1,683 persons less than 19 years old were treated for pediatric out-of-hospital cardiac arrest in the study community, with 91 patients surviving to hospital discharge. Of these 91 survivors, 20 (22%) subsequently died during 1449 person-years of follow-up. Survival following hospital discharge was 92% at 1 year, 86% at 5 years, and 77% at 20 years. Compared to those who subsequently died, long-term survivors were more likely at the time of discharge to be older (mean age, 8 vs 1 yr), had a witnessed arrest (83% vs 56%), presented with a shockable rhythm (40% vs 10%), and had a favorable Pediatric Cerebral Performance Category of 1 or 2 (67% vs 0%).

Conclusions: In this population-based cohort study evaluating the long-term outcome of pediatric survivors of out-of-hospital cardiac arrest, we observed that long-term survival was generally favorable. Age, arrest characteristics, and functional status at hospital discharge were associated with prognosis. These findings support efforts to improve pediatric resuscitation, stabilization, and convalescent care.

1University of Washington, School of Medicine, Seattle, WA.

2Department of Emergency Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI.

3Department of Pediatrics, Seattle Children’s Hospital, Seattle, WA.

4Paris Cardiovascular Research Center, Paris Descartes University, Paris, France.

* See also p. 821.

This work was performed at Seattle Children’s Hospital, Seattle, WA.

Supported, in part, by Medic One Foundation and the Laerdal Foundation for Acute Medicine. Neither organization had a role in data collection, analysis, or interpretation.

Drs. Michiels and Quan received grant support from the Medic One Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Address requests for reprints to: Erica A. Michiels, MD, 4100 Embassy Drive SE, Suite 400, Grand Rapids, MI 49546. E-mail: Erica.michiels@spectrumhealth.org

©2013The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies