Elsevier

Resuscitation

Volume 88, March 2015, Pages 12-19
Resuscitation

Clinical Paper
Out-of-hospital cardiac arrests in children and adolescents: Incidences, outcomes, and household socioeconomic status

https://doi.org/10.1016/j.resuscitation.2014.11.025Get rights and content

Abstract

Background

There is insufficient knowledge of out-of-hospital cardiac arrest (OHCA) in the very young.

Objectives

This nationwide study sought to examine age-stratified OHCA characteristics and the role of parental socioeconomic differences and its contribution to mortality in the young population.

Methods

All OHCA patients in Denmark, ≤21 years of age, were identified from 2001 to 2010. The population was divided into infants (<1 year); pre-school children (1–5 years); school children (6–15 years); and high school adolescents/young adults (16–21 years). Multivariate logistic regression analyses were used to investigate associations between pre-hospital factors and study endpoints: return of spontaneous circulation and survival.

Results

A total of 459 individuals were included. Overall incidence of OHCA was 3.3 per 100,000 inhabitants per year. The incidence rates for infants, pre-school children, school children and high school adolescents were 11.5, 3.5, 1.3 and 5.3 per 100,000 inhabitants. Overall bystander CPR rate was 48.8%, and for age groups: 55.4%, 41.2%, 44.9% and 63.0%, respectively. Overall 30-day survival rate was 8.1%, and for age groups: 1.4%, 4.5%, 16.1% and 9.3%, respectively. High parental education was associated with improved survival after OHCA (OR 3.48, CI 1.27–9.41). Significant crude difference in survival (OR 3.18, CI 1.22–8.34) between high household incomes vs. low household incomes was found.

Conclusion

OHCA incidences and survival rates varied significantly between age groups. High parental education was found to be associated with improved survival after OHCA.

Introduction

While out-of-hospital cardiac arrest (OHCA) in children and adolescents is an uncommon event, it does have devastating consequences for the affected families and relatives. Till date, the majority of young OHCA population studies performed have been on a regional level,1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 which means that the availability of nationwide studies examining incidence and survival outcomes of young OHCA populations are scarce.1, 12, 13, 14, 15, 16 This is an important limitation as differences in geographic and demographic factors could mean that regional studies may not provide an adequate representation of the true population disparity within a nation.

Existing studies report highly variable OHCA incidence rates (from 3.0/100,000 person years to 19.7/100,000 person years) and OHCA survival rates (from 2.0% to 11.1%).1, 3, 5, 6, 9, 12, 13, 17 Even though a part of this variability may relate to methodological differences, true differences in prevention and treatment might exist.1, 18, 19 Differences in socioeconomic compositions could also be an important factor on the outcome variability, as demonstrated for the adult population.20, 21, 22, 23 Identifying potential socioeconomic differences in pre-hospital factors is crucial, as it would allow targeted initiatives to improve survival across all socioeconomic classes. However, there have been no previous reports highlighting the role of socioeconomic compositions that includes household incomes and educational levels, on outcomes in young OHCA populations.

In this nationwide study, age-stratified incidences and survival and the role of socioeconomic status (defined as household income and level of parental education) on outcomes of OHCA in a young population are examined as principal findings.

Section snippets

Data source and definitions

All OHCA from June 1st, 2001 to December 31st, 2010 were identified from the nationwide Danish Cardiac Arrest Registry. This registry holds information on all patients with an OHCA, defined as a clinical condition of unresponsiveness and apnoea where an ambulance has been summoned, and where CPR has been attempted, either by a bystander or emergency medical service (EMS) personnel. The EMS is activated for all medical emergencies in Denmark, and the obligatory short case report form recorded by

Results

In total, 32,577 patients with an OHCA from 2001 to 2010 were identified. Of these, 459 patients were ≤21 years old at the time of event and comprised the final study population. The study selection process is depicted in Fig. 1.

Discussion

This study had three major findings: (1) incidences and survival rates varied significantly between different age groups with infants having the highest incidences of OHCA as well as the poorest survival outcomes; (2) high parental education level was found to be associated with 30-day survival after OHCA and (3) factors that contributed to this finding were that high parental education was associated with having a cardiac arrest in public, having a witnessed arrest, receiving bystander CPR,

Conclusion

In this study we demonstrated that incidences and survival rates varied significantly between age groups, and infants (<1 year) had the highest incidences of OHCA and lowest survival rates. High parental education was associated with improved survival after OHCA. Factors that contributed to this finding were that high parental education was associated with having a cardiac arrest in public, having a witnessed arrest, receiving bystander CPR, and having a shockable heart rhythm.

Conflict of interest statement

The authors declare that there are no conflicts of interest.

Acknowledgements

We extend our appreciations to all the personnel of the Danish Emergency Medical Services for their cooperation and support in completing the case report forms for the Danish Cardiac Arrest Register. The Danish foundations TrygFonden, Heart Foundation and the Health Insurance Foundation have supported this study. TrygFonden supports the Danish Cardiac Arrest Registry and the Automated External Defibrillator (AED) Network, and has no commercial interest in the field of cardiac arrest. Dr.

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