Author + information
- Ryan Kobayashi,
- Allison Hill,
- Yaniv Bar-Cohen and
- Michael Silka
Background: In general, the prognosis is very poor for pediatric patients who experience out-of-hospital (OOH) cardiac arrest. This study describes the causes and outcomes of a subset of pediatric patients who experienced OOH cardiac arrest due to documented ventricular fibrillation (VF) and who had sustained return of spontaneous circulation (ROSC) following defibrillation with survival to hospital admission.
Methods: Retrospective case review of OOH VF patients less than 19 years of age evaluated at a large, urban tertiary children's hospital from 2004-2016. Main outcome measures: demographics, arrest and resuscitation parameters, cardiac disease, survival to discharge, and neurologic outcome.
Results: 47 patients fulfilled criteria for OOH VF documentation, with a median age of 12 years (range: 2 months – 18 years). 60% were male and 62% were Hispanic. The most common location of arrest was school (26%) and home (26%), with 64% occurring in a public area. Patients were physically active at the onset of arrest in 57% of cases and 43% of patients received bystander CPR prior to emergency medical services arrival. All patients underwent defibrillation (1-6 shocks) with ROSC in the field and survival to hospital admission. Underlying etiology was classified as primary electrical disease (28%), cardiomyopathy (28%), other cardiac (13%), congenital heart defect (10%) or unknown (21%), defined as normal ECG, cardiac imaging, and genetic testing. 40% of patients had a known cardiac diagnosis at the time of arrest and 30% had reported prior symptoms (palpitations 9%, syncope 21%). Ultimately 42 patients (89%) survived to discharge. Using the standardized Neurologic Impairment Scale, 38% of long-term survivors had a good neurologic outcome, whereas 33% had mild to moderate and 29% had moderate to severe neurologic impairment.
Conclusions: In this population of pediatric patients resuscitated from VF with sustained ROSC and hospital admission, 89% survived to discharge with 38% having a favorable neurologic outcome. Compared to other forms of cardiac arrest such as pulseless electrical activity or asystole, the prognosis for pediatric patients with OOH VF and sustained ROSC appears more encouraging.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Fibrillatory Arrhythmias: Outcomes With Contemporary Practice
Abstract Category: 8. Arrhythmias and Clinical EP: Supraventricular/Ventricular Arrhythmias
Presentation Number: 1110-096
- 2017 American College of Cardiology Foundation