Evaluation of hospital management of paediatric out-of-hospital cardiac arrest

Dhruv Gupte; Maysaa Assaf; Michael R Miller; Kate McKenzie; Jay Loosley; Janice A Tijssen

doi:10.1016/j.resplu.2023.100433

Evaluation of hospital management of paediatric out-of-hospital cardiac arrest

Resusc Plus. 2023 Jul 27:15:100433. doi: 10.1016/j.resplu.2023.100433. eCollection 2023 Sep.

Authors

Dhruv Gupte¹, Maysaa Assaf², Michael R Miller^{2

3}, Kate McKenzie¹, Jay Loosley⁴, Janice A Tijssen^{1

2

3

5}

Affiliations

¹ Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada.
² Department of Paediatrics, London Health Sciences Centre, 800 Commissioners Rd. E., London, ON N6A 5W9, Canada.
³ Children's Health Research Institute, 800 Commissioners Rd. E., London, ON N6C 2V5, Canada.
⁴ Middlesex-London Paramedic Service, 1035 Adelaide St. S., London, ON N6E 1R4, Canada.
⁵ Lawson Health Research Institute, 750 Base Line Rd. E., London, ON N6C 2R5, Canada.

Abstract

Introduction: Pediatric out of hospital cardiac arrest (POHCA) is rare, with high mortality and neurological morbidity. Adherence to Pediatric Advanced Life Support guidelines standardizes in-hospital care and improves outcomes. We hypothesized that in-hospital care of POHCA patients was variable and deviations from guidelines were associated with higher mortality.

Methods: POHCA patients in the London-Middlesex region between January 2012 and June 2020 were included. The care of children with ongoing arrest (intra-arrest) and post-arrest outcomes were reviewed using the Children's Hospital, London Health Sciences Centre (LHSC) patient database and the Adverse Event Management System.

Results: 50 POHCA patients arrived to hospital, with 15 (30%) patients admitted and 2 (4.0%) surviving to discharge, both with poor neurological outcomes and no improvement at 90 days. Deviations occurred at every event with intra-arrest care deviations occurring mostly in medication delivery and defibrillation (98%). Post-arrest deviations occurred mostly in temperature monitoring (60%). Data missingness was 15.9% in the intra-arrest and 1.7% in the post-arrest group.

Discussion: Deviations commonly occurred in both in-hospital arrest and post-arrest care. The study was under-powered to identify associations between DEVs and outcomes. Future work includes addressing specific deviations in intra-arrest and post-arrest care of POHCA patients and standardizing electronic documentation.

Keywords: CPR; Cardiac arrest; Deviations; Guidelines; Pediatric Advanced Life Support; Pediatrics.