Assess the Mortality Factors among Retrieved and Non-retrieved Paediatrics Presented with Out of Hospital Cardiac Arrest
Introduction:
Paediatric Out of Hospital Cardiac Arrests (OHCAs) are considered unusual events, unlike adult OHCAs (1). Occurring in 1.3 in 100,000 children and represent about 1% of UK PICU admissions/year (2). Children with OHCA who are managed in pre-hospital settings may be brought to the emergency departments (EDs) of district general hospitals that lack paediatric intensive care units (PICUs). In such cases, regional paediatric critical care retrieval service teams provide management support and are involved in the safe and efficienty transfer to tertiary hospitals, for definitive care (3). In UK about 150 children post OHCA per year are transported to a PICU for further definitive care.
In preliminary work from Birmingham, the requirement for transport/retrieval to a tertiary PICU has been identified as a risk factor for worse survival outcome in OHCA patients and the reasons for this are unclear and require exploration, as there may be modifiable factors which could lead to improvement in clinical care and patients’ outcomes. (4)
However, the paediatric survival rate of OHCAs is low even for those who are retrieved and admitted to PICUs. The factors associated with this rate were investigated in 2012 by studying patients admitted to PICUs (7). The researchers retrospectively reviewed patient data collected during 2004–2010 from three PICUs in the United Kingdom (UK). Among 155 infants and children, only 50 patients (32%) survived after PICU admission. Those who presented with shockable rhythms received fewer epinephrine doses and had shorter cardiac arrest durations than other patients and were more likely to survive after their admission to a PICU (4).
Nonetheless, there is little data on this survival rate and the factors that influence mortality in retrieved paediatric patients. This study aimed to address this research gap by assessing the factors that influenced mortality in retrieved and non-retrieved paediatric patients who presented with OHCAs.
Questions:
This argument aims to address the following questions:
1) What is the current evidence base to support retrieved pediatrics post OHCA?
2) What are the variables influencing paediatric retrieval mortality after OHCA?
3) Are there any challenges related to staff training, followed protocol, pre-transfer communication, or patients’ journey affecting the status of retrieved children with OHCA?
4) Are there any differences in the initial management for the retrieved and non-retrieved children after OHCA?
5) What are the association between OHCA pediatric patients’ demographics, clinical presentation, and high mortality rate in retrieval services?
6) What are the modifiable factors influencing OHCA retrieved pediatrics mortality?
7) What are the avoidable events occur during the interfacility transportation for paediatrics patients retrieved after OHCA?
8) What are the modifiable features that could be potentially improve the paediatrics resuscitation management in district general hospitals?
o PICO Model
• P – infants and children (age <18) OHCA
• I – initial resuscitation management in specialist hospital (has a PICU on site)
• C – no -specialist hospital (without PICU that needs transfer)
• O – survival – morbidity/neurological outcome
• S – systemic review
• Quantitative design study:
o Retrospective Descriptive study of retrieved paediatric; factors associated with mortality.
o Comparison of retrieved and non-retrieved survival rate of paediatrics with OHCA.
• Qualitative design study:
o Observational study of retrieved paediatric; to explain the factors associated with mortality.
o DGH/ Retrieval service team – interview, survey.
o NAP7 data – on resuscitation in no-specialist hospitals.
Details of methodology
Research & Training Support
References:
1. Pruitt CM. Pediatric out-of-hospital cardiac arrest: More common than we thought? Resuscitation. 2020 Aug;153:260–1.
2. Scholefield BR, Gao F, Duncan HP, Tasker RC, Parslow RC, Draper ES, et al. Observational study of children admitted to United Kingdom and Republic of Ireland Paediatric Intensive Care Units after out-of-hospital cardiac arrest. Resuscitation. 2015 Dec;97:122–8.
3. Ramnarayan P, Polke E. The state of paediatric intensive care retrieval in Britain. Arch Dis Child. 2012 Feb 1;97(2):145–9.
4. Scholefield B, Raman S, Hussey A, Haigh F, Kanthimathinathan H, Skellett S, et al. 152 Predictive Factors for Survival after Paediatric Out-Of-Hospital Cardiac Arrest: A UK Multicentre Cohort Study. Arch Dis Child. 2012 Oct 1;97(Suppl 2):A43–A43.
