Incidence, Causes, and Outcomes of Out-of-Hospital Cardiac Arrest in Children: A Comprehensive, Prospective, Population-Based Study in the Netherlands

Apr 28, 2011
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Authors:
Bardai A, Berdowski J, van der Werf C, et al.
Citation:
J Am Coll Cardiol 2011;57:1822-1828.
Summary By:
Timothy B. Cotts, MD, FACC

Study Questions:

What are the incidence and characteristics of pediatric out-of-hospital cardiac arrest (OHCA)?

Methods:

A prospective study was performed of OHCA victims younger than age 21 in one province of the Netherlands. OHCA victims were identified through emergency service and coroner records over a 4.3-year period. Death certificate data were examined to confirm total pediatric mortality over the study period. Additional measures included survival status after OHCA and neurologic status at hospital discharge.

Results:

There were a total of 233 cases of OHCA during the study period with 12 survivors, in the setting of total pediatric mortality of 923. Natural causes of OHCA accounted for 115 (49%) cases, of which 90 (39%) were cardiac in etiology. Fifty-two percent of OHCAs due to cardiac causes occurred in adolescents, of which 32% were involved in exercise or sports at the time of arrest. The incidence of pediatric OHCA was 9.0 per 100,000 pediatric person-years (95% confidence interval [CI], 7.8-10.3), whereas the incidence of pediatric OHCA from cardiac causes was 3.2 (95% CI, 2.5-3.9). Of 51 resuscitated patients, 12 (24%) survived; among survivors, 10 (83%) had a neurologically intact outcome.

Conclusions:

The authors concluded that OHCA accounts for a significant proportion of pediatric mortality, and that a cardiac etiology is the most common cause of OHCA.

Perspective:

This study is a comprehensive investigation of OHCA in children performed in a single geographic region. The overall prevalence of 9.0 occurrences of OHCA per 100,000 is slightly higher than reported in other series, but this is likely because the authors included arrests due to all causes, unnatural and otherwise. Additionally, the authors used multiple methods of identifying cases, leading to a lower likelihood of missed cases. Finally, although the high rate (83%) of intact neurologic outcome in survivors is encouraging, further study and verification is required.

Keywords: Survivors, Prevalence, Out-of-Hospital Cardiac Arrest, Netherlands


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