Thursday, July 11, 2013

Out-of-hospital cardiac arrest due to drowning among children and adults from the Utstein Osaka Project



Out-of-hospital cardiac arrest due to drowning among children and adults from the Utstein Osaka Project
Authors: Masahiko Nitta, et al.
Journal: Resuscitation, Article in Press, 2013

This study out of Japan looked at 11 years of out of hospital cardiac arrest (OHCA) data, primarily focusing on the patients who experienced arrest secondary to drowning and who remained pulseless on EMS arrival.  Using data from a Utstein-style out of hospital cardiac arrest database, the authors compared outcomes between the following three groups: younger children (0-4 years), older children (5-17 years), and adults ( > 18 years).

Breakdown of subjects

  • Total 1737 OHCA due to drowning
    • 1669 adults
    • 32 older children
    • 36 younger children

Important findings:

  • Younger and older children were more likely to receive bystander CPR
  • Rates of return of spontaneous circulation (ROSC)
    • Younger children > older children > adults
    • Significant differences
  • Rates of survival to hospital admission
    • Younger children > older children > adults
    • Significant differences
  • Neurologically favorable outcome 
    • Younger children > older children > adults
    • Significant differences
  • Witnessed event significantly associated with improved one month survival and favorable neurological outcome
  • Overall survival with favorable neurologic outcome: < 1 %
Weaknesses:
  • Single area
  • Low numbers of children as compared to adults may hamper comparisons
  • Does not include differences in in-hospital treatment, but it is safe to say that most of the neurological insult is likely suffered during initial event
  • Does not include scene information like submersion duration.
The statistic we always worry about is neurological outcome.  In this study, younger children displayed much better outcomes.  This can be attributed to multiple factors including physiologic differences, lack of comorbidities, and the fact that in general children receive more bystander CPR.  In performing studies of this nature, we can uncover differences in the acute treatment of drowning victims which improve outcome.  What I would like to see in future studies is more focus on scene information and acute EMS treatments since that initial time-period has the most effect on neurologic injury.

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