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

Resuscitation Plus (Sep 2023)

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

Affiliations

Dhruv Gupte: Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
Maysaa Assaf: Department of Paediatrics, London Health Sciences Centre, 800 Commissioners Rd. E., London, ON N6A 5W9, Canada
Michael R. Miller: Department of Paediatrics, London Health Sciences Centre, 800 Commissioners Rd. E., London, ON N6A 5W9, Canada; Children’s Health Research Institute, 800 Commissioners Rd. E., London, ON N6C 2V5, Canada
Kate McKenzie: Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
Jay Loosley: Middlesex-London Paramedic Service, 1035 Adelaide St. S., London, ON N6E 1R4, Canada
Janice A. Tijssen: Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada; Department of Paediatrics, London Health Sciences Centre, 800 Commissioners Rd. E., London, ON N6A 5W9, Canada; Children’s Health Research Institute, 800 Commissioners Rd. E., London, ON N6C 2V5, Canada; Lawson Health Research Institute, 750 Base Line Rd. E., London, ON N6C 2R5, Canada; Corresponding author at: Schulich School of Medicine and Dentistry, Western University, Director- Paediatric Critical Care Medicine, London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A5W9, Canada.

Journal volume & issue: Vol. 15
p. 100433

Abstract

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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.

Published in Resuscitation Plus

ISSN: 2666-5204 (Online)
Publisher: Elsevier
Country of publisher: Netherlands
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine
Website: https://www.journals.elsevier.com/resuscitation-plus

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Abstract

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