Effect of prehospital advanced airway management for pediatric out-of-hospital cardiac arrest

Naoko Ohashi-Fukuda; Tatsuma Fukuda; Kent Doi; Naoto Morimura

doi:10.1016/j.resuscitation.2017.03.002

Effect of prehospital advanced airway management for pediatric out-of-hospital cardiac arrest

Resuscitation. 2017 May:114:66-72. doi: 10.1016/j.resuscitation.2017.03.002. Epub 2017 Mar 4.

Authors

Naoko Ohashi-Fukuda¹, Tatsuma Fukuda², Kent Doi³, Naoto Morimura³

Affiliations

¹ Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan; Comprehensive Perinatal Medical Center, Department of Obstetrics and Gynecology, Tokyo Metropolitan Bokutoh Hospital, 4-23-15, Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan.
² Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan; Center for Resuscitation Science, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA. Electronic address: tatsumafukuda-jpn@umin.ac.jp.
³ Department of Emergency and Critical Care Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.

PMID: 28267617
DOI: 10.1016/j.resuscitation.2017.03.002

Abstract

Background: Respiratory care may be important in pediatric out-of-hospital cardiac arrest (OHCA) due to the asphyxial nature of the majority of events. However, evidence of the effect of prehospital advanced airway management (AAM) for pediatric OHCA is scarce.

Methods: This was a nationwide population-based study of pediatric OHCA in Japan from 2011 to 2012 based on data from the All-Japan Utstein Registry. We included pediatric OHCA patients aged between 1 and 17 years old. The primary outcome was one-month neurologically favorable survival defined as a Glasgow-Pittsburgh cerebral performance category (CPC) score of 1-2 (corresponding to a Pediatric CPC score of 1-3).

Results: A total of 2157 patients were included in the final cohort; 365 received AAM and 1792 received bag-valve-mask (BVM) ventilation only. Among the 2157 patients, 213 (9.9%) survived with favorable neurological outcomes (CPC of 1-2) one month after OHCA. There were no significant differences in neurologically favorable survival between the AAM and BVM groups after adjusting for potential confounders, although there was a tendency favoring BVM ventilation: propensity score matching, OR 0.74 (95%CI 0.35-1.59), and multivariable logistic regression modeling, OR_adjusted 0.55 (95%CI 0.24-1.14). Subgroup analyses demonstrated that there were no subgroups in which AAM was associated with neurologically favorable survival, including the non-cardiac (primarily asphyxial) etiology group.

Conclusions: In pediatric OHCA, prehospital AAM was not associated with an increased chance of neurologically favorable survival compared with BVM-only ventilation. However, careful consideration is required to interpret the findings, as there may be unmeasured residual confounders and selection bias.

Keywords: Cardiopulmonary resuscitation; Children; Epidemiology; Out-of-hospital cardiac arrest; Pediatrics.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Airway Management / methods*
Cardiopulmonary Resuscitation / methods
Cardiopulmonary Resuscitation / mortality
Child
Child, Preschool
Cohort Studies
Cross-Sectional Studies
Emergency Medical Services / methods*
Female
Humans
Japan / epidemiology
Male
Multivariate Analysis
Out-of-Hospital Cardiac Arrest / mortality
Out-of-Hospital Cardiac Arrest / therapy*
Population Surveillance
Propensity Score
Registries
Regression Analysis
Respiration, Artificial / methods*