Applying a Set of Termination of Resuscitation Criteria to Paediatric Out-of-Hospital Cardiac Arrest,Resuscitation

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Applying a Set of Termination of Resuscitation Criteria to Paediatric Out-of-Hospital Cardiac Arrest
Resuscitation ( IF 6.5 ) Pub Date : 2021-09-20 , DOI: 10.1016/j.resuscitation.2021.09.015
Matthew I Harris ₁ , Remle P Crowe ₂ , Jennifer Anders ₃ , Salvatore D'Acunto ₄ , Kathleen M Adelgais ₅ , Jennifer Fishe ₆

Affiliation

Objective

Prehospital Termination of Resuscitation (TOR) protocols for adults can reduce the number of futile transports of patients in cardiac arrest, yet similar protocols are not widely available for paediatric out-of-hospital cardiac arrest (POHCA). The objective of this study was to apply a set of criteria for paediatric TOR (pTOR) from the Maryland Institute for Emergency Medical Services Systems (MIEMSS) to a large national cohort and determine its association with return of spontaneous circulation (ROSC) after POHCA.

Methods

We identified patients ages 0-17 treated by Emergency Medical Services (EMS) with cardiac arrest in 2019 from the ESO dataset and applied the separate pTOR criteria for medical and traumatic arrests. We calculated predictive test characteristics for the outcome of prehospital ROSC, stratified by medical and traumatic cause of arrest.

Results

We analyzed records for 1,595 POHCA patients. Eighty-eight percent (n=1,395) were classified as medical. ROSC rates were 23% among medical POHCA and 27% among traumatic POHCA. The medical criteria correctly classified >99% (322/323) of patients who achieved ROSC as ineligible for TOR. The trauma criteria correctly classified 93% (50/54) of patients with ROSC as ineligible for TOR. Of the five misclassified patients, three were involved in drowning incidents.

Conclusions

The Maryland pTOR criteria reliably identified POHCA patients unlikely to achieve ROSC. As most misclassified patients were victims of drowning, we recommend considering the exclusion of drowning patients from future pTOR guidelines. Further studies are needed to evaluate the long-term survival and neurologic outcome of patients misclassified by pTOR criteria.

中文翻译：

将一套终止复苏标准应用于小儿院外心脏骤停

客观的

成人院前终止复苏 (TOR) 协议可以减少心脏骤停患者的无用转运次数，但类似的协议并未广泛用于儿科院外心脏骤停 (POHCA)。本研究的目的是将马里兰州紧急医疗服务系统研究所 (MIEMSS) 的一套儿科 TOR (pTOR) 标准应用于大型国家队列，并确定其与 POHCA 后自主循环恢复 (ROSC) 的关联。

方法

我们从 ESO 数据集中确定了 2019 年接受紧急医疗服务 (EMS) 治疗的心脏骤停的 0-17 岁患者，并对医疗和创伤性骤停应用单独的 pTOR 标准。我们计算了院前 ROSC 结局的预测性测试特征，根据逮捕的医学和外伤原因进行分层。

结果

我们分析了 1,595 名 POHCA 患者的记录。百分之八十八 (n=1,395) 被归类为医疗。ROSC 率在医疗 POHCA 中为 23%，在创伤性 POHCA 中为 27%。医学标准正确地将超过 99% (322/323) 的达到 ROSC 的患者分类为不符合 TOR 的条件。创伤标准正确地将 93% (50/54) 的 ROSC 患者归类为不适合 TOR。在五名错误分类的患者中，三名涉及溺水事件。