Akademik Veri Yönetim Sistemi
European Resuscitation Council Congress, Ljubljana, Slovenya, 19 - 21 Eylül 2019, ss.24-25
Purpose of the study: To analyse the peculiarities of patients with unexpected good overall outcome at 6 months in emergency department and out-of-hospital paediatric cardiac arrest (OHCA).
Materials and methods: Prospective multicentre study of paediatric cardiac arrest in emergency department and OHCA in children under 18 years old. We selected patients with at least one of the following criteria: asystole as first rhythm, bloodpH<7, blood lactate ≥12 mmol/l or death probability >80% according to PELOD scale at 24 first hours. We also collected Paediatric Overall Performance Category (POPC) at 6 months. T-test, Fisher’s exact test and Chi-square test.
Results: 181/229 cardiac arrests had at least one criterium of bad prognosis, 166 were followed 6 months and 15.7% had good overall outcome (POPC 1 or 2). In patients with bad prognosis and POPC 1 or 2 at 6 months we found:
- lower proportion of trauma as cause of cardiac arrest (4% vs 22,1%, p = 0.037) and orotracheal intubation during cardiac arrest (87.1 vs 69.2%, p = 0.021),
- higher proportion of witnessed cardiac arrests (21.4% vs 8.1%, p = 0.016), shockable rhythms as first rhythm (38.5% vs 13.5%, p = 0.017) and treatment with hypothermia (36.4% vs 10.5%, p < 0.001). When we studied only patients with sustained ROSC, those who were treated with hypothermia had higher proportion of POPC 1 or 2 at 6 months, next to statistical significance (42.9% vs 23%, p = 0.055). There was not any significative difference in age, gender, time until basic or advanced life support.
Conclusions: Some patients with criterium of bad prognosis achieved good overall outcome at 6months, mainly those who had witnessed cardiac arrests and shockable rhythms. Traumatic cardiac arrest is still a challenge. While orotracheal intubations could not always be the first line of airway management, hypothermia seems to be useful to improve the overall outcome.