Lai Peng Tham1, Win Wah2, Rachel Phillips3, Nur Shahidah4, Yih Yng Ng5, Sang Do Shin6, Tatsuya Nishiuchi7, Kwanhathai Darin Wong8, Patrick Chow-In Ko9, Nalinas Khunklai10, Ghulam Yasin Naroo11, Marcus Eng Hock Ong12. 1. Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore. Electronic address: tham.lai.peng@singhealth.com.sg. 2. Department of Emergency Medicine, Singapore General Hospital, Singapore. 3. Department of Primary Care and Public Health Sciences, King's College London, London, United Kingdom. 4. Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore. 5. Medical Department, Singapore Civil Defence Force, Singapore, Singapore. 6. Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea. 7. Department of Acute Medicine, Kindai University Faculty of Medicine, Osaka, Japan. 8. Emergency Department, Hospital Pulau Pinang, Penang, Malaysia. 9. Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan. 10. Department of Emergency Medicine, Rajavithi Hospital, Bangkok, Thailand. 11. Department of Health and Medical Services, ED-Trauma Center, Rashid Hospital, Dubai, United Arab Emirates. 12. Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore.
Abstract
BACKGROUND: The Pan Asian Resuscitation Outcomes Study (PAROS) is a retrospective study of out- of-hospital cardiac arrest(OHCA), collaborating with EMS agencies and academic centers in Japan, South Korea, Malaysia, Singapore, Taiwan, Thailand and UAE-Dubai. The objectives of this study is to describe the characteristics and outcomes, and to find factors associated with survival after paediatric OHCA. METHODS: We studied all children less than 17 years of age with OHCA conveyed by EMS and non-EMS transports from January 2009 to December 2012. We did univariate and multivariate logistic regression analyses to assess the factors associated with survival-to-discharge outcomes. RESULTS: A total of 974 children with OHCA were included. Bystander cardiopulmonary resuscitation rates ranged from 53.5% (Korea), 35.6% (Singapore) to 11.8% (UAE). Overall, 8.6% (range 0%-9.7%) of the children survived to discharge from hospital. Adolescents (13-17 years) had the highest survival rate of 13.8%. 3.7% of the children survived with good neurological outcomes of CPC 1 or 2. The independent pre-hospital factors associated with survival to discharge were witnessed arrest and initial shockable rhythm. In the sub-group analysis, pre-hospital advanced airway [odds ratio (OR) = 3.35, 95% confidence interval (CI) = 1.23-9.13] was positively associated with survival-to-discharge outcomes in children less than 13 years-old. Among adolescents, bystander CPR (OR = 2.74, 95%CI = 1.03-7.3) and initial shockable rhythm (OR = 20.51, 95%CI = 2.15-195.7) were positive factors. CONCLUSION: The wide variation in the survival outcomes amongst the seven countries in our study may be due to the differences in the delivery of pre-hospital interventions and bystander CPR rates.
BACKGROUND: The Pan Asian Resuscitation Outcomes Study (PAROS) is a retrospective study of out- of-hospital cardiac arrest(OHCA), collaborating with EMS agencies and academic centers in Japan, South Korea, Malaysia, Singapore, Taiwan, Thailand and UAE-Dubai. The objectives of this study is to describe the characteristics and outcomes, and to find factors associated with survival after paediatric OHCA. METHODS: We studied all children less than 17 years of age with OHCA conveyed by EMS and non-EMS transports from January 2009 to December 2012. We did univariate and multivariate logistic regression analyses to assess the factors associated with survival-to-discharge outcomes. RESULTS: A total of 974 children with OHCA were included. Bystander cardiopulmonary resuscitation rates ranged from 53.5% (Korea), 35.6% (Singapore) to 11.8% (UAE). Overall, 8.6% (range 0%-9.7%) of the children survived to discharge from hospital. Adolescents (13-17 years) had the highest survival rate of 13.8%. 3.7% of the children survived with good neurological outcomes of CPC 1 or 2. The independent pre-hospital factors associated with survival to discharge were witnessed arrest and initial shockable rhythm. In the sub-group analysis, pre-hospital advanced airway [odds ratio (OR) = 3.35, 95% confidence interval (CI) = 1.23-9.13] was positively associated with survival-to-discharge outcomes in children less than 13 years-old. Among adolescents, bystander CPR (OR = 2.74, 95%CI = 1.03-7.3) and initial shockable rhythm (OR = 20.51, 95%CI = 2.15-195.7) were positive factors. CONCLUSION: The wide variation in the survival outcomes amongst the seven countries in our study may be due to the differences in the delivery of pre-hospital interventions and bystander CPR rates.
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