EMS World

JAN 2018

EMS World Magazine is the most authoritative source in the world for clinical and educational material designed to improve the delivery of prehospital emergency medical care.

Issue link: https://emsworld.epubxp.com/i/917718

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Page 29 of 51

EMSWORLD.com | JANUARY 2018 29 For More Information Circle 25 on Reader Service Card related to CPR quality, is critical to this success. A Pit Crew Model for Pediatric OHCA The Austin-Travis County EMS system cur- rently covers an urban/suburban popula- tion of more than 1.14 million people, with more than 120,000 scene responses per year. 28 In January 2011 leaders undertook a quality initiative to improve OHCA survival, specifically targeting implementation of high-quality CPR with a pit crew model of resuscitation. A retrospective case review was performed to characterize all traumatic and nontraumatic pediatric out-of-hospital cardiac arrests from January 2011 to March 2013 that occurred in the system after implementation of its pit crew approach. Out of 53 pediatric OHCAs with outcome data during the study period, 18 (34%; 95% CI, 22%–48%) patients achieved ROSC in the field, and 9 (17%; 95% CI, 8%–30%) survived to hospital discharge. Survivors were more likely to have had witnessed arrests (p=0.016) and less likely to pres- ent in asystole (p<0.001). Patient age did not differ for survivors and nonsurvivors (median [IQR] 7 [3–7] years vs. 1 [0–9] years; p=0.122). There were also no significant associa- tions between cardiac arrest etiologies, per- formance of bystander CPR, or presenta- tion with a shockable rhythm and survival to hospital discharge. Asystole was the most common presenting rhythm (59%), and shockable rhythms were rare (9%). Presumed etiologies for pediatric cardiac arrests across the entire study were most commonly recorded as respiratory (30%) or other/unknown (32%), with cardiac (17%) and traumatic (13%) etiologies making up the balance. Future of Pediatric Pit Crew Resuscitation In developing the first published evaluation of outcomes in pediatric out-of-hospital cardiac arrest following pit crew resusci- tation, we obtained a 17% overall survival rate—markedly higher than previously reported outcomes for pediatric OHCA patients. 2,4,5 Albeit from a small and single- system study, these results underscore the benefit and consideration of moving away from a "scoop and run" approach to a focus on early, high-quality CPR for children. Larger multisystem studies evaluating the pit crew approach to pediatric OHCA are needed to further validate this approach. REFERENCES 1. Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: A systematic review and meta- analysis. Circ Cardiovasc Qual Outcomes, 2010 Jan; 3(1): 63–81. 2. Atkins DL, Everson-Stewart S, Sears GK, et al. Resuscitation Outcomes Consortium Investigators. Epidemiology and outcomes from out-of- hospital cardiac arrest in children. Circulation, 2009 Mar 24; 119(11): 1,484–91. 3. Go AS, Mozaffarian D, Roger VL, et al. American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Executive summary: heart disease and stroke statistics—2013 update: A report from the American Heart Association. Circulation, 2013 Jan 1; 127(1): 143–52. 4. Young KD, Gausche-Hill M, McClung CD, Lewis RJ. A prospective, population-based study of the epidemiology and outcome of out- of-hospital pediatric cardiopulmonary arrest. Pediatrics, 2004 Jul; 114(1): 157–64. 5. Jayaram N, McNally B, Tang F, Chan PS. Survival after out-of-hospital

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