The epidemiology of cardiac arrest in children and young adults

doi:10.1016/S0300-9572(03)00108-4

Resuscitation

Volume 58, Issue 2, August 2003, Pages 131-138

https://doi.org/10.1016/S0300-9572(03)00108-4 Get rights and content

Abstract

Aim: To describe the epidemiology of children and young adults suffering from out-of-hospital cardiac arrest. Patients: All patients suffering from out-of-hospital cardiac arrest in whom, resuscitation efforts were attempted in the community of Göteborg between 1980 and 2000. Methods: Between 31 October 1980 and 31 October 2000, all consecutive cases of cardiac arrest in which the emergency medical service (EMS) system responded and attempted resuscitation were reported and followed-up to discharge from hospital. Results: Among 5505 cardiac arrests information on age was available in 5290 cases (96%). Of these 5290 cases 98 (2%) were children (age 0–17 years), 197 (4%) were young adults (age 18–35 years) and the remaining 4995 (94%) were adults (age >35 years). Children and young adults differed from adults by suffering from a witnessed arrest less frequently, being found by the ambulance crew in ventricular fibrillation/tachycardia less frequently and being judged as having an underlying cardiac aetiology less frequently. Of the children only 5% were discharged from hospital alive compared with 8% for young adults and 9% for adults. Among survivors the cerebral performance categories (CPC) score at discharge tended to differ with 38% of young adults registering a CPC score of 1 (no neurological deficit) compared with 52% among adults. Conclusion: Children and young adults suffering from out-of-hospital cardiac arrest differed from adults in terms of aetiology and observed initial arrhythmia. Children had a particularly bad outcome whereas young adults had a similar outcome as adults.

Sumàrio

Objectivo: Descrever a epidemiologia da paragem cardı́aca extra-hospitalar em crianças e adultos jovens. População: Todas as vı́timas de paragem cardı́aca extra-hospitalar, nas quais foram realizadas manobras de reanimação, na comunidade de Gotemburgo, entre 1980 e 2000. Método: Foram referidos e seguidos até à alta hospitalar todos os casos consecutivos de paragem cardı́aca, entre 31 de Outubro de 1980 e 31 de Outubro de 2000, em que o Sistema dos Serviços de Emergência Médica (SEM) foi activado e em que foram realizadas manobras de reanimação. Resultados: Das 5505 paragens cardı́acas foi possı́vel obter informação relativamente à idade das vı́timas em 5290 casos (96%). Destes 5290 casos 98 (2%) eram crianças (idade 0–17 anos), 197 (4%) eram jovens adultos (idade 18–35 anos) e os restantes 4995 (94%) eram adultos (idade superior a 35 anos). As crianças e os adultos jovens diferiam dos adultos por serem menos frequentemente vı́timas de paragem cardı́aca testemunhada, por serem encontradas, pela tripulação da ambulância, em Fibrilhação Ventricular/Taquicardia menos vezes e por se considerar menos vezes que possam ter subjacente à paragem uma causa cardı́aca. Só 5% das crianças tiveram alta hospitalar com vida comparativamente com 8% dos adultos jovens e 9% dos adultos. A pontuação do ı́ndice de Categorias de Performance Cerebral (CPC) dos sobreviventes à alta foi diferente entre os grupos; 38% dos jovens adultos tiveram uma pontuação CPC de 1 (sem qualquer défice neurológico) comparativamente com 52% dos adultos. Conclusão: As crianças e os adultos jovens vı́timas de paragem cardı́aca extra-hospitalar diferem dos adultos em termos de etiologia da paragem e da arritmia inicialmente observada. As crianças têm um prognóstico particularmente mau, enquanto que os adultos jovens têm um prognóstico semelhante aos adultos.

Resumen

Objetivo: Describir la epidemiologı́a de niños y adultos jóvenes que sufren paro cardı́aco extrahospitalario. Pacientes: Todos los pacientes que sufrieron un paro cardiorrespiratorio en la comunidad de Goteborg entre 1980 y 2000, en quienes se realizo algún intento de reanimación. Métodos: Todos los casos consecutivos de paro cardiorespiratorio entre el 31 de Octubre de 1980 y el 31 de Octubre de 2000, en quienes respondió el sistema de emergencias médicas(EMS) e intentó reanimación fueron reportados y sometidos a seguimiento hasta el alta del hospital. Resultados: Entre los 5505 casos habı́a 5290 que (96%) disponı́an de información acerca de edad. De estos 5290 casos 98 (2%) eran niños (edad entre 0 y 17 años), 197 (4%) eran adultos jóvenes (18 a 35 años) y el resto 4995 (94%) eran adultos (edad >35 años). Los niños y adultos jóvenes diferı́an de los adultos por sufrir paro presenciado menos frecuentemente, siendo encontrados por el personal de ambulancia en fibrilación o taquicardia ventricular menos frecuentemente y con menos frecuencia considerados como etiologı́a cardiológico subyacente. De los niños solo el 5% fue dado de alta del hospital vivo comparado con 8% para adultos jóvenes y 9% para adultos. Entre los sobrevivientes el puntaje de categorı́a de desempeño cerebral (CPC) al alta tendı́a a diferir del 38% de adultos jóvenes con CPC de 1 (sin déficit neurológico), comparado con el 52% entre adultos. Conclusión: Los niños y adultos jóvenes que presentan paro cardiorrespiratorio extrahospitalario difieren de los adultos en términos de etiologı́a y arritmia observada inicialmente. Los niños tienen un resultado particularmente malo mientras que los adultos jóvenes tienen un resultado similar a los adultos.

Introduction

Out-of-hospital cardiac arrest is different in terms of aetiology and initially observed arrhythmia in adults and children [1], [2]. Most cardiac arrests in adults are caused by cardiovascular disease; in children the most common cause of out-of-hospital cardiac arrest is the sudden infant death syndrome (SIDS) [3].

The purpose of this study was to describe the epidemiology of out-of-hospital cardiac arrest and resuscitation in children and young adults compared with adults based on experiences from the emergency medical service (EMS) of one single community during a 20-year-period.

Section snippets

Target population

Since 1974, the municipality of Göteborg has had an area of 455 km², areas of water excluded. The population increased from 431 000 to 455 000 between 1980 and 1998. Of the total population, 49% are men. The age distribution of the population is as follows: 0–4 years, 6.1%; 5–14 years, 10.6%; 15–24 years, 12.9%; 25–34 years, 17.8%; 35–44 years, 13.5%; 45–54 years, 13.0%; 55–64 years, 8.8%; 65–74 years, 8.4%; 75–84 years, 6.7% and age 8 ≥5 years, 2.2% (1996).

In 1990, there were 5108 deaths in

Statistical methods

For comparison between two groups in terms of ordered and continuous variables, Fisher's non-parametric permutation test was used [6]. All correlations were tested with Pitman's non-parametric test [7]. In the evaluation of proportions Fisher's test was used, which is a special form of Pitman's non-parametric test. A P-value <0.05 was regarded as significant. Two tailed tests were applied. Comparisons were made between children and adults and between young adults and adults. Children were

Results

During the period of the survey there were 5505 out-of-hospital cardiac arrests in which resuscitation was were attempted. Information on age was available in 5290 of these (96%). This report deals with these 5290 cases, of whom 98 (2%) were children, 197 (4%) were young adults and the remaining 4995 (94%) were adults.

Discussion

This survey describes characteristics and outcome for children and young adults suffering from out-of-hospital cardiac arrest in whom resuscitation efforts were attempted. As a reference group adults in the same situation were used. In terms of characteristics young adults were found to be an intermediate group between children and adults in many aspects. In terms of outcome young adults are more similar to adults than to children.

Limitations

1
Information on age was missing in 4% of the patients.
2
The classification of the cause of cardiac arrest was often based on limited information since autopsy reports were mostly not available. Such information has previously been reported to increase the proportion of cardiac arrests being of non-cardiac aetiology [16].

Conclusion

Children and young adults suffering from out-of-hospital cardiac arrest differ from adults in terms of aetiology and observed initial arrhythmia. Children have a particularly poor outcome whereas young adults have a similar outcome as compared with adults, despite the fact that they are less frequently found in ventricular fibrillation/tachycardia.

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Citation Excerpt :
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The epidemiology of cardiac arrest in children and young adults

Abstract

Sumàrio

Resumen

Introduction

Section snippets

Target population

Statistical methods

Results

Discussion

Limitations

Conclusion

JACEP

Ann. Emerg. Med.

Am. J. Emerg. Med.

Ann. Emerg. Med.

Resuscitation

Am. J. Emerg. Med.

Ann. Emerg. Med.

Ann. Emerg. Med.