Out-of-hospital pediatric cardiac arrest: An epidemiologic review and assessment of current knowledge
Out-of-hospital pediatric cardiac arrest: An epidemiologic review and assessment of current knowledge
复制标题
DOI：
10.1016/j.annemergmed.2005.05.028
复制
发表时间：
2005-12-01
影响因子：
6.2
通讯作者：
Stiell, IG
中科院分区：
文献类型：
--
作者：
Donoghue, AJ;Nadkarni, V;Stiell, IG
研究目的：我们系统地总结了儿科院外心脏骤停的流行病学，并评估了特定院外干预措施的效果。方法：我们对1966年至2004年发表的文章进行了全面的回顾，这些文章可通过MEDLINE、护理和相关健康文献累积索引、EmBase和科克伦注册中心获得，描述了18岁以下院外心脏骤停儿童的结局。使用儿科Utstein结局报告指南对患者特征、护理过程和结局进行比较。院外护理过程对生存结局的影响进行了总结。结果：41项研究符合纳入标准，8符合Utstein报告指南。该综述纳入了5，363例患者：12.1%存活至出院，4%存活至神经功能完好。创伤患者（n= 2，299）的总生存率较高（21.9%，6.8%完好）;对更严格心脏骤停定义的研究进行的单独检查显示生存率较低（总体1.1%，神经系统完好0.3%）。浸没损伤相关的心脏骤停（n=442）的总生存率更高（22.7%，6%完好）。对旁观者心肺复苏和见证人心跳骤停状态的汇总数据分析显示，见证人心跳骤停的生存可能性增加（相对风险1.99，95%置信区间1.54 - 2.57）。由于研究的异质性，旁观者心肺复苏的效果难以确定。结论：院外儿童心脏骤停的结局普遍较差。患者亚组的生存率可能存在差异，但差异很难准确描述。报告和研究设计与Utstein指南的一致性不完整。目击逮捕状态仍然与提高生存率有关。前瞻性对照试验的需求仍然是一个高度优先事项。
Study objective: We systematically summarize pediatric out-of-hospital cardiac arrest epidemiology and assess knowledge of effects of specific out-of-hospital interventions.Methods: We conducted a comprehensive review of published articles from 1966 to 2004, available through MEDLINE, Cumulative Index to Nursing and Allied Health Literature, EmBase, and the Cochrane Registry, describing outcomes of children younger than 18 years with an out-of-hospital cardiac arrest. Patient characteristics, process of care, and outcomes were compared using pediatric Utstein outcome report guidelines. Effects of out-of-hospital care processes on survival outcomes were summarized.Results: Forty-one studies met inclusion criteria; 8 complied with Utstein reporting guidelines. Included in the review were 5,363 patients: 12.1% survived to hospital discharge, and 4% survived neurologically intact. Trauma patients (n=2,299) had greater overall survival (21.9%, 6.8% intact); a separate examination of studies with more rigorous cardiac arrest definition showed poorer survival (1.1% overall, 0.3% neurologically intact). Submersion injury-associated arrests (n=442) had greater overall survival (22.7%, 6% intact). Pooled data analysis of bystander cardiopulmonary resuscitation and witnessed arrest status showed increased likelihood of survival (relative risk 1.99, 95% confidence interval 1.54 to 2.57) for witnessed arrests. The effect of bystander cardiopulmonary resuscitation is difficult to determine because of study heterogeneityConclusion: Outcomes from out-of-hospital pediatric cardiac arrest are generally poor. Variability may exist in survival by patient subgroups, but differences are hard to accurately characterize. Conformity with Utstein guidelines for reporting and research design is incomplete. Witnessed arrest status remains associated with improved survival. The need for prospective controlled trials remains a high priority.