Pediatric prehospital evaluation of NYC respiratory arrest survival (PHENYCS).

ABSTRACT

OBJECTIVE: The objective of this study was to describe the demographics, epidemiology, and characteristics associated with survival of children younger than 18 years who had an out-of-hospital respiratory arrest (OOHRA) during a 1-year period in a large urban area. METHODS: A prospective observational cohort of consecutive children younger than 18 years with OOHRA cared for by the New York City 911 emergency medical services (EMS) system from April 12, 2002, to March 31, 2003. Following resuscitative efforts, data were collected from prehospital providers by trained paramedics using a previously validated telephone interview process. Data included Pediatric Utstein core measures and critical prehospital time intervals. Analyses used descriptive statistics and bivariate association with survival. RESULTS: Resuscitation was attempted on 109 OOHRAs during the study period. The median age was 7 years, 52% were male. Lay bystanders witnessed 56%. Most occurred at home (77%). Witnesses were family members in 59%. Bystander cardiopulmonary resuscitation (CPR) was performed in 31% of all respiratory arrests (RAs). A chronic medical condition existed in 28%. Median EMS response time was 4.4 minutes (range, 0-12 min). Overall survival was 79% to hospital discharge. Time interval to EMS arrival, witnessed arrest, bystander CPR, and ventilation method were not associated with survival. CONCLUSIONS: Most OOHRAs occurred at home, and bystander CPR occurred infrequently. The majority of children in OOHRA survived. Strategies to increase the rate of bystander CPR, especially by family members, are needed. Out-of-hospital RAs are a large proportion of all arrests in children. Future studies of pediatric arrest should include RA as well as cardiac arrest.