Journal Article

Age-specific considerations in aetiology of paediatric out-of-hospital cardiac arrest

Albrecht, Roland, Bockemuehl, Deliah, Pietsch, Urs, Mueller, Martin, Fuchs, Alexander, Greif, Robert

2025

Overview

Dear Editor, The recent advancements in paediatric out-of-hospital cardiac arrest (OHCA) management underscore the importance of understanding age-specific aetiologies and their influence on neurological outcomes. (docum.) No (CPC > 2) Yes (CPC 1/2) P-value Patient & mission characteristics  Age group    < 1y 56 (100.0) 45 (100.0) 11 (100.0) -  Late/night mission (20:00–07:59) 10 (17.9) 10 (22.2) 0 (0.0) 0.085 Activity  Transport   Car 1 (1.8) 1 (2.2) 0 (0.0) 0.618  Watersport   Swimming 1 (1.8) 1 (2.2) 0 (0.0) 0.618  Other   In and around the house 44 (78.6) 38 (84.4) 6 (54.5)  No activity or unknown 10 (17.9) 5 (11.1) 5 (45.5) 0.026 Aetiology detail Non-traumatic 54 (96.4) 43 (95.6) 11 (100.0) 0.476 Asphyxia—total 18 (32.1) 15 (33.3) 3 (27.3) 0.700  Asphyxia—drowning 4 (7.1) 4 (8.9) 0 (0.0) 0.305  Asphyxia—aspiration 14 (25.0) 11 (24.4) 3 (27.3) 0.846  Asphyxia—strangulation 0 [0.0] 0 [0.0] 0 [0.0] -  Asphyxia—burial 0 [0.0] 0 [0.0] 0 [0.0] - Other pulmonary 2 (3.6) 0 (0.0) 2 (18.2) 0.004 Cardiac 3 (5.4) 2 (4.4) 1 (9.1) 0.540 SIDS 21 (37.5) 21 (46.7) 0 (0.0) 0.004 Anaphylactic 0 [0.0] 0 [0.0] 0 [0.0] - Intoxication 0 [0.0] 0 [0.0] 0 [0.0] - Non-traumatic, reason unknown 6 (10.7) 3 (6.7) 3 (27.3) 0.048 Other non-traumatic 4 (7.1) 2 (4.4) 2 (18.2) 0.113 Traumatic 2 (3.6) 2 (4.4) 0 (0.0) 0.476 Traffic accident 1 (1.8) 1 (2.2) 0 (0.0) 0.618 Fall from a height 0 [0.0] 0 [0.0] 0 [0.0] - Burning/scalding 0 [0.0] 0 [0.0] 0 [0.0] - Other traumatic 1 (1.8) 1 (2.2) 0 (0.0) 0.618 First rhythm Non-shockable 54 (96.4) 43 (95.6) 11 (100.0) 0.476  Pulseless Electrical Activity 8 (14.3) 6 (13.3) 2 (18.2) 0.680  Asystole 31 (55.4) 31 (68.9) 0 (0.0)  < 0.001 Shockable initial rhythm 2 (3.6) 2 (4.4) 0 (0.0) 0.476  Pulseless Ventricular Tachycardia 0 [0.0] 0 [0.0] 0 [0.0] -  Pulseless Ventricular Fibrillation 2 (3.6) 2 (4.4) 0 (0.0) 0.476 Normal Sinus rhythm / ROSC 5 (8.9) 0 (0.0) 5 (45.5)  < 0.001 Unknown 10 (17.9) 6 (13.3) 4 (36.4) 0.074 No measures taken (obviously dead) 0 [0.0] 0 [0.0] 0 [0.0] - Injuries  Traumatic brain injury 2 (3.6) 2 (4.4) 0 (0.0) 0.476  Chest trauma 0 [0.0] 0 [0.0] 0 [0.0] -  Abdominal trauma 0 [0.0] 0 [0.0] 0 [0.0] -  Pelvic trauma 0 [0.0] 0 [0.0] 0 [0.0] -  Upper extremity trauma 0 [0.0] 0 [0.0] 0 [0.0] -  Lower extremity trauma 0 [0.0] 0 [0.0] 0 [0.0] - Outcome  Favor. neurol. outcome, 30d (CPC 1/2) 11 (19.6) 0 (0.0) 11 (100.0)  < 0.001 Depending on normality testing (Shapiro Wilk) median (IQR) respectively mean (SD) are shown for continuous variables, p-values obtained by Wilcoxon rank sum test respectively unpaired T-test. Categorical variables are shown with number (%) in each category, p-values obtained by Chi-squared test Abbreviations: CPC Cerebral Performance Category, ROSC Return of Spontaneous Circulation, SIDS Sudden Infant Death Syndrome Preschoolers (1–6 Years): drowning as the leading cause In preschool-aged children, drowning was the predominant cause of cardiac arrest, responsible for 37.7% of cases. (docum.) No (CPC > 2) Yes (CPC 1/2) P-value Patient & mission characteristics  Age group   1-6y 114 (100.0) 86 (100.0) 28 (100.0) -  Late/night mission (20:00–07:59) 8 (7.0) 8 (9.3) 0 (0.0) 0.094 Activity  Transport   Car 3 (2.6) 3 (3.5) 0 (0.0)   Bicycle 1 (0.9) 1 (1.2) 0 (0.0)   Pedestrian 8 (7.0) 8 (9.3) 0 (0.0)   Other means of transport 3 (2.6) 3 (3.5) 0 (0.0) 0.229  Watersport   Swimming 21 (18.4) 7 (8.1) 14 (50.0)  < 0.001  Summersport   Hiking 5 (4.4) 4 (4.7) 1 (3.6) 0.809  Wintersport   Skiing/Carving 3 (2.6) 2 (2.3) 1 (3.6)   Other winter sports 1 (0.9) 1 (1.2) 0 (0.0) 0.798  Work   In agriculture 1 (0.9) 1 (1.2) 0 (0.0) 0.567  Other   No other activity 46 (40.4) 30 (34.9) 16 (57.1)   In and around the house 60 (52.6) 48 (55.8) 12 (42.9)   Relocation (secondary deployment) 1 (0.9) 1 (1.2) 0 (0.0)  No activity or unknown 7 (6.1) 7 (8.1) 0 (0.0) 0.118 Aetiology detail Non-traumatic 76 (66.7) 49 (57.0) 27 (96.4)  < 0.001 Asphyxia – total 55 (48.2) 32 (37.2) 23 (82.1)  < 0.001  Asphyxia – drowning 43 (37.7) 24 (27.9) 19 (67.9)  < 0.001  Asphyxia – aspiration 6 (5.3) 5 (5.8) 1 (3.6) 0.644  Asphyxia – strangulation 6 (5.3) 3 (3.5) 3 (10.7) 0.137  Asphyxia – burial 0 [0.0] 0 [0.0] 0 [0.0] - Other pulmonary 7 (6.1) 6 (7.0) 1 (3.6) 0.514 Cardiac 2 (1.8) 2 (2.3) 0 (0.0) 0.416 SIDS 2 (1.8) 2 (2.3) 0 (0.0) 0.416 Anaphylactic 0 [0.0] 0 [0.0] 0 [0.0] - Intoxication 1 (0.9) 0 (0.0) 1 (3.6) 0.078 Non-traumatic, reason unknown 5 (4.4) 4 (4.7) 1 (3.6) 0.809 Other non-traumatic 4 (3.5) 3 (3.5) 1 (3.6) 0.983 Traumatic 38 (33.3) 37 (43.0) 1 (3.6)  < 0.001 Traffic accident 24 (21.1) 24 (27.9) 0 (0.0) 0.002 Fall from a height 5 (4.4) 4 (4.7) 1 (3.6) 0.809 Burning/scalding 0 [0.0] 0 [0.0] 0 [0.0] - Other traumatic 9 (7.9) 9 (10.5) 0 (0.0) 0.074 First rhythm Non-shockable 109 (95.6) 81 (94.2) 28 (100.0) 0.192  Pulseless Electrical Activity 18 (15.8) 16 (18.6) 2 (7.1) 0.149  Asystole 57 (50.0) 56 (65.1) 1 (3.6)  < 0.001 Shockable initial rhythm 5 (4.4) 5 (5.8) 0 (0.0) 0.192  Pulseless Ventricular Tachycardia 0 [0.0] 0 [0.0] 0 [0.0] -  Pulseless Ventricular Fibrillation 5 (4.4) 5 (5.8) 0 (0.0) 0.192 Normal Sinus rhythm / ROSC 23 (20.2) 1 (1.2) 22 (78.6)  < 0.001 Unknown 9 (7.9) 6 (7.0) 3 (10.7) 0.524 No measures taken (obviously dead) 2 (1.8) 2 (2.3) 0 (0.0) 0.416 Injuries  Traumatic brain injury 29 (25.4) 28 (32.6) 1 (3.6) 0.002  Chest trauma 10 (8.8) 10 (11.6) 0 (0.0) 0.059  Abdominal trauma 7 (6.1) 7 (8.1) 0 (0.0) 0.119  Pelvic trauma 1 (0.9) 1 (1.2) 0 (0.0) 0.567  Upper extremity trauma 1 (0.9) 1 (1.2) 0 (0.0) 0.567  Lower extremity trauma 4 (3.5) 4 (4.7) 0 (0.0) 0.245

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Age factors in disease / Age groups / Cardiac arrest / Cardiac arrhythmia / Care and treatment / Causes of / Comment / Demographic aspects / Emergency Medicine / Etiology / Hypoxia / Medicine / Medicine & Public Health / Metabolism / Pediatric emergencies / Pediatrics / SIDS / Strangulation / Sudden infant death syndrome / Trauma / Traumatic brain injury / Traumatic Surgery