The impact of bystanders and emergency medical services on out-of-hospital cardiac arrest outcomes in children

Albargi, Hussin (2023). The impact of bystanders and emergency medical services on out-of-hospital cardiac arrest outcomes in children. University of Birmingham. Ph.D.

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Abstract

Survival after out of hospital cardiac arrest (OHCA) in the paediatric populations is rare and often results in poor neurological outcomes. Bystander cardiopulmonary resuscitation (BCPR) intervention has been linked to improving survival outcomes. Several factors, including demographic, prehospital and socioeconomic status (SES) may influence the rate of the BCPR. However, limited evidence exists regarding the relationship of these factors and the rate of BCPR, and the association between BCPR and eventual survival outcomes in England.

To improve the knowledge about the impact of BCPR on survival outcomes we conducted a systematic review compared bystander versus no bystander CPR in paediatric OHCA and found a higher chance of achieving return of spontaneous circulation (ROSC) (pOR 2.30(95% CI 1.17-4.52)) , survival to hospital discharge (pOR 2.30(95% CI 1.41-3.75) and survival at one month (pOR 1.43 (95% CI 1.27-1.60)) in those who received BCPR; however, data was limited and there was no study from England.

Using the English OHCA outcomes registry and the Office of National Statistics (ONS) databases, the incidence rate of paediatric OHCA in England was calculated as 5.3 per 100,000 person-years, with a higher incidence in infants less than one year (27.3 per 100,000). Two thirds of OHCA cases received BCPR. Survival to hospital discharge was 11.0% and varied across Emergency Medical Services (EMS) regions.

Using the OHCA registry, patients receiving BCPR were compared with no-BCPR. BCPR was associated with improved rates of ROSC but not with survival at hospital discharge. The rate of BCPR varied significantly across EMS geographic regions (range 57.7% (206/367) to 83.7% (139/166)).

Finally, the geographical variation was examined by exploring the impact of SES population factors on rate of BCPR. BCPR was less likely to be performed in areas of higher deprivation, higher proportion of ethnic minorities and low work levels. However, after adjusting for prehospital factors, only areas with a higher proportion of people with white ethnicity were associated with increased delivery of BCPR. Further research is needed to describe the effect of SES factors on survival outcomes.

In this thesis, based on the information provided in the systematic review, we concluded that although BCPR is associated with improved survival outcomes, there is limited data regarding the impact of BCPR on long-term survival with good neurological outcomes, suggesting that further studies are required in the future. This thesis provides essential knowledge on the epidemiology, incidence rate, regional variations in clinical factors (e.g. BCPR rate, the status of witness), and survival outcomes in paediatric OHCA in England. The overall survival to hospital discharge observed in this thesis was comparable to that reported in previous studies on paediatric OHCA. Further, this thesis suggests that the impact of BCPR on survival to hospital discharge in paediatric OHCA in England is clearly affected by whether the CA was witnessed. Therefore, further studies should explore factors that affect the willingness to provide BCPR in witnessed cases. Results also suggest that SES could impact the BCPR rate, although further studies are needed to describe the impact of BCPR on survival outcomes in geographical areas with higher and lower SES.

Type of Work:

Thesis (Doctorates > Ph.D.)

Award Type:

Doctorates > Ph.D.

Supervisor(s):