Adverse Safety Events in Emergency Medical Services Care (EMS) of Children With Out-of-Hospital Cardiac Arrest – 60% of all patients experienced at least 1 severe ASE (30% had 2 or more)

thehealthtransformation
.foundation

Joaquim Cardoso MSc

January 31, 2024

The following abstract was taken from the study published by the JAMA Netowork and written by Carl O. Eriksson, MD, MPH; Nathan Bahr, PhD; Garth Meckler, MD, et al Matthew Hansen, MD; Grace Walker-Stevenson, MPH; Ahamed Idris, MD; Tom P. Aufderheide, MD; Mohamud R. Daya, MD; Ericka L. Fink, MD; Jonathan Jui, MD; Maureen Luetje, DO⁷; Christian Martin-Gill, MD; Steven Mcgaughey, MD; Jon Pelletier, MD; Danny Thomas, MD; Jeanne-Marie Guise, MD; for the Child Safety Initiative–Emergency Medical Services for Children

Key Points

Question  

What are the frequency of and factors associated with severe adverse safety events in emergency medical services care of children with out-of-hospital cardiac arrest?

Findings

  In this cohort study of 1019 encounters, 60% of patients experienced at least 1 severe adverse safety event. Neonates had increased odds of a severe adverse safety event compared with adolescents.

Meaning

  These findings suggest that decreasing severe adverse safety events may improve current poor outcomes for children with out-of-hospital cardiac arrest, especially younger children.

Abstract

Importance  

Survival for children with out-of-hospital cardiac arrest (OHCA) remains poor despite improvements in adult OHCA survival.

Objective  

To characterize the frequency of and factors associated with adverse safety events (ASEs) in pediatric OHCA.

Design, Setting, and Participants  

This population-based retrospective cohort study examined patient care reports from 51 emergency medical services (EMS) agencies in California, Georgia, Oregon, Pennsylvania, Texas, and Wisconsin for children younger than 18 years with an OHCA in which resuscitation was attempted by EMS personnel between 2013 and 2019.

Medical record review was conducted from January 2019 to April 2022 and data analysis from October 2022 to February 2023.

Main Outcomes and Measure  

Severe ASEs during the patient encounter (eg, failure to give an indicated medication, 10-fold medication overdose).

Results  

A total of 1019 encounters of EMS-treated pediatric OHCA were evaluated; 465 patients (46%) were younger than 12 months.

At least 1 severe ASE occurred in 610 patients (60%), and 310 patients (30%) had 2 or more.

Neonates had the highest frequency of ASEs. The most common severe ASEs involved epinephrine administration (332 [30%]), vascular access (212 [19%]), and ventilation (160 [14%]).

In multivariable logistic regression, the only factor associated with severe ASEs was young age.

Neonates with birth-related and non–birth-related OHCA had greater odds of a severe ASE compared with adolescents (birth-related: odds ratio [OR], 7.0; 95% CI, 3.1-16.1; non–birth-related: OR, 3.4; 95% CI, 1.2-9.6).

Conclusions and Relevance

 In this large geographically diverse cohort of children with EMS-treated OHCA, 60% of all patients experienced at least 1 severe ASE.

The odds of a severe ASE were higher for neonates than adolescents and even higher when the cardiac arrest was birth related.

Given the national increase in out-of-hospital births and ongoing poor outcomes of OHCA in young children, these findings represent an urgent call to action to improve care delivery and training for this population.

To read the original publication, click here.