What makes the difference in children with unexpected good outcome 6 months after cardiac arrest?

Nieves de Lucas1, Patrick Van de Voorde 2, Antonio Rodríguez-Núñez3, Jesús López-

Herce4, Ian Maconochie5, Jorge Sotoca6, Anil Er7, Rafael Marañón4, Nuria Clerigué8,

Laura Pérez-Gay9, Zulema Lobato10, Esther Aleo11, Estefanía Romero12, Asunción

Pino13, Ramón Fernández14, José Fernández Arribas15, Julio Alvarez Pitti16, Anna Piza

Oliveras17, Mariano Plana18, Paediatric cardiac arrest study group REPEM, RISEUP,


1SAMUR-PC, Madrid, Spain. 2Ghent University Hospital , Ghent, Belgium. 3Complejo U

Hospitalario de Santiago, Santiago de Compostela, Spain. 4HU Gregorio Marañón,

Madrid, Spain. 5St Mary's Hospital , London, United Kingdom. 6Skane's University

Hospital, Lund-Malmö, Lund-Malmö, Sweden. 7Dr.Behcet Uz Hospital, Izmir, Turkey.

8Complejo Hospitalari de Navarra, Pamplona, Spain. 9Hospital de Lugo, Lugo, Spain.

10Xarxa Assistencial Universitaria de Manresa, Manresa, Spain. 11H Clínico

universitario, Madrid, Spain. 12HU Puerta del mar, Cadiz, Spain. 13HU Clínico Valladolid,

Valladolid, Spain. 14H Cabueñes, Gijón, Spain. 15HU Río Hortega, Valladolid, Spain. 16HU

General Valencia, Valencia, Spain. 17HU MútuaTerrassa, Terrasa, Spain. 18Hospital

Barbastro, Barbastro, Spain. 19., ., Spain


·Purpose of the study. To analyse the peculiarities of patients with unexpected good

overall outcome at 6 months in emergency department and out-of-hospital paediatric

cardiac arrest (OHCA).

·Materials and methods. Prospective multicentre study of paediatric cardiac arrest in

emergency department and OHCA in children under 18 years old. We selected patients

with at least one of the following criteria: asystole as first rhythm, blood pH <7, blood

lactate ≥12 mmol/l or death probability >80% according to PELOD scale at 24 first

hours. We also collected Paediatric Overall Performance Category (POPC) at 6 months.

T-test, Fisher´s exact test and Chi-square test.

·Results. 181/229 cardiac arrests had at least one criterium of bad prognosis, 166 were

followed 6 months and 15.7% had good overall outcome (POPC 1 or 2). In patients with

bad prognosis and POPC 1 or 2 at 6 months we found:

– lower proportion of trauma as cause of cardiac arrest (4% vs 22,1%, p=0.037) and

orotracheal intubation during cardiac arrest (87.1 vs 69.2%, p=0.021),

– higher proportion of witnessed cardiac arrests (21.4% vs 8.1%, p= 0.016), shockable

rhythms as first rhythm (38.5% vs 13.5%, p=0.017) and treatment with hypothermia

(36.4% vs 10.5%, p<0.001). When we studied only patients with sustained ROSC, those

who were treated with hypothermia had higher proportion of POPC 1 or 2 at 6 months,

next to statistical significance (42.9% vs 23%, p=0.055).

There was not any significative difference in age, gender, time until basic or advanced

life support.

·Conclusions. Some patients with criterium of bad prognosis achieved good overall

outcome at 6 months, mainly those who had witnessed cardiac arrests and shockable

rhythms. Traumatic cardiac arrest is still a challenge. While orotracheal intubations

could not always be the first line of airway management, hypothermia seems to be

useful to improve the overall outcome.