Adverse Safety Events in Emergency Medical Services Care of Children With Out-of-Hospital Cardiac Arrest.

Autor:	Eriksson CO; Department of Pediatrics, Oregon Health and Science University, Portland., Bahr N; Department of Emergency Medicine, Oregon Health and Science University, Portland., Meckler G; Department of Pediatric Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.; Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada., Hansen M; Department of Emergency Medicine, Oregon Health and Science University, Portland., Walker-Stevenson G; Public Health Division, Multnomah County Health Department, Portland, Oregon., Idris A; Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas., Aufderheide TP; Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee., Daya MR; Department of Emergency Medicine, Oregon Health and Science University, Portland., Fink EL; Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Jui J; Department of Emergency Medicine, Oregon Health and Science University, Portland., Luetje M; Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee., Martin-Gill C; Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania., Mcgaughey S; Department of Emergency Medicine, Oregon Health and Science University, Portland., Pelletier J; Department of Pediatrics, Akron's Children's Hospital, Akron, Ohio., Thomas D; Department of Pediatrics, Medical College of Wisconsin, Milwaukee., Guise JM; Department of Obstetrics, Gynecology, and Reproductive Biology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts.
Jazyk:	angličtina
Zdroj:	JAMA network open [JAMA Netw Open] 2024 Jan 02; Vol. 7 (1), pp. e2351535. Date of Electronic Publication: 2024 Jan 02.
DOI:	10.1001/jamanetworkopen.2023.51535
Abstrakt:	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.
Databáze:	MEDLINE
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