Public access defibrillation and outcomes after pediatric out-of-hospital cardiac arrest

Abstract Background Use of automated external defibrillators (AEDs) has been recommended for pediatric out-of-hospital cardiac arrest (OHCA). However, there are no conclusive studies that elucidated the effectiveness of public-access defibrillation (PAD) in children. Methods This was a nationwide, population-based, propensity score-matched study of pediatric OHCA in Japan from 2011 to 2012, based on data from the All-Japan Utstein Registry. We included pediatric OHCA patients (aged 1–17 years) who received bystander cardiopulmonary resuscitation. The primary outcome was a favorable neurological state 1 month after OHCA defined as a Glasgow–Pittsburgh cerebral performance category (CPC) score of 1–2 (corresponding to a Pediatric CPC score of 1–3). Results A total of 1193 patients were included in the final cohort; 57 received PAD and 1136 did not. Among 1193 patients, 188 (15.8%) survived with a favorable neurological status 1 month after OHCA. The odds of neurologically favorable survival were significantly higher for patients receiving PAD after adjusting for potential confounders: propensity score matching, OR 3.17 (95% CI 1.40–7.17), and multivariable logistic regression modeling, ORadjusted 5.10 (95% CI 2.01–13.70). Similar findings were observed for the secondary outcomes (i.e., neurologically favorable survival with a CPC score of 1, one-month survival, and prehospital return of spontaneous circulation). In subgroup analyses, there were no significant differences in neurologically favorable survival between the PAD group and non-PAD group in the unwitnessed cohort (ORadjusted 7.76 [0.75–81.90]) or the non-cardiac etiology cohort (ORadjusted 6.65 [0.64–66.24]). Conclusions PAD was associated with an increased chance of neurologically favorable survival in pediatric OHCA (aged 1–17 years) who received bystander CPR, except for in cases of unwitnessed or non-cardiac etiology.