Medics’ time on scene associated with better pediatric cardiac arrest survival

A new study found that 10 to 35 minutes of paramedic care delivers the best survival rates for pediatric patients

TORONTO — Less than 10 percent of pediatric patients who suffer a cardiac arrest outside of the hospital survive.

A new study found that the length of time spent on the scene and onsite medical interventions by paramedics are associated with improved survival for pediatric patients.

"The findings of this study as well as those of other recent research confirm that early intervention and care from Paramedics in the prehospital setting makes a significant difference in quality of life and outcomes for our patients," said Cindy Nicholson, deputy chief of Program Development and Service Quality at Toronto Paramedic Services.

In particular, the study found that survival was the highest, especially among teens, with 10 to 35 minutes on the scene in the care and under the treatment of paramedics. After 35 minutes, the outcomes do not improve and actually get worse.

"Interestingly, we found that while longer on-scene time (more than 35 minutes) was associated with higher rates of resuscitation, it had lower rates of survival," said Dr. Jamie Hutchison, research director in critical care medicine . "This paradox is valuable information for paramedics as they weigh the potential benefits of spending more time on the scene while considering how to achieve the best possible outcome for the patient.”

The study, led by The Hospital for Sick Children and Lawson Health Research Institute, also found that improved survival was associated with intravenous access and fluid administration, whereas advanced airway attempts and resuscitation drugs were not.

Adolescents had the highest rate of survival followed by children and then infants. Infants had the shortest scene time, fewest interventions and lowest rate of witnessed events (meaning the cause of the arrest was unknown). It is possible that there may be a large number of infants who had sudden infant death syndrome.

The study also revealed that more than 10 minutes on the scene was associated with more interventions, suggesting that a "scoop and run" approach of less than 10 minutes does not allow enough time to apply interventions like IV fluids that may benefit the patient.

This was an observational study looking at data from the Resuscitation Outcomes Consortium (ROC) cardiac arrest database from 11 North American regions, including Vancouver, Hamilton, Toronto and Ottawa between 2005 and 2012. The team studied 2,244 patients ranging from three days old to 19 years old with non-traumatic out-of-hospital cardiac arrest, and evaluated survival to the time of hospital discharge.

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