title: Pediatric prehospital evaluation of NYC cardiac arrest survival (PHENYCS).
abstract: OBJECTIVE
  The objective of this study was to describe the demographics of out-of-hospital cardiac arrests (OOHCAs) in children younger than 18 years and characteristics associated with survival among these children in New York City (NYC).
  
  
  METHODS
  A prospective observational cohort of all children younger than 18 years with OOHCA in NYC between April 1, 2002, and March 31, 2003. Data were collected from prehospital providers by trained paramedics utilizing a previously validated telephone interview process. Data included Pediatric Utstein core measures and critical prehospital time intervals. Analyses utilized descriptive statistics and bivariate association with survival.
  
  
  RESULTS
  Resuscitation was attempted on 147 pediatric OOHCA patients in NYC during the study period; outcome data were collected on these patients. The median age was 2 years; most (58%) were male. The majority of arrests occurred at home (69%). Lay bystanders witnessed 33% of all OOHCA; 68% of witnesses were family members. Bystander cardiopulmonary resuscitation (CPR) was performed on 30% of children. Median emergency medical services response time was 3.6 minutes (range, 0.4-14.4 minutes). Initial rhythm was as follows: ventricular fibrillation, 2%; asystole, 50%; pulseless electrical activity, 9.5%; other rhythms, 11.6%; no rhythm recorded, 26%. Survival was 4% to hospital discharge and was present only among witnessed arrests (6/58 witnessed vs 0/70 unwitnessed, P < 0.05).
  
  
  CONCLUSIONS
  Pediatric OOHCA survival rate is low. Witnessed arrest was the most important determinant of survival. Ventricular fibrillation was an uncommon rhythm measured by emergency medical services. The majority of arrests occurred at home. The rate of bystander CPR was low. Strategies to increase the rate of bystander CPR for children, especially by family members, are needed.
authors.affiliation: Department of Pediatrics, Maimonides Infant and Children's Hospital of Brooklyn, Brooklyn, NY 11219, USA. glfoltin@maimonidesmed.org
authors.forename: George L
authors.initials: GL
authors.lastname: Foltin
authors.forename: Neal
authors.initials: N
authors.lastname: Richmond
authors.forename: Marsha
authors.initials: M
authors.lastname: Treiber
authors.forename: Andrew
authors.initials: A
authors.lastname: Skomorowsky
authors.forename: Sandro
authors.initials: S
authors.lastname: Galea
authors.forename: David
authors.initials: D
authors.lastname: Vlahov
authors.forename: Shannon
authors.initials: S
authors.lastname: Blaney
authors.forename: Monique
authors.initials: M
authors.lastname: Kusick
authors.forename: Robert
authors.initials: R
authors.lastname: Silverman
authors.forename: Michael G
authors.initials: MG
authors.lastname: Tunik
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003710:Demography; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009519:New York City / Q000453:epidemiology; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology / Q000628:therapy*; D015995:Prevalence; D011446:Prospective Studies; D012737:Sex Factors; D015996:Survival Rate