title: Time on the scene and interventions are associated with improved survival in pediatric out-of-hospital cardiac arrest.
abstract: BACKGROUND
  Survival is less than 10% for pediatric patients following out-of-hospital cardiac arrest. It is not known if more time on the scene of the cardiac arrest and advanced life support interventions by emergency services personnel are associated with improved survival.
  
  
  OBJECTIVE
  This study was performed to determine which times on the scene and which prehospital interventions were associated with improved survival.
  
  
  METHODS
  We studied patients aged 3 days to 19 years old with out-of-hospital cardiac arrest, using the Resuscitation Outcomes Consortium cardiac arrest database from 11 North American regions, from 2005 to 2012. We evaluated survival to hospital discharge according to on-scene times (<10, 10 to 35 and >35 min).
  
  
  RESULTS
  Data were available for 2244 patients (1017 infants, 594 children and 633 adolescents). Infants had the lowest rate of survival (3.7%) compared to children (9.8%) and adolescents (16.3%). Survival improved over the 7 year study period especially among adolescents. Survival was highest in the 10 to 35 min on-scene time group (10.2%) compared to the >35 min. group (6.9%) and the <10 min. group (5.3%, p=0.01). Intravenous or intra-osseous access attempts and fluid administration were associated with improved survival, whereas advanced airway attempts were not associated with survival and resuscitation drugs were associated with worse survival.
  
  
  CONCLUSIONS
  In this observational study, a scene time of 10 to 35 min was associated with the highest survival, especially among adolescents. Access for fluid resuscitation was associated with increased survival but advanced airway and resuscitation drugs were not.
authors.affiliation: Division of Pediatric Critical Care Medicine, Department of Pediatrics, London Health Sciences Centre, University of Western Ontario, London, ON, Canada; The Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada. Electronic address: Janice.Tijssen@lhsc.on.ca.
authors.forename: Janice A
authors.initials: JA
authors.lastname: Tijssen
authors.affiliation: Data Coordinating Center, Resuscitation Outcomes Consortium, University of Washington, Seattle, WA, United States.
authors.forename: David K
authors.initials: DK
authors.lastname: Prince
authors.affiliation: Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Morrison
authors.affiliation: Stead Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, United States.
authors.forename: Dianne L
authors.initials: DL
authors.lastname: Atkins
authors.affiliation: Department of Emergency Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Austin
authors.affiliation: Departments of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA, United States.
authors.forename: Robert
authors.initials: R
authors.lastname: Berg
authors.affiliation: Data Coordinating Center, Resuscitation Outcomes Consortium, University of Washington, Seattle, WA, United States.
authors.forename: Siobhan P
authors.initials: SP
authors.lastname: Brown
authors.affiliation: Department of Emergency Medicine, University of British Columbia Faculty of Medicine, Vancouver, BC, Canada.
authors.forename: Jim
authors.initials: J
authors.lastname: Christenson
authors.affiliation: Division of Cardiovascular Sciences, Heart Failure and Arrhythmias Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States.
authors.forename: Debra
authors.initials: D
authors.lastname: Egan
authors.affiliation: Division of Emergency Medicine, Department of Surgery, University of Texas Southwestern, Dallas, TX, United States.
authors.forename: Preston J
authors.initials: PJ
authors.lastname: Fedor
authors.affiliation: Department of Critical Care Medicine, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Centre, Pittsburgh, PA, United States.
authors.forename: Ericka L
authors.initials: EL
authors.lastname: Fink
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; British Columbia Children's Hospital, Vancouver, BC, Canada.
authors.forename: Garth D
authors.initials: GD
authors.lastname: Meckler
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, The University of Ottawa, Ottawa, ON, Canada; Children's Hospital of Eastern Ontario, The University of Ottawa, Ottawa, ON, Canada.
authors.forename: Martin H
authors.initials: MH
authors.lastname: Osmond
authors.affiliation: Data Coordinating Center, Resuscitation Outcomes Consortium, University of Washington, Seattle, WA, United States.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Sims
authors.affiliation: Department of Critical Care and Neuroscience and Mental Health Research Program, The Hospital for Sick Children, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, Faculty of Medicine and Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada. Electronic address: Jamie.Hutchison@sickkids.ca.
authors.forename: James S
authors.initials: JS
authors.lastname: Hutchison
mesh_terms: D000293:Adolescent; D002170:Canada / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Cardiac arrest; Emergency medical services; Pediatric