title: Incidence, characteristics and survival outcomes of out-of-hospital cardiac arrest in children and adolescents between 1997 and 2014 in Perth, Western Australia.
abstract: OBJECTIVE
  The present study was to describe the trends in the incidence, characteristics and survival of paediatric out-of-hospital cardiac arrest (OHCA) over an 18 year period.
  
  
  METHODS
  We conducted a population-based retrospective cohort study using prospectively collected data from all OHCA patients aged <18 years who were attended by St John Ambulance Western Australia paramedics in the Perth metropolitan area, WA, between 1997 and 2014. The incidence, characteristics and survival were compared across 4 year periods (1997-2000, 2001-2005, 2006-2010 and 2011-2014). The Paediatric Cerebral Performance Category at hospital discharge was determined by medical record review. Incidence per 100 000 population was calculated for four age groups (<1, 1-4, 5-12 and 13-17).
  
  
  RESULTS
  In total, 723 OHCAs were identified, and 451 (62.4%) had resuscitation commenced by paramedics. The patients were predominantly male (61.6%) with a median age of 2 years (IQR 0-14 years). Bystander CPR increased over time from 35.0% (1997-2000) to 63.0% (2011-2014) (P < 0.001). Any return of spontaneous circulation was 39/451 (8.6%), and survival to hospital discharge was 21/451 (5.0%). Of the 20 survivors assessed, 11 had good neurological status at hospital discharge (Paediatric Cerebral Performance Category 1 or 2). The overall incidence decreased from 14.1 (1997-2000) to 8.7 (2011-2014) per 100 000 population (P < 0.001). This was almost halved in children aged <1 year group (P < 0.001).
  
  
  CONCLUSIONS
  The incidence of paediatric OHCA decreased over time, but survival remained poor. Strategies to strengthen the chain of survival for paediatric OHCA need to be considered.
authors.affiliation: Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
authors.forename: Madoka
authors.initials: M
authors.lastname: Inoue
authors.affiliation: Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
authors.forename: Hideo
authors.initials: H
authors.lastname: Tohira
authors.affiliation: Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.|St John Ambulance Western Australia (SJA-WA), Perth, Western Australia, Australia.
authors.forename: Teresa
authors.initials: T
authors.lastname: Williams
authors.affiliation: St John Ambulance Western Australia (SJA-WA), Perth, Western Australia, Australia.|Emergency Department, St John of God Murdoch Hospital, Murdoch, Western Australia, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Bailey
authors.affiliation: Schools of Paediatric and Child Health, and Primary, Aboriginal and Rural Health Care, The University of Western Australia, Perth, Western Australia, Australia.|Emergency Department, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
authors.forename: Meredith
authors.identifier: http://orcid.org/0000-0002-5326-5008
authors.initials: M
authors.lastname: Borland
authors.affiliation: Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.
authors.forename: Nicole
authors.initials: N
authors.lastname: McKenzie
authors.affiliation: St John Ambulance Western Australia (SJA-WA), Perth, Western Australia, Australia.
authors.forename: Deon
authors.initials: D
authors.lastname: Brink
authors.affiliation: Prehospital Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia.|St John Ambulance Western Australia (SJA-WA), Perth, Western Australia, Australia.|School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
authors.forename: Judith
authors.initials: J
authors.lastname: Finn
mesh_terms: D000293:Adolescent; D000488:Allied Health Personnel / Q000706:statistics & numerical data; D024201:Bystander Effect; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000592:standards; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D006801:Humans; D015994:Incidence; D007223:Infant; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology / Q000401:mortality*; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014904:Western Australia / Q000453:epidemiology
keywords: cohort studies; incidence; out-of-hospital cardiac arrest; paediatrics; survival rate