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Out-of-hospital cardiac arrest (OHCA) accounts for a significant proportion of paediatric mortality, the most prevalent causes being cardiac, according to a prospective population-based study published recently in the Journal of the American College of Cardiology.1

The investigation covered 588,389 persons younger than 21 years who suffered OHCA between 2005 and 2010 in the North Holland province of the Netherlands.  Death certificate data on total pediatric mortality, survival status, and neurological outcome at hospital discharge also were obtained.

OHCA was found to have caused 24% of deaths, with an incidence of 9.0 per 100,000 pediatric person-years.  Natural causes of OHCA accounted for 49% of cases, with cardiac causes in 39% of these cases.  Causes were considered cardiac when evidence for a noncardiac or non-natural cause was absent.  A total of 24% of resuscitated patients survived, 85% with a neurologically-intact outcome.

In an accompanying editorial2 Dr Sumeet Chugh, Cedars-Sinai Medical Center, Los Angeles, asserts that the rates of survival to hospital discharge  (12 of 51) may reflect “successful bystander education” in the region.  It is likely, Chugh says, “that this favorable outcome is attributable to the high rates of witnessed collapse, bystander cardiopulmonary resuscitation, and use of automated external defibrillators” in North Holland”.

Chugh also points out a limitation of the study: “the manner in which Bardai et al. presented their data tends to overestimate the actual incidence of pediatric OHCA. Their definition of OHCA was very broad and included natural causes (cardiac and noncardiac) as well as all unnatural causes of OHCA, such as traffic accidents and violent trauma”.


1 Bardai A, Berdowski J, van der Werf C, et al. Incidence, Causes, and Outcomes of Out-of-Hospital Cardiac Arrest in Children: A Comprehensive, Prospective, Population-Based Study in the Netherlands.  JACC 2011:57;1822–8.

2 Chugh SS. Improved Outcomes for Cardiac Arrest in Children: Share the Baton with the Bystander. JACC 2011:57;1829–30.

Published on: June 8, 2011

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  • ArrhythmiaAlliance
  • Stars
  • Anticoagulation Europe
  • Atrial Fibrillation Association

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