P2A094: Utilization of Recommended Screening After Pediatric Out-of-hospital Cardiac Arrest

Background: Out-of-hospital cardiac arrest (OHCA) in a pediatric patient may be sudden and life-threatening. Etiologies span a broad differential diagnosis, necessitating thorough clinical evaluation. The American Academy of Pediatrics (AAP) published a policy statement in 2021 for the evaluation of patients following cardiac arrest. The purpose of this study is to quantify completion of all recommended arrest guidelines across different departments at a free-standing children’s hospital. We hypothesized that all screening elements were completed if a cardiology consult was obtained.

Methods: A retrospective review of pediatric patients with OHCA at a tertiary referral center from 2012 to 2022 was performed. Exclusion criteria included age >18 years, chronic medical history (tracheostomy/ventilator dependence, seizure disorder, known cardiac disease or abnormal cardiac anatomy), in-hospital cardiac arrest, or an arrest with a known preceding event such as drowning, illness, or ingestion. Patients were compared by discharging service.

Results: There were 39 patients who met inclusion criteria (average age 4.3 years, 62% male): 8 in cardiac care unit (CCU), 15 in pediatric intensive care unit (PICU), 11 in emergency department (ED), and 5 on general pediatric teams. Of these, 26 patients (66%) did not survive to hospital discharge and were evaluated by the PICU or ED. One patient was considered deceased on arrival to the ED. There was no difference among services in documenting history of presentation and medical history (p=0.192); however, there were statistical differences in completion of the 5 remaining items of evaluation: multi-generational family (p=0.027), electrocardiogram (p=0.004), exercise stress test (p=0.012), echocardiogram (p=0.012), additional testing (p=0.033) (genetic testing, cardiac MRI, Holter monitor). Eighteen cardiology (general and electrophysiology) consultations were made, of which 8 complete evaluations were performed. All patients discharged from the CCU were considered to have a cardiology consult unless an electrophysiology consult was made. Six out of the 8 CCU patients underwent a complete evaluation. Of the 18 consultations, 8 electrophysiology consults were made and 6 performed all recommended items. The remaining 2 patients were deceased and unable to pursue further evaluation. Without a consultation, no patient successfully had all screening items performed. Overall, cardiology involvement led to a statistical difference in performing electrocardiograms (p=0.014), echocardiograms (p=0.014), exercise stress tests (p=0.005), and additional tests (p=0.001) compared to those without consultation.

Conclusion: The study demonstrates that cardiology, and in particular, electrophysiology involvement resulted in more completed screening elements outlined by the AAP. It is our recommendation to have prompt electrophysiology involvement in patients who present with an OHCA.