• Takashi Nagata, Takeru Abe, Eiichiro Noda, Manabu Hasegawa, Makoto Hashizume, and Akihito Hagihara.
• Faculty of Medical Sciences, Department of Advanced Medical Initiatives, Kyushu University, Fukuoka, Japan.
• BMJ Open. 2014 Feb 12; 4 (2): e003481.

ObjectivesTo better understand and predict clinical outcomes of paediatric out-of-hospital cardiac arrest (OHCA).DesignA population-based, observational study.SettingThe National Japan Utstein Registry.Participants2900 children aged 5-17 years who experienced OHCA and received resuscitation by emergency responders. Signal detection analysis using 17 variables was applied to identify factors associated with OHCA outcomes; the primary endpoint was cerebral performance category (CPC) 1 or 2. A validation study was conducted to verify the model.ResultsOHCA was identified as cardiac origin in 706 participants and non-cardiac origin in 2194 participants. Rates of CPC 1 or 2 for cardiac and non-cardiac causes were 20% and 6.4%, respectively. Cardiac origin arrest was categorised following signal detection into six subgroups defined by public automated external defibrillator use, defibrillation by emergency medical service, age, initial ECG rhythm and eye-witness to arrest; the ranges of CPC 1 or 2 in the six subgroups were between 87.5% and 0.7%. Non-cardiac origin arrest was categorised into four subgroups. Bystander rescue breathing was the most significant factor contributing to outcome; additionally, two other factors-eye-witness to arrest and age-were also significant. CPC 1 or 2 rates ranged between 38.5% and 4% across the four subgroups. Rates of CPC 1 or 2 in the validation study did not differ among any subgroup.ConclusionsFor children who have OHCA from non-cardiac origin, bystander rescue breathing is mandatory to achieve CPC 1 or 2.

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