Skip to main content

Favourable neurological outcome following paediatric out-of-hospital cardiac arrest: authors’ reply

The Original Article was published on 22 January 2024

The Original Article was published on 21 December 2023

We thank Benjamin Stretch [1] for commenting on our article[2] in which we investigated factors associated with favourable neurological outcome in paediatric patients sustaining out-of-hospital cardiac arrest (CA).

Considering all helicopter emergency service system (HEMS) missions in Switzerland, paediatric out-of-hospital CA is a very rare condition [3]. We agree that traumatic CA substantially differs from non-traumatic CA. Given the large proportion of traumatic CA in our analysis, we felt the importance of including both aetiology as it reflects real-life data of a high-performing national HEMS. Indeed, survival with favourable neurological outcome was significantly higher in patients with non-traumatic CA (n = 53/199, 26.3%) compared to traumatic CA (n = 3/97, 3.1%) [2].

We thank the author for mentioning the 2021 European Resuscitation Council (ERC) guidelines for CA in special circumstances [4]. However, the mentioned guidelines cover adult patients. In Switzerland, patients up to 16 years sustaining out-of-hospital CA are treated in specialised paediatric hospitals [5], which was the rationale for our age limitations. Unfortunately, the applicable guidelines on Paediatric Life Support [6] only recommend adjusting the algorithm in special settings (e.g. trauma). The very brief chapter on Traumatic CA in the ERC Paediatric Life Support guidelines [6] recommends starting standard CPR while searching for and treating reversible causes. These guidelines [6] suggest that the interventions for reversible causes might precede adrenaline administration. We agree that performing chest compressions in patients with severe exsanguination, tension pneumothorax, or cardiac tamponade might be useless. However, no specific algorithm is provided in the guidelines [6] to aid decision-making for clinicians in these stressful situations. Swiss HEMS physicians are trained in paediatric advanced trauma life support, including traumatic CA.

The analysis of our data showed that favourable neurological outcome was higher for patients receiving immediate bystander CPR before HEMS treatment. We don’t consider ground-based ambulances competing HEMS. The latter poses additional advantages to the whole performance of the emergency medicine system. Indeed, HEMS offers the possibility to bring highly experienced personnel fast on-scene, which might be an advantage as potentially life-saving critical interventions can be performed early [3]. Other important factors in the chain of survival include the critical phase of post-resuscitation care. HEMS physicians can initiate state-of-the-art post-resuscitation care already on-scene and during the flight into specialised paediatric hospitals with adjunct operating rooms and intensive care units. These specialised paediatric hospitals [5] can be reached by helicopter fast.

However, such retrospective data analysis should be carefully interpreted as the association does not imply causality. Several of these limitations are discussed in our article [2].

Finally, we highly appreciate the awareness campaign ‘Aaron’s Heart’ of the Resuscitation Council United Kingdom to improve outcomes for paediatric CA patients.

Data availability

Not applicable.

Abbreviations

CA:

Cardiac Arrest

CPC:

Cerebral Performance Category

CPR:

Cardiopulmonary resuscitation

HEMS:

Helicopter Emergency Medical Service

ERC:

European Resuscitation Council

References

  1. Stretch B. Paediatric cardiac arrest prognostication in the context of a HEMS service. Scand J Trauma Resusc Emerg Med 2024.

  2. Fuchs A, Bockemuehl D, Jegerlehner S, et al. Favourable neurological outcome following paediatric out-of-hospital cardiac arrest: a retrospective observational study. Scand J Trauma Resusc Emerg Med. 2023;31:106.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Fuchs A, Huber M, Riva T, et al. Factors influencing on-scene time in a physician-staffed helicopter emergency medical service (HEMS): a retrospective observational study. Scand J Trauma Resusc Emerg Med. 2023;31:20.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lott C, Truhlář A, Alfonzo A, et al. European Resuscitation Council guidelines 2021: cardiac arrest in special circumstances. Resuscitation. 2021;161:152–219.

    Article  PubMed  Google Scholar 

  5. Fuchs A, Franzmeier L, Cheseaux-Carrupt M, et al. Characteristics and neurological survival following intraoperative cardiac arrest in a Swiss University Hospital: a 7-year retrospective observational cohort study. Front Med (Lausanne). 2023;10:1198078.

    Article  PubMed  Google Scholar 

  6. Van de Voorde P, Turner NM, Djakow J, et al. European Resuscitation Council guidelines 2021: paediatric life support. Resuscitation. 2021;161:327–87.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

Not applicable.

Author information

Authors and Affiliations

Authors

Contributions

AF: Conceptualisation, Writing– original draft. RA, RG: Writing– review & editing. MM: Writing– review & editing, Formal Analysis. UP: Supervision, Writing– original draft. All authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Alexander Fuchs.

Ethics declarations

Competing interests

RG is the European Resuscitation Council (ERC) Board Director of International Liaison Committee on Resuscitation (ILCOR) and Guidelines, and ILCOR Education, Implementation and Team Task Force Chair. All other authors declare that there are no conflicts of interest.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fuchs, A., Albrecht, R., Greif, R. et al. Favourable neurological outcome following paediatric out-of-hospital cardiac arrest: authors’ reply. Scand J Trauma Resusc Emerg Med 32, 8 (2024). https://doi.org/10.1186/s13049-024-01176-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13049-024-01176-3