5 - Clinical Outcomes and Family Decision-Making After Out of Hospital Cardiac Arrest in Children

Poster Number: 5
Publication Number: 5.107

Jessica Frelinger, Children's Hospital Los Angeles, Los Angeles, CA, United States; Jonathan M.. Tan, Children's Hospital Los Angeles, Glendale, CA, United States; Margaret J. Klein, Children's Hospital Los Angeles, Los Angeles, CA, United States; Christopher J. Newth, Unviersity of Southern California, Los Angeles, CA, United States; Patrick A.. Ross, Children's Hospital Los Angeles, Los Angeles, CA, United States; Meredith C.. Winter, Children’s Hospital Los Angeles, Los Angeles, CA, United States

Background: Out of hospital cardiac arrest (OHCA) in children carries significant morbidity and mortality. Prior studies have examined factors that affect pre-hospital care and clinical outcomes, such as neurologic status and mortality. There is a paucity of literature on advance care planning and medical decision-making after OHCA.

Objective: To identify demographics, area-based social determinants of health, and clinical features that are associated with two representative outcomes of medical decision-making after OHCA: (1) adoption of new advance care plan (ACP), and (2) discharge with new medical technology (feeding tube or tracheostomy tube).

Design/Methods: Retrospective cohort study of patients < 18 years old admitted to the ICU at a tertiary care children’s hospital from 2011 to 2022 after OHCA. Demographic and clinical factors were abstracted from a departmental ICU database and the electronic health record. Area-based social determinants of health indices were obtained by spatial linkage of patient registered street addresses to the United States Center for Disease Control and Prevention 2018 Social Vulnerability Index (SVI) and Child Opportunity Index 2.0 (COI). Statistical and spatial analysis was conducted using SAS and ArcGIS Pro.

Results: 218 patients were admitted with a primary diagnosis of OHCA. 115 patients (53%) died, 78 patients (36%) had a new ACP, and 27 patients (14%) underwent new medical technology. Univariate analysis showed high Pediatric Risk of Mortality (PRISM) score, cardiac arrest at home, prolonged cardiopulmonary resuscitation (CPR), non-shockable rhythm, arrest due to accident or trauma, and use of mechanical ventilation to be associated with a new ACP. English-speaking families were less likely than Spanish-speaking families to adopt an ACP (OR = 5.5, 95% Cl [1.6-13.8]). Low PRISM score and palliative care consultation were associated with new medical technology at time of discharge. There were no associations between SVI or COI and adoption of a new ACP or new medical technology at discharge.

Conclusion(s): Higher severity of illness, prolonged cardiac arrest, and non-English speaking family were associated with a new ACP after OHCA. Lower severity of illness and palliative care consultation were associated with new medical technology at discharge. Representative outcomes of family medical decision-making were not impacted by area-based social determinants of health. Further studies are warranted to identify if these findings are consistent across different institutions and patient populations.