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Dear Editor,
The recent advancements in paediatric out-of-hospital cardiac arrest (OHCA) management underscore the importance of understanding age-specific aetiologies and their influence on neurological outcomes. Based on our analysis of 296 paediatric patients up to 16 years of age treated by helicopter emergency medical services (HEMS) between 01–01–2011 and 31–12–2021, we noted that favourable neurologicaloutcomes, defined by a Cerebral Performance Category (CPC) score of 1 or 2 at 30 days post-arrest, were achieved in 18.9% of cases [1]. By examining age-specific trends (Fig. 1), we aim to gain a deeper understanding of the aetiology and to highlight critical aspects for improving favourable neurological outcome [1, 2].
Fig. 1 [Images not available. See PDF.]
Age specific categorization of the aetiology of paediatric out of hospital cardiac arrest
Cardiac vs. non-cardiac aetiology across ages
In our cohort, 23 cases of paediatric OHCA were due to cardiac causes, with a median patient age of 10 years. Among these, 65% had a known cardiac comorbidity, and immediate bystander cardiopulmonary resuscitation (CPR) was often initiated, suggesting greater awareness among caregivers trained for critical events. Key cardiac factors included congenital heart defects (e.g., hypoplastic left heart syndrome), acquired cardiomyopathies and arrhythmias (e.g., Long QT syndrome) [3]. Non-cardiac causes, however, accounted for a significant portion (n = 233, 78%) of arrests and varied in origin across age groups, underscoring the need for age-targeted strategies. These non-cardiac aetiologies included respiratory insufficiency (mostly due to asphyxia as well as respiratory infections), trauma and metabolic derangements.
Infants (< 1 Year): high risk of hypoxia-related arrests
Infants demonstrate a unique vulnerability to hypoxia-related arrests, primarily due to physiological factors such as higher metabolic rates, lower functional residual capacity and immature cardiovascular response [4]. In this age group, 89.3% of cases were non-traumatic, with sudden infant death syndrome (SIDS) and bronchopulmonary aspiration accounting for 37.5% and 25% of cases, respectively. The diagnosis of SIDS is made when there is no explanation for cardiac arrest found after thorough investigation. Pathophysiological mechanisms remain mostly unclear, while several risk factors were identified such as prone sleeping, over-heating, smoke exposure and infection [5]. Infants with return of spontaneous circulation (ROSC) upon arrival of HEMS had significantly improved neurological outcomes (p < 0.05). This age group had a high incidence (53.6%)...