Survival Following Witnessed Pediatric Out-of-hospital Cardiac Arrests During Nights and Weekends

Background: The relationship between survival rate following pediatric out-of-hospital cardiac arrests (OHCAs) and time of day or day of week is unknown.

Methods: A nationwide, prospective, population-based observational investigation of consecutive witnessed pediatric OHCAs (<18 years) with resuscitation attempts was conducted from January 2005 to December 2011. Days were defined as 9:00 am to 4:59 pm, nights as 5:00 pm to 8:59 am, weekdays as Mondays to Fridays, and weekends as Saturdays, Sundays, and national holidays. Primary outcome was one-month survival and secondary outcome was survival with favorable neurologic outcome, defined as cerebral performance category 1 or 2.

Results: A total of 3278 bystander-witnessed pediatric OHCAs were registered. One month survival rate was significantly lower during nights than days (15.5% [95% CI: 13.8-17.2%] versus 23.3% [95% CI: 21.1-25.6%]; P<0.001 and during weekends/holidays (15.7% [95% CI: 13.6-18.0%] than weekdays (20.4% [95% CI: 18.7-22.2%]; P=0.001. Survival rate with favorable neurologic outcome was substantially lower during nights 7.5% [95% CI: 6.3-8.8%] than days (12.2% [95% CI: 10.6-14.1%]; P<0.001), and during weekends/holidays (7.7% [95% CI: 6.2-9.5%] than weekdays (10.4% [95% CI: 9.2-11.8%]; P=0.012). After adjusting for potential confounding factors, one-month survival rate remained significantly lower during nights compared to days (odds ratio 0.68; 95% CI: 0.56-0.82), and during weekends/holidays compared to weekdays (odds ratio 0.79; 95% CI, 0.65-0.97).

Conclusions: One-month survival rate following bystander-witnessed pediatric OHCAs was lower during nights and weekends/holidays than days and weekdays, even when adjusted for potentially confounding factors.