Physician-researchers from the Cardiac Center at Children's Hospital of Philadelphia (CHOP) recently presented new findings on pediatric cardiovascular disease at the American Heart Association's Scientific Sessions 2017 in Anaheim, Calif. Among many abstracts presented were research on racial disparities in bystander CPR methods in children with sudden cardiac arrest, and findings that children with hypertrophic cardiomyopathy may be at risk for sudden cardiac death. Both abstracts were highlighted in the featured oral abstract sessions during the Resuscitation Symposium and the Congenital Heart Disease Session at the conference.
Race, ethnicity and neighborhood socioeconomic characteristics are associated with the use of bystander cardiopulmonary resuscitation (CPR) for pediatric out-of-hospital cardiac arrest. Researchers from Children's Hospital of Philadelphia analyzed the Cardiac Arrest Registry to Enhance Survival database for pediatric non-traumatic out-of-hospital cardiac arrest in the United States from January 1, 2013 through December 31, 2016. There were 5,049 out-of-hospital cardiac arrests in children. White and black children comprised the largest racial/ethnic groups, followed by Hispanic and other groups. Bystander CPR was provided in 49 percent of cases. Bystander CPR was more common in white neighborhoods, where it was provided in 54 percent of cardiac arrests, than in non-white neighborhoods where it was provided in 38 percent of arrests. Bystander CPR was also more common in neighborhoods with higher income and lower unemployment. Higher socioeconomic status was associated with increased bystander CPR and increased survival with favorable neurological outcome. "Our previous work (published in JAMA Pediatrics) had shown a racial disparity in bystander CPR provision and outcome following pediatric out-of-hospital cardiac arrest," said Maryam Naim, MD, pediatric cardiac intensivist at CHOP and the study's lead author. "However, we were unsure if this was a true racial disparity or possibly related to socioeconomic factors such as income and education. Our current work shows that the racial disparity exists in the provision of bystander CPR, but as most CPR is provided by family members, this is likely because of lack of training on bystander CPR and recognition of cardiac arrest. Targeted CPR training in low-income, non-white communities may increase the bystander CPR rates and improve outcome from cardiac arrest in children," added Naim.
Maryam Y. Naim et al. Race/Ethnicity and Socioeconomic Factors are Associated with Bystander CPR in Pediatric Out of Hospital Cardiac Arrest in the United States: A Study from the Cardiac Arrest Registry to Enhance Survival (CARES). Presented at the AHA Scientific Sessions.
Children with hypertrophic cardiomyopathy (HCM) may be at risk for sudden cardiac death (SCD). Researchers from Children's Hospital of Philadelphia collected retrospective data on children with HCM at 35 U.S. and international centers, to perform risk stratification. The study included 614 patients aged 20 or younger, of whom 448 (73 percent) had implantable cardioverter defibrillators (ICDs). Posterior left ventricle wall thickness was the most important risk factor in this study. Other risk factors evaluated for SCD in this pediatric population included history of fainting, family history of SCD, interventricular wall thickness, co-existent Wolff-Parkinson-White syndrome and inferior leads on ECG. Left outflow tract obstruction was not associated with SCD. The researchers recommend establishing an international prospective registry of children with HCM to gain more insight into risk factors.
Seshadri Balaji, Maully Shah et al. Risk Stratification for Sudden Death in Children with Hypertrophic Cardiomyopathy: an international multi-center study. Presented at the AHA Scientific Sessions. This research received the 2017 American Heart Association's Council on Cardiovascular Disease in the Young's 2017 CVDY Outstanding Research Award in Pediatric Cardiology.
Note to media: For more information, or to speak with the author of either abstract presented at the A.H.A. Scientific Sessions, please contact Joey McCool Ryan at McCool@email.chop.edu or 267-426-6070.
About Children's Hospital of Philadelphia: Children's Hospital of Philadelphia was founded in 1855 as the nation's first pediatric hospital. Through its long-standing commitment to providing exceptional patient care, training new generations of pediatric healthcare professionals and pioneering major research initiatives, Children's Hospital has fostered many discoveries that have benefited children worldwide. Its pediatric research program is among the largest in the country. In addition, its unique family-centered care and public service programs have brought the 546-bed hospital recognition as a leading advocate for children and adolescents. For more information, visit http://www.chop.edu.