{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T15:42:36Z","timestamp":1793374956306,"version":"4.5.0"},"reference-count":36,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>For pediatric out-of-hospital cardiac arrest (OHCA), emergency medical services (EMS) may elect to transport to the hospital during active cardiopulmonary resuscitation (CPR) (ie, intra-arrest transport) or to continue on-scene CPR for the entirety of the resuscitative effort. The comparative effectiveness of these strategies is unclear.<\/jats:p><\/jats:sec>Objective<\/jats:title>To evaluate the association between intra-arrest transport compared with continued on-scene CPR and survival after pediatric OHCA, and to determine whether this association differs based on the timing of intra-arrest transport.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study included pediatric patients aged younger than 18 years with EMS-treated OHCA between December 1, 2005 and June 30, 2015. Data were collected from the Resuscitation Outcomes Consortium Epidemiologic Registry, a prospective 10-site OHCA registry in the US and Canada. Data analysis was performed from May 2022 to February 2024.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Intra-arrest transport, defined as an initiation of transport prior to the return of spontaneous circulation, and the interval between EMS arrival and intra-arrest transport.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was survival to hospital discharge. Patients who underwent intra-arrest transport at any given minute after EMS arrival were compared with patients who were at risk of undergoing intra-arrest transport within the same minute using time-dependent propensity scores calculated from patient demographics, arrest characteristics, and EMS interventions. We examined subgroups based on age (&amp;lt;1 year vs \u22651 year).<\/jats:p><\/jats:sec>Results<\/jats:title>Of 2854 eligible pediatric patients (median [IQR] age, 1 [0-9] years); 1691 males [59.3%]) who experienced OHCA between December 2005 and June 2015, 1892 children (66.3%) were treated with intra-arrest transport and 962 children (33.7%) received continued on-scene CPR. The median (IQR) time between EMS arrival and intra-arrest transport was 15 (9-22) minutes. In the propensity score\u2013matched cohort (3680 matched cases), there was no significant difference in survival to hospital discharge between the intra-arrest transport group and the continued on-scene CPR group (87 of 1840 patients [4.7%] vs 95 of 1840 patients [5.2%]; risk ratio [RR], 0.81 [95% CI, 0.59-1.10]). Survival to hospital discharge was not modified by the timing of intra-arrest transport (P<\/jats:italic> value for the interaction between intra-arrest transport and time to matching\u2009=\u2009.10). Among patients aged younger than 1 year, intra-arrest transport was associated with lower survival to hospital discharge (RR, 0.52; 95% CI, 0.33-0.83) but there was no association for children aged 1 year or older (RR, 1.22; 95% CI, 0.77-1.93).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study of a North American OHCA registry, intra-arrest transport compared with continued on-scene CPR was not associated with survival to hospital discharge among children with OHCA. However, intra-arrest transport was associated with a lower likelihood of survival to hospital discharge among children aged younger than 1 year.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.11641","type":"journal-article","created":{"date-parts":[[2024,5,20]],"date-time":"2024-05-20T15:32:40Z","timestamp":1716219160000},"page":"e2411641","source":"Crossref","is-referenced-by-count":12,"title":["Survival After Intra-Arrest Transport vs On-Scene Cardiopulmonary Resuscitation in Children"],"prefix":"10.1001","volume":"7","author":[{"given":"Masashi","family":"Okubo","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sho","family":"Komukai","sequence":"additional","affiliation":[{"name":"Division of Biomedical Statistics, Department of Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junichi","family":"Izawa","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, Okinawa, Japan"},{"name":"Department of Preventive Services, Graduate School of Public Health, Kyoto University, Kyoto, Japan"},{"name":"Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"SunHee","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Oregon Health and Science University, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian R.","family":"Drennan","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian E.","family":"Grunau","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua R.","family":"Lupton","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Oregon Health and Science University, Portland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sriram","family":"Ramgopal","sequence":"additional","affiliation":[{"name":"Division of Emergency Medicine, Ann & Robert H. 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