Pediatric Patients Requiring CPR in the Prehospital Setting☆,☆☆,★
Section snippets
INTRODUCTION
Several studies have examined the course and outcome of pediatric patients requiring CPR in the prehospital setting. We sought to increase the number of these patients described in the medical literature and in particular to describe the outcome of patients still requiring CPR on arrival in the emergency department.
MATERIALS AND METHODS
The computerized disease index of Columbus Children's Hospital (CCH) was searched for patients admitted to the ED from January 1988 to January 1993 with a history of cardiopulmonary arrest. Diagnostic categories selected for the search included cardiac arrest, respiratory arrest, drowning, ventricular fibrillation, ventricular tachycardia, asystole, CPR, death, and sudden infant death syndrome. Records identified with the initial search then were reviewed to determine the circumstances of the
RESULTS
Ninety-seven patients met the inclusion criteria. Two patients' records could not be located. Fifty-six patients had their initial hospital care at CCH. The remaining 39 underwent initial resuscitation at outside institutions and were transferred to CCH for further care. In general, outside institutions transport only successfully resuscitated patients to CCH; therefore the demographics and survival correlates of this population were confounded by selection bias and were considered separately
DISCUSSION
The age distribution and causes for arrest in this study are similar to those in other studies examining prehospital arrest.4, 5 However, the most common cause of arrest in this study was drowning; in other studies sudden infant death predominates.4, 5 Asystole and idioventricular electrical activity were the most common dysrhythmias, followed by ventricular fibrillation/ventricular tachycardia and pulseless electrical activity. This is in agreement with the findings of others.2, 5
The rate of
CONCLUSION
Most successfully resuscitated pediatric arrest victims are resuscitated in the prehospital setting, and most survivors who are successfully resuscitated in the prehospital setting do not sustain neurologic devastation. Although it is possible to temporarily resuscitate the pediatric patient who presents to the ED in continued cardiopulmonary arrest, survival to discharge is rare, and most sur vivors are neurologically devastated.
Acknowledgements
The authors thank Nicholas P Quelette, EMT-P; Nancy B Nelson, MSW, LISW; and Kimberly Kirtland, BA, for their help in collecting patient information.
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From the Section of Emergency Medicine, Columbus Children's Hospital, and the Department of Pediatrics, The Ohio State University;* and the College of Medicine, The Ohio State University.‡
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Address for reprints: Robert W Hickey, MD, Section of Emergency Medicine, Children's Hospital, 700 Children's Drive, Columbus, Ohio 43205, 614-722-4386, Fax 614-722-4380
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Reprint no. 47/1/63470