Pediatric Patients Requiring CPR in the Prehospital Setting,☆☆,

Presented at the Ambulatory Pediatrics Association/Society for Pediatric Research Annual Meeting Seattle, May 1994.
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Abstract

Study objective: To determine the outcome of pediatric patients with prehospital cardiopulmonary arrest.

Design: Chart review of all patients with prehospital cardiopulmonary arrest who were subsequently admitted to a pediatric emergency department from January 1988 to January 1993. Cardiopulmonary arrest was considered to have been present if assisted ventilation and chest compressions were performed on an apneic, pulseless patient. Setting: Pediatric ED. Participants: Pediatric patients in prehospital cardiac arrest. Results: In all, 95 patients were identified. Fifty-six had initial hospital care at the pediatric ED (primary patients). The remaining 39 were transported to the pediatric ED after initial care at another institution (secondary patients). Forty-one percent of patients were younger than 1 year. Most arrests were respiratory in origin; asystole was the most common dysrhythmia. Fifteen patients (27%) survived to discharge. Fourteen of the survivors had return of spontaneous circulation before ED arrival. Thirty-three patients were in arrest on ED arrival; in 16 (48%) of these, return of spontaneous circulation subsequently developed in the ED, and 1 survived to discharge. Two survivors, including the survivor with return of spontaneous circulation in the ED, had severe neurologic sequelae. Ten (26%) of the secondary patients survived. All survivors had return of spontaneous circulation before arrival in the ED. Two survivors had severe neurologic sequelae. Conclusion: Most successfully resuscitated pediatric arrest victims are resuscitated in the prehospital setting and do not suffer severe neurologic injury. Most patients who present to the ED in continued arrest and survive to discharge have severe neurologic injury. [Hickey RW, Cohen DM, Strausbaugh S, Dietrich AM: Pediatric patients requiring CPR in the prehospital setting. Ann Emerg Med April 1995;25:495-501.]

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.

References (22)

  • L Tsai et al.

    Epidemiology of pediatric prehospital care

    Ann Emerg Med

    (1987)
  • Cited by (200)

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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

    Reprint no. 47/1/63470

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