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PEDIATRICS Vol. 114 No. 1 July 2004, pp. 157-164

A Prospective, Population-Based Study of the Epidemiology and Outcome of Out-of-Hospital Pediatric Cardiopulmonary Arrest

Kelly D. Young, MD, MS*,{ddagger},§, Marianne Gausche-Hill, MD{ddagger},§,||,¶, Christian D. McClung, MD, MPhil#,** and Roger J. Lewis, MD, PhD{ddagger},§,||

* Departments of Pediatrics
|| Departments of Medicine, David Geffen University of California Los Angeles School of Medicine, Los Angeles, California
{ddagger} Emergency Medicine
# Surgery, Harbor-University of California Los Angeles Medical Center, Torrance, California
§ Harbor-University of California Los Angeles Research and Education Institute, Los Angeles, California
Little Company of Mary Hospital, Torrance, California
** Department of Emergency Medicine, University of Southern California Medical Center, Los Angeles, California

Background. This study reports the epidemiologic features, survival rates, and neurologic outcomes of the largest population-based series of pediatric out-of-hospital cardiopulmonary arrest patients with prospectively collected data.

Methods. Secondary analysis of data from a prospective, interventional trial of out-of-hospital pediatric airway management conducted from 1994 to 1997 (Gausche M, Lewis RJ, Stratton SJ, et al. JAMA. 2000;283:783-790). Consecutive out-of-hospital patients from 2 large urban counties in California <12 years old or 40 kg in bodyweight who were determined by paramedics to be pulseless and apneic were included. Main outcome measures included survival to hospital discharge, patient demographics, arrest etiology, arrest rhythm, event intervals, and neurologic outcomes.

Results. In 599 patients, 601 events were studied (54% were <1 year old, 58% were male). Return of spontaneous circulation was achieved in 29%; 25% were admitted to the hospital, and 8.6% (51) survived to hospital discharge. The most prevalent etiologies were sudden infant death syndrome and trauma; these resulted in relatively higher mortality. Respiratory etiologies and submersions followed; these resulted in relatively lower mortality. Twenty-six percent of the arrests were witnessed by citizens, and an additional 8% were witnessed by rescue personnel. Witnessed arrests had a higher survival rate (16%). Thirty-one percent of patients received bystander cardiopulmonary resuscitation, which was not demonstrated to result in improved survival rates. Arrest rhythms were asystole (67%), pulseless electrical activity (24%), and ventricular fibrillation (9%); children with the latter 2 rhythms had better survival rates. One third of the survivors (16 of 51) had good neurologic outcome, none of whom received >3 doses of epinephrine or were resuscitated for >31 minutes in the emergency department.

Conclusions. The 8.6% survival rate after out-of-hospital pediatric cardiopulmonary arrest is poor. Administration of >3 doses of epinephrine or prolonged resuscitation is futile.

Key Words: cardiopulmonary arrest • cardiopulmonary resuscitation • out-of-hospital • prehospital • pediatric

Abbreviations: EMS, emergency medical services • BMV, bag-mask ventilation • CPR, cardiopulmonary resuscitation • ED, emergency department • ROSC, return of spontaneous circulation • PCPC, Pediatric Cerebral Performance Category • PEA, pulseless electrical activity • IQR, interquartile range • SIDS, sudden infant death syndrome • VF, ventricular fibrillation • VT, ventricular tachycardia

Received for publication Sep 29, 2003; Accepted Jan 28, 2004.




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