PEDIATRIC INJURIES FROM CARDIOPULMONARY-RESUSCITATION

Study objective: To assess the type, rate, and severity of unanticipat ed complications of CPR (external cardiac compressions and ventilation ) in a pediatric population. Methods: A retrospective review was under taken of the records from all deceased children (<12 years old) who ha d been given CPR during an 8-year period (1988 through 1995). Patients with historical or physical evidence of preceding trauma were exclude d. Clinical and autopsy records were abstracted for patient demographi cs, clinical findings, duration of CPR, persons administering CPR, and medical examiner summaries. Results: Two hundred eleven children (mea n age, 19.0 months) met the inclusion criteria and were entered into t he study. The most common cause of cardiac arrest was sudden infant de ath syndrome (56%), followed by drowning (8%), congenital heart diseas e (7%), and pneumonia (4%). Mean duration of CPR was 45 minutes (range , 3 to 180 minutes). Fifteen children (7%) had at least one injury as a result of CPR; 7 (3%) had injuries that were considered medically si gnificant. These included retroperitoneal hemorrhage (n=2), pneumothor ax (n=1), pulmonary hemorrhage (n=1), epicardial hematoma (n=1), and g astric perforation (n=1); in spite of prolonged resuscitation performe d with variable degrees of skill, only one patient was noted to have r ib fractures. Conclusion: Significant iatrogenic injuries are rare in children who receive CPR; they occur in approximately 3% of cases. Rec ognizing the possibility of a complication may help in the management of children who survive cardiac arrest. Regardless of resuscitation hi story, abuse should be considered whenever traumatic injuries are-enco untered..