OUTCOME AND COST AT A CHILDRENS-HOSPITAL FOLLOWING RESUSCITATION FOR OUT-OF-HOSPITAL CARDIOPULMONARY ARREST

Objective: To determine the outcome and cost for children resuscitated following out-of-hospital cardiopulmonary arrest. Design: Retrospecti ve case series. Setting: An organized prehospital emergency medical sy stem within Birmingham, Ala, in a county with 150 493 children under t he age of 15 years. Patients: Sixty-three pediatric victims of out-of- hospital cardiopulmonary arrest of any cause presenting to the emergen cy department of a children's hospital. Intervention: Standard resusci tative techniques were performed for all patients until resuscitative efforts were discontinued in the hospital emergency department or succ essful resuscitation was achieved. Main Outcome Measures: Successful r esuscitation, survival to hospital discharge, neurological outcome, fi nal disposition, and cost of hospital care. Results: Of 63 children wi th out-of-hospital cardiopulmonary arrest treated in the emergency dep artment of a children's hospital, 60 were pulseless and apneic on arri val, 18 (28.6%) were successfully resuscitated and admitted to the int ensive care unit, and six (9.5%) were discharged from the hospital. Fi ve of the survivors had severe neurological deficits and one appeared normal. On followup, two patients had died (1 month and 7 months after discharge), three were in a vegetative state, and one was normal. The normal patient had successful defibrillation prior to arrival at the emergency department. The average inpatient charge was $10 667 per pat ient for those who died and $100 000 for those discharged. Conclusions : Aggressive treatment does not lead to intact survival for victims of out-of-hospital cardiopulmonary arrest who present to the pediatric e mergency department with a preterminal rhythm and absence of spontaneo us circulation. Resuscitation efforts in the emergency department are commonly successful but lead to death or severe neurological sequelae at discharge with extremely high cost of care.