PEDIATRIC-PATIENTS REQUIRING CPR IN THE PREHOSPITAL SETTING

Study objective: To determine the outcome of pediatric patients with p rehospital cardiopulmonary arrest. Design: Chart review of all patient s with prehospital cardiopul monary arrest who were subsequently admit ted to a pediatric emergency department from January 1988 to January 1 993. Cardiopulmonary arrest was considered to have been present if ass isted ventilation and chest compressions were performed on an apneic, pulseless patient. Setting: Pediatric ED. Participants: Pediatric pati ents in prehospital cardiac arrest. Results: In all, 95 patients were identified. Fifty-six had initial hospital care at the pediatric ED (p rimary patients). The remaining 39 were transported to the pediatric E D after initial care at another institution (secondary patients). Fort y-one percent of patients were younger than 1 year. Most arrests were respira tory in origin; asystole was the most common dysrhythmia. Fift een patients (27%) survived to discharge. Fourteen of the survivors ha d return of spontaneous circulation before ED arrival. Thirty-three pa tients were in arrest on ED arrival; in 16 (48%) of these, return of s pontaneous circulation subsequently developed in the ED, and 1 survive d to discharge. Two survivors, including the survivor with return of s pontaneous 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 se vere neurologic sequelae. Conclusion: Most successfully resuscitated p ediatric arrest victims are resuscitated in the prehospital setting an d do not suffer severe neurologic injury. Most patients who present to the ED in continued arrest and survive to discharge have severe neuro logic injury.