OUTCOME AND COST OF OPEN-CHEST AND CLOSED-CHEST CARDIOPULMONARY-RESUSCITATION IN PEDIATRIC CARDIAC ARRESTS

Objective. The dismal survival rates of cardiac arrest in children man aged with conventional closed-chest cardiopulmonary resuscitation (CC- CPR) have renewed interest in the use of open-chest CPR (OC-CPR). We d etermined the efficacy of the early use of OC-CPR in children after ca rdiac arrest. Methods. A retrospective review of emergency medical ser vices (EMS) and hospital records revealed 27 children who were brought to the emergency department under CPR after blunt trauma. Results. Tw elve children had CC-CPR and 15 children underwent OC-CPR. Prehospital resuscitation and transport of both groups of children was excellent by current standards, and OC-CPR was performed within 5 minutes of arr ival in the emergency department. CPR was successful with restoration of spontaneous circulation in 17% of children after CC-CPR, whereas 20 % of children had restoration of spontaneous circulation after OC-CPR. This difference was not statistically significant. None of the childr en regained consciousness or survived to discharge. The hospital charg es for patients who underwent OC-CPR were significantly higher (P = .0 05). Less than 30% of the hospital charges were reimbursed in both gro ups. Conclusions. OC-CPR does not improve survival in children who sus tain cardiac arrest and receive CPR for more than 20 minutes in the fi eld. Under these circumstances OC-CPR is an expensive and futile proce dure to undertake.