PEDIATRIC CARDIAC-ARREST AND RESUSCITATION PROVIDED BY PHYSICIAN-STAFFED EMERGENCY CARE UNITS

Background: Most paediatric cardiac arrest studies have been conducted in the USA, where paramedics provide prehospital emergency care. We w anted to study the outcome of paediatric cardiac arrest patients in an emergency medical system which is based on physician staffed emergenc y care units. Methods: We analysed retrospectively the files of 100 pr ehospital cardiac arrest patients from Southern Finland during a 10-ye ar study period. The patients were less than 16 years of age. Results: Fifty patients were declared dead on the scene (DOS) without attempte d resuscitation, and cardiopulmonary resuscitation (CPR) was initiated in 50 patients. The sudden infant death syndrome was the mast common cause of arrest in the DOS patients (68%) as well as in those receivin g CPR (36%). Asystole was the initial cardiac rhythm in 70% of the pat ients in whom CPR was attempted. Resuscitation was successful in 13 pa tients, 8 of whom were ultimately discharged. Six of the patients surv ived with mild or no disability and 4 of them had near-drowning aetiol ogy. In multivariate analysis, the short duration of CPR (less than or equal to 15 min) was the only factor significantly associated with be tter survival. Conclusions: Although prehospital care was provided by physicians, the overall rate of survival was found to be equally poor as reported from systems with paramedics. The only major difference be tween physician- and paramedic-staffed emergency care units is the abi lity of physicians to refrain from resuscitation already on the scene when prognosis is poor. (C) Acta Anaesthesiologica Scandinavica 41 (19 97).