USE AND EFFECT OF PEDIATRIC ADVANCED LIFE-SUPPORT SKILLS FOR PEDIATRIC ARREST IN THE A-AND-E DEPARTMENT

Objectives-To define the use of paediatric advanced life support by th e Leicestershire Ambulance and Paramedic Service (LAPS) and the A&E de partment of a large university teaching hospital; and to identify the outcome and determine the factors that are consistent with a successfu l outcome. Subjects and methods-The prehospital, accident and emergenc y (A&E), and inpatient notes of all patients aged 0-16 years who had b een admitted to the resuscitation room at the Leicester Royal Infirmar y in cardiac arrest between 1 January 1992 and 31 December 1995 were r eviewed. Cardiac arrest was defined according to the Utstein template for reporting of prehospital data. Results-During the four year period , 51 cases of paediatric cardiac arrest were identified, with a median age of 3.2 years (range two days to 15 years). In eight patients, res uscitation was not attempted. Of the remaining 43, 15 (37%) were disch arged from A&E to the intensive care unit. Five (11.5%) ultimately sur vived to discharge from hospital. Subsequent neurological development was recorded as normal in four of the five. Of the patients who had a prehospital cardiac arrest and were initially resuscitated by the LAPS there was only one survivor. He was discharged from hospital with sev ere neurological injury and died three months later. Conclusions-The o utcome for established prehospital paediatric cardiac arrest, in a wel l defined emergency medical services system, is very poor at present. It does not seem to be affected by the institution of paediatric life support teaching programmes for hospital staff alone. The timing in in stituting advanced life support measures remains the most critical fac tor affecting outcome in these patients.