CHILDREN AND ADULTS IN CARDIOPULMONARY ARREST - ARE ADVANCED LIFE-SUPPORT GUIDELINES FOLLOWED IN THE PREHOSPITAL SETTING

Study objective: To compare the proportions of children and adults in whom advanced life support (ALS) guidelines for prehospital management of cardiopulmonary arrest. Methods: We conducted a retrospective cros s-sectional study of an urban EMS system and an urban ED. We studied 1 41 consecutive patients (47 children and 94 adults, matched by date of presentation) in cardiopulmonary arrest who were transported to the p ediatric and adult EDs by AIS-trained prehospital providers (paramedic s) between January 1992 and July 1995. We reviewed ambulance trip repo rts and ED records to determine when and which interventions were perf ormed in the prehospital setting. Significance of differences between the groups was determined with Fisher's exact test and Student's t tes t. Results: In 47 children (median age, 1 year; range, 2 days to 15 ye ars) and 94 adults (median age, 67 years; range, 16 to 95 years), puls elessness was documented at the time of the initial response of the AL S provider. Basic life support was performed in all patients. Among th e 21 children and 7 adults who were not intubated, intubation was atte mpted in 13 children (62%) and in 6 adults (86%) (P=.26). Among the 29 children and 16 adults in whom intravascular access was not establish ed, unsuccessful attempts to establish access were made in 1 child (3% ) and in 15 adults (94%) (P=.0001). Among the 30 children and 91 adult s who were intubated, in whom intravascular access was established, or both, epinephrine was not administered to 12 children (40%) and 6 adu lts (7%) (P<.0001). Conclusion: In our study population endotracheal i ntubation, intravascular access, and administration of epinephrine wer e attempted and performed significantly less frequently in children th an in adults. Given the relative infrequency with which ALS providers encounter children in cardiopulmonary arrest, they need additional tra ining to maintain their skills.