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Only 9 percent of children with out-of-hospital cardiopulmonary arrest survive, despite prolonged CPR and epinephrine

Only 9 percent of children who suffer an out-of-hospital cardiopulmonary arrest survive. Administration of more than three doses of epinephrine (adrenalin) or prolonged cardiopulmonary resuscitation (CPR) is futile, concludes the largest population-based study to date of cardiopulmonary arrest among pediatric patients.

Research to improve therapeutic measures and emergency medical services (EMS) protocols is needed. However, efforts to prevent conditions leading to out-of-hospital arrest (for example, sudden infant death syndrome [SIDS], burns, near-drowning, and poisoning) and community outreach to improve the rate of bystander CPR may have a greater impact on the survival of these children, suggests Marianne Gausche-Hill, M.D., of Harbor-University of California Los Angeles Medical Center.

In a study that was supported in part by the Agency for Healthcare Research and Quality (HS09065), the researchers conducted secondary analysis of data from an earlier trial (1994-1997) of out-of-hospital airway management of children 12 years of age or younger or weighing less than 40 kg. They studied 601 arrests in 599 children (54 percent were less than 1 year old, and 58 percent were male). Return of spontaneous circulation was achieved in 29 percent, 25 percent were admitted to the hospital, and 8.6 percent survived to hospital discharge. The most frequent causes of arrest were SIDS and trauma, followed by respiratory problems and near-drowning, which had relatively lower mortality.

One-third of the survivors (16 of 51) had good neurologic outcome. None of the survivors in this group received more than three doses of epinephrine or were resuscitated for longer than 31 minutes in the emergency department. Survival was higher when fewer doses of epinephrine were needed, and in nearly half (49 percent) of the survival events, no epinephrine was required. Bystander CPR was not demonstrated to result in improved survival rates in this study, although the time between arrest and discovery by the bystander may have been too long for them to benefit. There was, however, a nonsignificant trend toward higher survival for patients with witnessed arrests who received bystander CPR.

See "A prospective, population-based study of the epidemiology and outcome of out-of-hospital pediatric cardiopulmonary arrest," by Kelly D. Young, M.D., M.S., Dr. Gausche-Hill, Christian D. McClung, M.D., M.Phil., and Roger J. Lewis, M.D., Ph.D., in the July 2004 Pediatrics 114(1), pp. 157-163.

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