参考文献（No. 1〜20）
No. 1
[PubMed] No. 2
[PubMed]
Guidelines for pediatric life support.
Pediatric Life Support Working Party of the European Resuscitation Council.
Guidelines for paediatric life support. Paediatric Life Support Working
Party of the European Resuscitation Council.
The paediatric life support working party of the European Resuscitation Council
was set up in 1992 with the aim of producing guidelines for basic and advanced
paediatric resuscitation that would be acceptable throughout Europe. The
commonest cause of cardiac arrest in children is problems with the airway. The
resulting difficulties in breathing and the associated hypoxia rapidly cause a
severe bradycardia or asystole. In contrast, adults have primary cardiac events
resulting in ventricular fibrillation. This important difference in the
pathogenesis of paediatric and adult cardiac arrest is reflected in these
European Resuscitation Council guidelines, which complement those already
published for adults.
Publication Types: Guideline, Practice guideline No. 3
[PubMed]
Australian Resuscitation Council Guidelines.
Advanced Life Support Committee of the Australian Resuscitation Council.
Paediatric advanced life support.
Publication Types: Guideline, Practice guideline
No. 4
[PubMed]
The Melbourne Chart--a logical guide to neonatal resuscitation.
Roy RN, Betheras FR
Division of Paediatrics, Royal Women's Hospital, Carlton, Victoria.
Resuscitation of the asphyxiated infant is one of the great emergencies in
medical practice. Properly done, it can save many lives and greatly reduce the
morbidity resulting from hypoxic-ischaemic encephalopathy, but if it is ineptly
performed, the effects of hypoxic-ischaemic encephalopathy may be accentuated,
with resultant increased morbidity and even mortality. Other than
paediatricians, few practitioners have regular experience in neonatal
resuscitation: indeed many, including obstetricians, anaesthetists, general
practitioners and midwives may only rarely face the problem of severe asphyxia.
It is therefore essential for the occasional practitioner to have ready
reference to a logical guide to resuscitation. We have designed such a guide
which is widely distributed in delivery suites and operating theatres in
Victoria. Its basic form has been in use for over a decade and it has recently
been revised. Use of the chart assists the resuscitator to judge the level of
resuscitation required. It is our experience that much unnecessary intervention
occurs at resuscitation, and we believe the methods outlined in this schematic
chart represent a more conservative but logical approach to neonatal
resuscitation. The chart is based on the pathophysiological changes that occur
in perinatal asphyxia, directing the user to the appropriate manoeuvres
required
to correct those changes, depending on the degree of asphyxia which is
determined by clinical signs and by use of the Apgar score.
Publication Types: Guideline
No. 5
[PubMed] No. 6
[PubMed]
CPR and the single rescuer: at what age should you "call first" rather than
"call fast"?
Appleton GO, Cummins RO, Larson MP, Graves JR
Center for Evaluation of Emergency Medical Services, King County EMS
Division of
the Seattle-King County Department of Public Health.
STUDY OBJECTIVE: To determine whether the age-related frequency of ventricular
fibrillation (VF) in cardiac arrest supports the guideline that single rescuers
should "call first" for all victims of sudden collapse older than 8 years.
DESIGN: Analysis of data on all nontraumatic cardiac arrests treated by
emergency medical service (EMS) personnel in King County, Washington, between
1976 and 1992.
MEASUREMENTS: Age, initial cardiac rhythm, witnessed versus
unwitnessed status, whether patient was discharged alive. RESULTS: We analyzed
10,992 cardiac arrests. Initial rhythm was VF in 4,252 (40%) and non-VF in
6,740
(60%). VF frequencies were 3% (0 to 8 years old), 17% (8 to 30 years), and 42%
(30 years or older).
CONCLUSION: Most patients under age 30 were not in VF at
the time of EMS evaluation. Our data suggest that a "call fast" strategy may be
more effective when a single rescuer is present and the victim is between 8 and
30 years old.
Comments:
No. 7
[PubMed]
Out-of-hospital ventricular fibrillation in children and adolescents: causes
and
outcomes.
Mogayzel C, Quan L, Graves JR, Tiedeman D, Fahrenbruch C, Herndon P
Department of Pediatrics, University of Washington School of Medicine, Seattle.
SETTING:
Urban/suburban prehospital system.
PARTICIPANTS: Pulseless, nonbreathing
patients less than 20 years who underwent out-of-hospital resuscitation.
Patients with lividity or rigor mortis or who were less than 6 months old and
died of sudden infant death syndrome were excluded.
RESULTS: Ventricular
fibrillation was the initial rhythm in 19% (29 of 157) of the cardiac arrests.
Rhythm assessment was performed by the first responder in only 44% (69 of 157)
of patients. All three rhythm groups were similar in age distribution,
frequency
of intubation (96%), and vascular access (92%); 93% of ventricular fibrillation
patients were defibrillated. The causes of ventricular fibrillation were
distributed evenly among medical illnesses, overdoses, drownings, and trauma,
only two patients had congenital heart defects. Seventeen percent were
discharged with no or mild disability, compared with 2% of asystole/pulseless
electrical activity patients (P = .003).
CONCLUSION: Ventricular
fibrillation is
not rare in child and adolescent prehospital cardiac arrest, and these patients
have a better outcome than those with asystole or pulseless electrical
activity.
Earlier recognition and treatment of ventricular fibrillation might improve
pediatric cardiac arrest survival rates.
Comments:
No. 8
[PubMed]
Is pediatric resuscitation unique? Relative merits of early CPR and ventilation
versus early defibrillation for young victims of prehospital cardiac arrest.
Hazinski MF
Publication Types: Comment, Editorial
Comments:
Mogayzel C, Quan L, Graves JR, Tiedeman D, Fahrenbruch C, Herndon P
Department of Pediatrics, University of Washington School of Medicine, Seattle.
STUDY OBJECTIVE: To compare causes and outcomes of patients younger than 20
years with an initial rhythm of ventricular fibrillation versus asystole and
pulseless electrical activity. DESIGN: Retrospective cohort study. SETTING:
Urban/suburban prehospital system. PARTICIPANTS: Pulseless, nonbreathing
patients less than 20 years who underwent out-of-hospital resuscitation.
Patients with lividity or rigor mortis or who were less than 6 months old and
died of sudden infant death syndrome were excluded. RESULTS: Ventricular
fibrillation was the initial rhythm in 19% (29 of 157) of the cardiac arrests.
Rhythm assessment was performed by the first responder in only 44% (69 of 157)
of patients. All three rhythm groups were similar in age distribution,
frequency
of intubation (96%), and vascular access (92%); 93% of ventricular fibrillation
patients were defibrillated. The causes of ventricular fibrillation were
distributed evenly among medical illnesses, overdoses, drownings, and trauma,
only two patients had congenital heart defects. Seventeen percent were
discharged with no or mild disability, compared with 2% of asystole/pulseless
electrical activity patients (P = .003). CONCLUSION: Ventricular
fibrillation is
not rare in child and adolescent prehospital cardiac arrest, and these patients
have a better outcome than those with asystole or pulseless electrical
activity.
Earlier recognition and treatment of ventricular fibrillation might improve
pediatric cardiac arrest survival rates.
Appleton GO, Cummins RO, Larson MP, Graves JR
Center for Evaluation of Emergency Medical Services, King County EMS
Division of
the Seattle-King County Department of Public Health.
STUDY OBJECTIVE: To determine whether the age-related frequency of ventricular
fibrillation (VF) in cardiac arrest supports the guideline that single rescuers
should "call first" for all victims of sudden collapse older than 8 years.
DESIGN: Analysis of data on all nontraumatic cardiac arrests treated by
emergency medical service (EMS) personnel in King County, Washington, between
1976 and 1992. MEASUREMENTS: Age, initial cardiac rhythm, witnessed versus
unwitnessed status, whether patient was discharged alive. RESULTS: We analyzed
10,992 cardiac arrests. Initial rhythm was VF in 4,252 (40%) and non-VF in
6,740
(60%). VF frequencies were 3% (0 to 8 years old), 17% (8 to 30 years), and 42%
(30 years or older). CONCLUSION: Most patients under age 30 were not in VF at
the time of EMS evaluation. Our data suggest that a "call fast" strategy may be
more effective when a single rescuer is present and the victim is between 8 and
30 years old.
No. 9
[PubMed]
Pediatric patients requiring CPR in the prehospital setting.
Hickey RW, Cohen DM, Strausbaugh S, Dietrich AM
Section of Emergency Medicine, Columbus Children's Hospital.
SETTING: Pediatric ED.
PARTICIPANTS: Pediatric patients in prehospital cardiac arrest.
RESULTS: In
all,
95 patients were identified. Fifty-six had initial hospital care at the
pediatric ED (primary patients). The remaining 39 were transported to the
pediatric ED after initial care of another institution (secondary patients).
Forty-one percent of patients were younger than 1 year. Most arrests were
respiratory in origin; asystole was the most common dysrhythmia. Fifteen
patients (27%) survived to discharge. Fourteen of the survivors had return of
spontaneous circulation before ED arrival. Thirty-three patients were in arrest
on ED arrival; in 16 (48%) of these, return of spontaneous circulation
subsequently developed in the ED, and 1 survived to discharge. Two survivors,
including the survivor with return of spontaneous circulation in the ED, had
severe neurologic sequelae. Ten (26%) of the secondary patients survived. All
survivors had return of spontaneous circulation before arrival in the ED. Two
survivors had severe neurologic sequelae.
CONCLUSION: Most successfully
resuscitated pediatric arrest victims are resuscitated in the prehospital
setting and do not suffer severe neurologic injury. Most patients who
present to
the ED in continued arrest and survive to discharge have severe neurologic
injury.
Publication Types: Review, multicase
Comments:
No.10
[PubMed]
Audit of paediatric cardiopulmonary resuscitation.
Innes PA, Summers CA, Boyd IM, Molyneux EM
Department of Anaesthesia, Royal Liverpool Children's Hospital.
The causes and outcome of cardiopulmonary arrests were studied in a paediatric
hospital over a 12 month period. Forty five resuscitation attempts were made
involving 41 children and one adult. Twenty eight (68%) of the children were
under 1 year of age and 10 (24%) were neonates. Twenty one (47%) arrests were
primarily respiratory and 11 (24%) primarily cardiac in origin. Eighty two per
cent of the respiratory arrests had an initially successful outcome, compared
with 36% of the cardiac arrests. Overall 70% of cardiopulmonary resuscitation
attempts were initially successful. There were no survivors from resuscitation
attempts longer than 30 minutes. At 12 months after cardiopulmonary
resuscitation 15 (37%) of the children were still alive. The 11 children who
had
been neurologically normal before the arrest showed no evidence of neurological
damage after successful cardiopulmonary resuscitation.
No.11
[PubMed]
CPR in children.
Zaritsky A, Nadkarni V, Getson P, Kuehl K
Department of Anesthesiology, Children's Hospital National Medical Center,
Washington, DC.
CPR has not been well studied in children and little is known about factors
predictive of outcome. We conducted a study with three goals: longitudinal
determination of demographic and laboratory data characterizing pediatric
arrest victims; identification of factor(s) predictive of outcome; and
determination of the prevalence of ionized hypocalcemia in pediatric arrest
victims. All resuscitation efforts were documented during a one-year period in
a 240-bed tertiary care children's hospital. Patients were classified into two
groups--respiratory arrest (RA, requiring only assisted ventilation), and
cardiac arrest (CA, absence of palpable cardiac activity requiring closed-chest
CPR). Collected data and laboratory tests were analyzed using a step-wise
discriminant analysis to determine which factors were predictive of outcome.
There were 113 arrests in 93 children; 53 were CA victims and 40 were RA
victims. CA had a high in-hospital mortality (90.6%) compared to RA (32.5%).
The population was young (55% less than 1 year old) and 87% had at least one
chronic underlying disease. No laboratory or demographic value was
significantly associated with eventual outcome. The number of doses of
epinephrine in CA victims, or bicarbonate in RA victims, was associated with
eventual outcome. None of 31 CA victims receiving more than two doses of
epinephrine survived to discharge. Low ionized calcium concentrations (less
than 3.5 mg/dL) were identified in ten patients; septic shock was present in
seven, and chronic renal failure in two.
No.12
[PubMed]
Death and resuscitation in the pediatric emergency department.
Teach SJ, Moore PE, Fleisher GR
Division of Emergency Medicine, Children's Hospital of Buffalo, USA.
DESIGN: Retrospective
case series of patients from July 1987 to June 1993.
SETTING: Urban, tertiary
care pediatric ED. PARTICIPANTS: All patients who sustained cardiopulmonary or
respiratory arrest while in the ED.
RESULTS: Thirty-two cases of
cardiopulmonary (n = 18) or respiratory arrest (n = 14) were identified, for an
incidence of 1.2 arrests per 10,000 patient visits. Causes of arrest varied
widely. Excluding those patients with do-not-resuscitate orders (n = 2), an
initial response to resuscitative efforts was obtained in 22 of 30 (73%)
patients. Overall rates of survival to discharge from the ED and from the
hospital were 21 of 30 (70%) and 15 of 30 (50%), respectively. Of those
patients who survived to hospital discharge, 12 of 15 (80%) were discharged at
a baseline level of overall function.
CONCLUSION: Cardiopulmonary or
respiratory arrest in the pediatric emergency department is rare. The rate of
survival of such an arrest is superior to that in outpatient arrests but
inferior to that in inpatient arrests.
No.13
[PubMed]
Pediatric cardiopulmonary arrests in rural populations.
Thompson JE, Bonner B, Lower GM Jr
Dept of Pediatrics, Gundersen Clinic, Ltd, La Crosse, WI 54601.
We reviewed emergency department records that spanned a period of 5 years at
seven rural hospitals to provide more specific data concerning pediatric
resuscitation. The purpose was to plan better for preventive programs and to
help rural health care providers prepare better for these difficult patients.
Patients entered in the study had either cardiorespiratory arrest or
respiratory arrest. Although the distribution by age was similar to studies
from other areas, the outcome for cardiorespiratory arrests was as bad or worse
(70 arrests with 3 survivors), and the outcome of respiratory arrests was as
good or better (25 arrests with 21 survivors) as reported previously. Survival
of arrest from trauma and accidents was markedly worse (16%) than survival from
nontraumatic arrests (44%). The etiologies of the arrests were dominated by
sudden infant death syndrome and pulmonary disease but with very few drownings
or farm-related fatalities. This study should encourage rural health care
providers to increase efforts in specific areas of trauma and accident
prevention. Also, respiratory illness needs to be monitored aggressively and
respiratory arrests treated more effectively to avoid the much more
consistently lethal cardiac arrests. In addition, more careful prospective
study of these patients may be able to identify care patterns that can be
improved to increase survival in these groups.
No.14
[PubMed]
Survey of 3765 cardiopulmonary resuscitations in British hospitals (the BRESUS
Study): methods and overall results.
Tunstall-Pedoe H, Bailey L, Chamberlain DA, Marsden AK, Ward ME, Zideman DA
Cardiovascular Epidemiology Unit, Ninewells Hospital and Medical School,
Dundee.
DESIGN--Hospitals
registered all cardiopulmonary resuscitation attempts for 12 months or longer
and followed survival to one year.
SETTING--12 metropolitan, provincial,
teaching, and non-teaching hospitals across Britain. SUBJECTS--3765 patients in
whom a resuscitation attempt was performed, including 927 in whom the onset of
arrest was outside the hospital.
MAIN OUTCOME MEASURE--Survival after initial
resuscitation, at 24 hours, at discharge from hospital, and at one year,
calculated by the life table method.
RESULTS--There were 417 known survivors at
one year, with 214 lost to follow up. By life table analysis for every eight
attempted resuscitations there were three immediate survivors, two at 24 hours,
1.5 leaving hospital alive, and one alive at one year. Survival at one year was
12.5% including out of hospital cases and 15.0% not including these cases. Each
hospital year averaged 30 survivors at one year: three who had an arrest
outside hospital, seven who had one in the accident and emergency department,
seven in the cardiac care unit, 10 in the general wards, and three in other,
non-ward areas. Within the hospitals survival rates were best in those who had
an arrest in the accident and emergency department, the cardiac care unit, or
other specialised units. Outcome varied 12-fold in subgroups defined by age,
type of arrest, and place of arrest.
CONCLUSION--71% of the mortality at one
year in patients undergoing attempted resuscitation occurred during the initial
arrest. Hospital resuscitation is life saving and cost effective and warrants
appropriate attention, training, coordination, and equipment.
Comments:
No.15
[PubMed]
Epidemiology of cardiac arrest and resuscitation in children.
Eisenberg M, Bergner L, Hallstrom A
A surveillance system identified all out-of-hospital cardiac patients under the
age of 18 who received emergency care in suburban King County, Washington. The
etiology, cardiac rhythm, and outcome were identified for each case. During a 6
1/2-year period, 119 cardiac arrests occurred (annual incidence, 12.7/100,000
among individuals less than 18). Sudden infant death was the most common
etiology (32%), and drowning was the second most common (22%). The most common
rhythm was asystole, accounting for 66% of all rhythms. Six percent of patients
treated with basic EMT care were discharged, compared with 7% of patients
treated with EMT and paramedic care. In contrast to resuscitation from cardiac
arrest in adults, the likelihood of successful resuscitation in children is
very poor. This is due to different etiologies and the higher proportion of
asystole seen in pediatric cardiac arrest as compared with adults.
No.16
[PubMed]
Terminal cardiac electrical activity in pediatric patients.
Walsh CK, Krongrad E
Ventricular fibrillation (VF) is a frequently reported terminal cardiac
electrical activity in adults. Such data are unavailable for pediatric
patients. Terminal cardiac electrical activity determined in 100 pediatric
patients was bradycardic arrest throughout the death process in 88% of
newborns, 67% of infants, and 64% of children. Although bradycardic arrest was
more common, the incidence of ventricular tachyarrhythmias was higher in
patients who had congenital heart disease, who had received cardiopulmonary
resuscitation, who were beyond the neonatal period, and/or who weighed greater
than 2.23 kg. No definite associations could be established between arterial
blood gases, electrolyte values, and type of terminal cardiac electrical
activity. The development of VF may be related to cardiac mass and the
developing autonomic nervous system and therefore is less likely to occur in
patients with a small heart.
No.17
[PubMed]
High-dose epinephrine in pediatric out-of-hospital cardiopulmonary arrest.
Dieckmann RA, Vardis R
Department of Emergency Services, San Francisco General Hospital, CA 94110,
USA.
SETTING. Prehospital emergency medical services (EMS) system of a large
metropolitan region.
PATIENTS. All children younger than 18 years of age, who
suffered nontraumatic CPA, did not meet local EMS criteria for death in the
field, and were treated by paramedics according to EMS pediatric CPA protocols.
INTERVENTIONS. Paramedics administered HDE (> 0.1 mg/kg), SDE (< 0.1 mg/kg), or
no epinephrine (NE), based on base hospital physician order and availability of
access for drug delivery. Protocols permitted either HDE or SDE. The drug was
given through an endotracheal tube, intraosseous line, or intravenous line.
MAIN
OUTCOME MEASURES. Return of spontaneous circulation (ROSC) and return of an
organized electrical rhythm (ROER) in the ambulance and emergency department,
hospital admission, hospital discharge, and short- and long-term neurologic
outcome by pediatric cerebral performance category (PCPC) score.
RESULTS.
During
the study period, 65 children met inclusion criteria and underwent attempted
out-of-hospital resuscitation. Forty patients (62%) received HDE (mean dose +/-
SD, 0.19 +/- 0.06 mg/kg); 13 patients (20%) received SDE (mean dose +/- SD,
0.02
+/- 0.02 mg/kg); and 12 patients (18%) received NE. The HDE and SDE groups were
statistically different only in epinephrine dose but not in age, gender,
proportion of asystolic presenting rhythms, success of endotracheal tube
intubation or intraosseous line insertion, rate of ROSC, rate of ROER,
survival,
or proportion of sudden infant death syndrome final diagnoses. Fifty-four
children (83%) presented in asystole, 5 (8%) had pulseless electrical activity
(PEA), and 6 (9%) had ventricular fibrillation (VF). None presented with either
supraventricular tachycardia or ventricular tachycardia. Thirty-nine patients
receiving HDE had asystole or VF as presenting rhythms, 4 (10%) had ROER, and 1
had ROSC. The single child receiving HDE presenting with PEA did not have ROSC.
Ten patients receiving SDE had asystole or VF, 2 (20%) had ROER, and none had
ROSC. There were 3 children receiving SDE who had PEA, and 1 had ROSC. Eleven
patients receiving NE had asystole or VF, and none had ROER. One child
receiving
NE had PEA and ROSC. Altogether, 1 patient receiving HDE, 1 receiving SDE,
and 1
receiving NE had ROSC in the field, which continued in the emergency
department;
all 3 were admitted to the hospital. Two children (3%), 1 receiving HDE and 1
receiving SDE, survived to hospital discharge. The survivor receiving HDE had
spastic quadriplegia and profound neurologic handicaps at discharge, with a
PCPC
score of 4 (severe disability with daily living milestones below the 10th
percentile and excessive dependence on others for provision of activities of
daily living); at a 1-year follow-up, she had a PCPC score of 4. The survivor
receiving SDE was neurologically healthy at discharge; at discharge and at
follow-up at age 1 year, she had a PCPC score of 1 (age-appropriate level of
functioning and developmentally appropriate).
CONCLUSIONS. HDE does not seem to
improve the rates of ROER and ROSC, hospital admission, survival, or neurologic
outcome when compared with SDE for treatment of out-of-hospital pediatric
CPA. A
large, blinded prospective clinical trial testing different epinephrine
doses is
necessary to determine drug efficacy and safety. Future pediatric CPA studies
must standardize reporting of core data elements, using the adult Utstein
criteria modified for pediatrics, to allow valid treatment comparisons.
Overall,
survival in out-of-hospital pediatric CPA is dismal.
No.18
[PubMed]
Prehospital countershock treatment of pediatric asystole.
Losek JD, Hennes H, Glaeser PW, Smith DS, Hendley G
Department of Pediatrics, Medical College of Wisconsin, Milwaukee 53201.
Prehospital care was retrospectively reviewed in 117 pulseless nonbreathing
(PNB) pediatric patients (0 to 18 years of age) to determine the effects of
immediate countershock treatment of asystole. Of 90 (77%) children with an
initial rhythm of asystole, 49 (54%) received countershock treatment. Rhythm
change occurred in ten (20%) of the asystolic children who received
countershock
treatment. Three of the countershocked asystolic children were successfully
resuscitated, but none survived. Rhythm change occurred in nine (22%) of the
asystolic children not countershocked. Six were successfully resuscitated, and
one survived. The two groups (countershocked asystole v noncountershocked
asystole) did not differ significantly in age, sex, witnessed arrest, witnessed
arrest with bystander basic life support (BLS), prehospital endotracheal
intubation, both intubation and vascular access success, or diagnosis. However,
prehospital vascular access was successfully established in a significantly
greater number of countershocked patients (P less than .05). The mean times to
the scene, at the scene, and to the hospital for the countershocked v
noncountershocked asystolic patients were 6.2, 23.8, and 6.1 v 5.9, 14.7 and
7.0
minutes. The mean time at the scene was significantly greater in the
countershock group (P less than .001). The successful performance of
prehospital
endotracheal intubation was significantly associated with rhythm change (P less
than .05). Patients age, witnessed arrest, witnessed arrest with bystander BLS,
successful establishment of prehospital vascular access, diagnosis, and
countershock treatment were not significantly associated with rhythm change. In
conclusion, prehospital countershock treatment prolonged prehospital care time
and was not associated with rhythm change in asystolic children. Therefore,
prehospital countershock treatment of asystolic children is not recommended.
No.19
[PubMed]
Outcome and cost at a children's hospital following resuscitation for
out-of-hospital cardiopulmonary arrest.
Ronco R, King W, Donley DK, Tilden SJ
Department of Pediatrics, University of Alabama at Birmingham.
DESIGN: Retrospective case series.
SETTING: An organized prehospital emergency medical system within Birmingham,
Ala, in a county with 150,493 children under the age of 15 years.
PATIENTS:
Sixty-three pediatric victims of out-of-hospital cardiopulmonary arrest of any
cause presenting to the emergency department of a children's hospital.
INTERVENTION: Standard resuscitative techniques were performed for all patients
until resuscitative efforts were discontinued in the hospital emergency
department or successful resuscitation was achieved.
MAIN OUTCOME MEASURES:
Successful resuscitation, survival to hospital discharge, neurological outcome,
final disposition, and cost of hospital care. RESULTS: Of 63 children with
out-of-hospital cardiopulmonary arrest treated in the emergency department of a
children's hospital, 60 were pulseless and apneic on arrival, 18 (28.6%) were
successfully resuscitated and admitted to the intensive care unit, and six
(9.5%) were discharged from the hospital. Five of the survivors had severe
neurological deficits and one appeared normal. On follow-up, two patients had
died (1 month and 7 months after discharge), three were in a vegetative state,
and one was normal. The normal patient had successful defibrillation prior to
arrival at the emergency department. The average inpatient charge was $10,667
per patient for those who died and $100,000 for those discharged.
CONCLUSIONS:
Aggressive treatment does not lead to intact survival for victims of
out-of-hospital cardiopulmonary arrest who present to the pediatric emergency
department with a preterminal rhythm and absence of spontaneous circulation.
Resuscitation efforts in the emergency department are commonly successful but
lead to death or severe neurological sequelae at discharge with extremely high
cost of care.
Publication Types: Clinical trial
No.20
[PubMed]
Appraisal of pediatric cardiopulmonary resuscitation.
Friesen RM, Duncan P, Tweed WA, Bristow G
Sixty-six patients more than 30 days and less thant 16 years of age
suffering an
unexpected cardiac arrest in an 18-month period were included in a study of
resuscitative measures in children. Six children survived to be discharged from
hospital. Respiratory disease accounted for most (29%) of the cardiac arrests,
but it also had the most favourable prognosis, 21% of the 19 patients
surviving.
None of the patients survived whose cardiac arrest was secondary to sepsis or
trauma, even when the resuscitative efforts were initially successful. Only
1 of
the 41 patients who had a cardiac arrest outside of hospital survived, and only
1 of the 34 patients who presented with asystole survived, and then with
considerable damage to the central nervous system. The interval between cardiac
arrest and application of basic life support was substantially shorter among
the
survivors. Also, most of the survivors did not present with asystole. The
results of this study suggest that survival among resuscitated children is no
better than that among adults but can be improved with early recognition and
monitoring of children at risk. earlier application of basic and advanced life
support, improved education of medical and lay personnel, and further research
into pediatric resuscitative techniques.
Hazinski MF
Publication Types: Comment, Editorial
Quan L, Mogayzel C
Publication Types: Comment, Letter
STUDY OBJECTIVE: To compare causes and outcomes of patients younger than 20
years with an initial rhythm of ventricular fibrillation versus asystole and
pulseless electrical activity. DESIGN: Retrospective cohort study.
Hazinski MF
Publication Types: Comment, Editorial
Quan L, Mogayzel C
Publication Types: Comment, Letter
STUDY OBJECTIVE: To determine the outcome of pediatric patients with
prehospital
cardiopulmonary arrest. DESIGN: Chart review of all patients with prehospital
cardiopulmonary arrest who were subsequently admitted to a pediatric emergency
department from January 1988 to January 1993. Cardiopulmonary arrest was
considered to have been present if assisted ventilation and chest compressions
were performed on an apneic, pulseless patient.
To the Editor:
Linda Quan, MD, FACEP, FAAP
Cyndra Mogayzel, MD
Department of Pediatrics
University of Washington School of Medicine
Seattle, Washington
STUDY OBJECTIVE: To describe a population of patients who arrived in a
pediatric emergency department with pulse and respirations but then sustained
cardiopulmonary or respiratory arrest while in the ED.
OBJECTIVE--To determine the circumstances, incidence, and outcome of
cardiopulmonary resuscitation in British hospitals.
OBJECTIVE. To compare the efficacy of high-dose epinephrine (HDE) and
standard-dose epinephrine (SDE) for out-of-hospital treatment of pediatric
cardiopulmonary arrest (CPA). DESIGN. Forty-eight-month retrospective cohort
study.
OBJECTIVE: To determine the outcome and cost for children resuscitated
following
out-of-hospital cardiopulmonary arrest.
（小児の心肺蘇生法）