Pediatric resuscitation and emergency medical services

Characteristics and outcome of cardiorespiratory arrest in children

OBJECTIVE

To analyse the present day characteristics and outcome of cardio-respiratory arrest in children in Spain.

DESIGN

An 18-month prospective, multicentre study analysing out-of-hospital and in-hospital cardio-respiratory arrest in children.

PATIENTS AND METHODS

Two hundred and eighty-three children between 7 days and 17 years of age with cardio-respiratory arrest. Data were recorded according to the Utstein style. The outcome variables were the sustained return of spontaneous circulation (initial survival), and survival at 1 year (final survival). Three hundred and eleven cardio-respiratory arrest episodes, composed of 70 respiratory arrests and 241 cardiac arrests in 283 children were studied. Accidents were the most frequent cause of out-of-hospital arrest (40%), and cardiac disease was the leading cause (31%) of in-hospital arrest. Initial survival was 60.2% and 1 year survival was 33.2%. The final survival was higher in patients with respiratory arrest (70%) than in patients with cardiac arrest (21.1%) (P <0.0001). Although many individual factors correlated with mortality, multivariate logistic regression revealed that the best indicator of mortality was a duration of cardiopulmonary resuscitation of over 20 min (odds ratio: 10.35; 95% CI 4.59-23.32).

CONCLUSIONS

In Spain, the present mortality from cardio-respiratory arrest in children remains high. Survival after respiratory arrest is significantly higher than after cardiac arrest. The duration of cardiopulmonary resuscitation attempt is the best indicator of mortality of cardio-respiratory arrest in children.

Sudden death in children and adolescents

This article focuses on sudden unexpected cardiac death (SCD) in children and adolescents. The authors discuss the epidemiology of SCD in children and adolescents, its incidence and etiologies, and strategies for prevention. Because most of the episodes of SCD or sudden cardiac arrest in children and adolescents occur in asymptomatic individuals unknown to have an underlying abnormality before their "event," the issues in this article primarily focus on this group of individuals.

Automated external defibrillators: safety and efficacy in children and adolescents

Although children do not suffer from ventricular fibrillation (VF) as frequently as adults, it does occur in 10% to 20% of pediatric cardiac arrests. The technology is available to recognize and treat ventricular fibrillation in children as quickly as we can for adults. This article discusses the evidence to support automated external defibrillator use in young children. As this technology gains increased acceptance, resuscitation rates and outcomes for VF in children should approach those that are seen in adults.

Lay rescuer automated external defibrillator programs for children and adolescents

This article summarizes the controversies regarding the establishment of lay rescuer automated external defibrillator (AED) programs in schools. It describes the elements of one successful program and provides recommendations for critical elements of AED programs in schools, using the recommendations that were described by the American Heart Association statement and experience gained in the establishment of AED programs in high schools in Wisconsin.