title: Outcome and cost of open- and closed-chest cardiopulmonary resuscitation in pediatric cardiac arrests.
abstract: OBJECTIVE
  The dismal survival rates of cardiac arrest in children managed with conventional closed-chest cardiopulmonary resuscitation (CC-CPR) have renewed interest in the use of open-chest CPR (OC-CPR). We determined the efficacy of the early use of OC-CPR in children after cardiac arrest.
  
  
  METHODS
  A retrospective review of emergency medical services (EMS) and hospital records revealed 27 children who were brought to the emergency department under CPR after blunt trauma.
  
  
  RESULTS
  Twelve children had CC-CPR and 15 children underwent OC-CPR. Prehospital resuscitation and transport of both groups of children was excellent by current standards, and OC-CPR was performed within 5 minutes of arrival in the emergency department. CPR was successful with restoration of spontaneous circulation in 17% of children after CC-CPR, whereas 20% of children had restoration of spontaneous circulation after OC-CPR. This difference was not statistically significant. None of the children regained consciousness or survived to discharge. The hospital charges for patients who underwent OC-CPR were significantly higher (P = .005). Less than 30% of the hospital charges were reimbursed in both groups.
  
  
  CONCLUSIONS
  OC-CPR does not improve survival in children who sustain cardiac arrest and receive CPR for more than 20 minutes in the field. Under these circumstances OC-CPR is an expensive and futile procedure to undertake.
authors.affiliation: Department of Pediatrics, University of California, Davis, Medical Center, Sacramento 95817.
authors.forename: A
authors.initials: A
authors.lastname: Sheikh
authors.forename: T
authors.initials: T
authors.lastname: Brogan
mesh_terms: D002140:California; D016887:Cardiopulmonary Resuscitation / Q000191:economics* / Q000592:standards; D002648:Child; D003362:Cost-Benefit Analysis; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006336:Heart Massage / Q000191:economics* / Q000592:standards; D017722:Hospital Charges; D006785:Hospitals, University / Q000191:economics; D006801:Humans; D015601:Injury Severity Score; D007349:Insurance, Health, Reimbursement; D008297:Male; D017063:Outcome Assessment, Health Care / Q000191:economics* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D015996:Survival Rate; D014193:Trauma Centers / Q000191:economics* / Q000592:standards