Prehospital care and outcome of pediatric out-of-hospital cardiac arrest.
Cardiac arrest in children outside the hospital is associated with high mortality rates. Recent investigations have suggested that the use of advanced life support (ALS) measures by emergency medical services (EMS) personnel may decrease survival. These studies have used the pediatric Utstein style of defining ALS and basic life support (BLS) measures. The pediatric Utstein style defines BLS as "an attempt to restore effective ventilation and circulation" using noninvasive means to open the airway but specifically excludes the use of bag-valve-mask devices. Advanced life support is defined as the "addition of invasive maneuvers to restore effective ventilation and circulation." The authors of the study described below believe that using this definition would categorize some patients into an ALS group who would otherwise be categorized as having received BLS (i.e., "bag-valve-mask only").


OBJECTIVE
To compare survival rates among children receiving BLS or ALS following out-of-hospital cardiac arrest using amended definitions of prehospital life support measures. Specifically, the definition of BLS was expanded to include the use of bag-valve-mask devices only.


METHODS
This was a retrospective chart review in an urban, pediatric emergency department. Patients included all children presenting to the emergency department between January 1, 1986, and December 31, 1999, following out-of-hospital cardiac arrest. The main outcome measure was survival to hospital discharge.


RESULTS
Two hundred ten children were identified. Twenty-one patients were excluded from further analysis because of absent or incomplete medical records. One hundred eighty-nine patients were studied. Five children (2.6%) survived to discharge from the hospital. Of 189 children, 39 (20.6%) were provided BLS measures by prehospital personnel; 150 (79.4%) received ALS. There was no significant difference between groups in survival to hospital discharge. Patients who survived to hospital discharge were more likely to be in sinus rhythm upon arrival in the emergency department (p < 0.001) and to have received fewer doses of standard-dose epinephrine in the emergency department (p < 0.001).


CONCLUSIONS
The use of ALS by prehospital personnel for children with out-of-hospital cardiac arrest did not improve survival to discharge from the hospital when compared with the use of BLS.
Department of Pediatrics, Children's Hospital of Pittsburgh/University of Pittsburgh School of Medicine, Pennsylvania 15213, USA. pitettr@chplink.chp.edu
Raymond
R
Pitetti
Joseph Z
JZ
Glustein
Mananda S
MS
Bhende
D016887:Cardiopulmonary Resuscitation / Q000592:standards* / Q000639:trends; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003266:Continuity of Patient Care; D004630:Emergencies; D004632:Emergency Medical Services / Q000592:standards* / Q000639:trends; D004636:Emergency Service, Hospital / Q000592:standards / Q000639:trends; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007223:Infant; D008020:Life Support Care / Q000379:methods; D008297:Male; D017063:Outcome Assessment, Health Care; D010414:Pennsylvania / Q000453:epidemiology; D011336:Probability; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014505:Urban Population