Presentation and survival of prehospital apparent sudden infant death syndrome.
BACKGROUND
Prehospital providers are often involved in the resuscitation of apparent sudden infant death syndrome (SIDS) victims; however, data are few on the presentation and outcome of these patients.


OBJECTIVE
To describe the presentation and determine the survival rate of infants who have an unwitnessed, prehospital arrest consistent with SIDS (apparent SIDS), and to compare the presentation of infants with a final diagnosis of SIDS with those who presented as apparent SIDS but had a different final diagnosis.


METHODS
This was a secondary analysis of data from a controlled trial whose methodology has been previously described. The setting was two large, urban emergency medical services (EMS) systems of Los Angeles and Orange Counties, California. The population included 113 apparent SIDS victims from the original interventional study who had a prehospital, unwitnessed arrest consistent with SIDS, defined by the scenario of an infant aged =12 months being placed to sleep and later found in full arrest (pulseless and apneic). Data collected included ethnicity, gender, arrest etiology, signs of death (lividity, rigor mortis), prehospital interventions, return of spontaneous circulation (ROSC), arrest rhythm, code 3 transport (lights and sirens), and survival to hospital discharge.


RESULTS
One hundred ten of 113 apparent SIDS patients had survival data; 0 of 110 (95% CI 0% to 3.3%) survived, although ROSC was achieved in 5%; for three patients data on survival were missing. Arrest rhythms were determined in 94% of the subjects: asystole 87%, pulseless electrical activity (PEA) 8%, and ventricular fibrillation 4%. Only 50 of 113 (44%) of the EMS records documented code 3 transport; the remainder of the records were ambiguous. SIDS was the final coroner's diagnosis for 79 of 113 (70%) of the cases. Other causes of death in these apparent SIDS victims included respiratory causes (12%), asphyxiation (3%), abuse (2%), congenital heart disease (2%), sepsis (2%), other (4%), and unknown (5%). Apparent SIDS victims with a final diagnosis of SIDS were more likely to show signs of death (27/79, 34% vs. 5/34, 15%, p = 0.035) and were less likely to have a rhythm of PEA (4/77, 5% vs. 5/31, 16%, p = 0.08), although the latter result was not statistically significant.


CONCLUSIONS
Apparent SIDS victims have a dismal prognosis; all infants presenting with apparent SIDS died, even the 30% whose final diagnosis was not SIDS. Given that there were no survivors, new prehospital policies are needed governing the use of lights and sirens, resuscitation decisions including termination of resuscitation, provision of grief support to families, and incident stress debriefing for prehospital personnel.
Smith
Matthew P
MP
Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA 90509, USA.
Kaji
Amy
A
Young
Kelly D
KD
Gausche-Hill
Marianne
M
D001741:Black or African American / Q000706:statistics & numerical data; D002140:California / Q000453:epidemiology; D003937:Diagnosis, Differential; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012140:Respiratory Tract Diseases / Q000175:diagnosis; D013398:Sudden Infant Death / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D016019:Survival Analysis