Outcome of out-of-hospital cardiorespiratory arrest in children.
OBJECTIVE
To analyze the characteristics and outcome of out-of-hospital cardiorespiratory arrest in children in Spain.


METHODS
Secondary analysis of data from a prospective, multicenter study analyzing cardiorespiratory arrest in children. Ninety-five children between 7 days and 16 years with cardiorespiratory 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). Neurologic and general performance outcome was assessed by the Pediatric Cerebral Performance Category (PCPC) scale and the Pediatric Overall Performance Category (POPC) scale.


RESULTS
Initial survival was 47.3% and 1-year survival was 26.4%. Mortality was higher in children younger than 1 year. Survival of patients with respiratory arrest (82.1%) was significantly higher than survival of cardiac arrest victims (14.4%). Patients who were initially resuscitated by laypersons or paramedics had higher survival (53.6%) than those who were initially resuscitated by doctors and/or nurses (15.2%) (P < 0.01). Mortality was higher in the patients who presented slow rhythms (asystole, severe bradycardia) or pulseless electrical activity than in those presenting ventricular fibrillation (P = 0.001). Multivariate logistic regression revealed that the best indicator of mortality was duration of cardiopulmonary resuscitation longer than 20 minutes. After 1 year, most survivors had normal or mild disability.


CONCLUSIONS
Mortality of out-of-hospital cardiorespiratory arrest in children is high. When resuscitation is started soon by layperson or paramedics, survival is increased. Duration of resuscitation efforts is the best indicator of mortality. Most of survivors had good long-term neurologic outcome.
López-Herce
Jesús
J
Gregorio Marañón Hospital, Madrid, Spain. pielvi@ya.com
García
Cristina
C
Domínguez
Pedro
P
Rodríguez-Núñez
Antonio
A
Carrillo
Angel
A
Calvo
Custodio
C
Delgado
Miguel Angel
MA
D000293:Adolescent; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D003625:Data Collection / Q000592:standards; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000401:mortality / Q000628:therapy*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D012131:Respiratory Insufficiency; D016019:Survival Analysis; D016896:Treatment Outcome