Characteristics and outcome of cardiopulmonary resuscitation in hospitalised African children.
OBJECTIVE
To review the characteristics and outcome of cardiopulmonary resuscitation in children at a rural hospital in Kenya.


METHODS
All children aged 0-14 years who experienced > or =1 episode of respiratory or cardiopulmonary arrest during April 2002--2004 were prospectively identified. Demographic variables, cause of hospitalisation, type and duration of arrest, resuscitation measures taken and outcomes were determined.


RESULTS
114 children experienced at least one episode of respiratory arrest (RA) or cardiopulmonary arrest (CPA). Cardiopulmonary resuscitation (CPR) was performed on all children. "Do not resuscitate order" (DNR) was given in 15 patients after initial resuscitation. Eighty two patients (72%) had RA and 32 (28%) had CPA. 25/82 (30%) patients with RA survived initial CPR compared to 5/32 (16%) with CPA. Survival at discharge was 22% (18/82) in children who had RA while no one with CPA survived at discharge. The leading underlying diseases were severe malaria, septicaemia and severe malnutrition. Prolonged resuscitation beyond 15 min and receiving adrenaline [epinephrine] (at least one dose of 10 microg/kg IV) were predictive of poor final outcome.


CONCLUSIONS
Cardiopulmonary arrest after admission has a very poor prognosis in our hospital. Infectious diseases are the main underlying causes of arrest. If a child fails to respond to the basic tenements of PALS within 15 min then it is unlikely that further efforts to sustain life will be fruitful in hospitals where ventilation facilities are not present.
Olotu
A
A
KEMRI/Welcome Trust Collaborative Research, Centre for Geographic Medicine Research, Coast, Kilifi, Kenya. Aolotu@kilifi.kemri-wellcome.org
Ndiritu
M
M
Ismael
M
M
Mohammed
S
S
Mithwani
S
S
Maitland
K
K
Newton
C R J C
CR
D000322:Adrenergic Agonists / Q000627:therapeutic use; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000706:statistics & numerical data*; D002648:Child; D002673:Child, Hospitalized / Q000706:statistics & numerical data*; D002675:Child, Preschool; D015897:Comorbidity; D004837:Epinephrine / Q000627:therapeutic use; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data; D016019:Survival Analysis; D016896:Treatment Outcome
D000322:Adrenergic Agonists; D004837:Epinephrine