title: Primary cardiac arrest following sport or exertion in children presenting to an emergency department: chest compressions and early defibrillation can save lives, but is intravenous epinephrine always appropriate?
abstract: OBJECTIVE
  The objective of this study was to describe the characteristics and outcome of pediatric patients presenting to an emergency department (ED) following out-of-hospital primary cardiac arrest (OHPCA), to determine if long-term survival is influenced by specific resuscitation interventions.
  
  
  METHODS
  This was a prospective observational study of cases of OHPCA during sport or exertion in young patients presenting to an ED over a 5-year period. Cases were identified from a resuscitation database, which documented patient demographics, nature of event, emergency treatment, response times, and clinical progress. These data were analyzed to determine outcomes.
  
  
  RESULTS
  Nine children were identified who presented following OHPCA during the study period. The mean age was 10.7 (±4.2) years. All were subsequently diagnosed with an underlying primary cardiac disorder. Six patients (66.6%) survived to make a full recovery. All patients who survived had received early chest compressions (within 5 minutes) and early defibrillation (within 10 minutes). The initial cardiac arrest rhythm in all survivors had been an electrically cardiovertable rhythm. Five (83%) of the 6 survivors did not receive epinephrine during resuscitation.
  
  
  CONCLUSIONS
  The importance of early chest compressions and defibrillation in collapsed young athletes is highlighted in this report. These interventions can result in full long-term neurological recovery. Use of epinephrine in these patients may be dangerous. We suggest that special consideration should be given to this subgroup of patients in the development of future resuscitation guidelines.
authors.affiliation: Department of Emergency Medicine & Academic Emergency Medicine, New South Wales, Australia. kevje26@hotmail.com
authors.forename: Kevin
authors.initials: K
authors.lastname: Enright
authors.forename: Christian
authors.initials: C
authors.lastname: Turner
authors.forename: Phil
authors.initials: P
authors.lastname: Roberts
authors.forename: Nicholas
authors.initials: N
authors.lastname: Cheng
authors.forename: Gary
authors.initials: G
authors.lastname: Browne
mesh_terms: D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000379:methods; D002648:Child; D002675:Child, Preschool; D004554:Electric Countershock / Q000379:methods*; D004636:Emergency Service, Hospital; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006336:Heart Massage / Q000379:methods*; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D005082:Physical Exertion; D011446:Prospective Studies; D020127:Recovery of Function; D013177:Sports; D013909:Thorax; D013997:Time Factors; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000008:administration & dosage
chemical_list: D014662:Vasoconstrictor Agents; D004837:Epinephrine