title: Impact of pre-hospital care on the outcome of children arriving with agonal breathing to a pediatric emergency service in South India.
abstract: BACKGROUND
  Data on the prehospital interventions received by critically ill children at arrival to Paediatric Emergency Services (PES) is limited in developing countries. This study aims to describe the pre-hospital care scenario, transport and their impact on outcome in non-traumatic, acutely ill children presenting in PES with agonal breathing.
  
  
  METHODS
  Prospective observational study done on children aged below 15 years arriving in PES with agonal breathing due to non-trauma related causes.
  
  
  RESULTS
  Out of 75 children studied, 69% were infants. The duration of illness among 65% of them (75) was less than 3 days. Majority of them (81%) had received treatment prior to arrival. Government sector physicians (72%), half of them (51%) being pediatricians were the major treating doctors. 37% of the children had arrived to the Emergency in an ambulance. Cardiopulmonary Resuscitation (CPR) was given to 27% on arrival in PES. Other interventions included fluid boluses to correct shock (92%) and inotrope infusion (56%). Sepsis (24%) and pneumonia (24%) were the most common diagnoses. Out of 75, 57 (76%) children who were stabilized and shifted to PICU and among them 27 (47%) survived to discharge. Normal blood pressure (p=0.0410) and non-requirement of CPR (0.0047) and inotropic infusion (0.0459) in PES were associated with a higher chance of survival.
  
  
  CONCLUSIONS
  36% (27/75) of children who arrived to our PES with agonal breathing survived to hospital discharge. Survival was significantly better among those who did not need CPR.
authors.affiliation: Pediatric Emergency Services, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Debasis Das
authors.initials: DD
authors.lastname: Adhikari
authors.affiliation: Pediatric Emergency Services, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Krishna
authors.initials: K
authors.lastname: Mahathi
authors.affiliation: Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Urmi
authors.initials: U
authors.lastname: Ghosh
authors.affiliation: Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Indira
authors.initials: I
authors.lastname: Agarwal
authors.affiliation: Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Anila
authors.initials: A
authors.lastname: Chacko
authors.affiliation: Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Ebor
authors.initials: E
authors.lastname: Jacob
authors.affiliation: Department of Pediatrics, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Kala
authors.initials: K
authors.lastname: Ebenezer
keywords: Agonal breathing; children; intubation; pediatric emergency service; resuscitation