A Prospective, Population-Based Study of the Demographics, Epidemiology, Management, and Outcome of Out-of-Hospital Pediatric Cardiopulmonary Arrest

doi:10.1016/S0196-0644(99)70391-4

Annals of Emergency Medicine

Volume 33, Issue 2, February 1999, Pages 174-184

https://doi.org/10.1016/S0196-0644(99)70391-4 Get rights and content

Abstract

Study Objectives: To perform a population-based study addressing the demography, epidemiology, management, and outcome of out-of-hospital pediatric cardiopulmonary arrest (PCPA). Methods: Prospective, population-based study of all children (17 years of age or younger) in a large urban municipality who were treated by EMS personnel for apneic, pulseless conditions. Data were collected prospectively for 3½ years using a comprehensive data collection tool and on-line computerized database. Each child received standard pediatric advanced cardiac life support. Results: During the 3½-year period, 300 children presented with PCPA (annual incidence of 19.7/100,000 at risk). Of these, 60% (n=181) were male (P =.0003), and 54% (n=161) were patients 12 months of age or younger (152,500 at risk). Compared with the population at risk (32% black patients, 36% Hispanic patients, 26% white patients), a disproportionate number of arrests occurred in black children (51.6% versus 26.6% in Hispanics, and 17% in white children; P <.0001). Over 60% of all cases (n=181) occurred in the home with family members present, and yet those family members initiated basic CPR in only 31 (17%) of such cases. Only 33 (11%) of the total 300 PCPA cases had a return of spontaneous circulation, and 5 of the 6 discharged survivors had significant neurologic sequelae. Only 1 factor, endotracheal intubation, was correlated positively with return of spontaneous circulation (P =.032). Conclusion: This population-based study underscores the need to investigate new therapeutic interventions for PCPA, as well as innovative strategies for improving the frequency of basic CPR for children.

[Sirbaugh PE, Pepe PE, Shook JE, Kimball KT, Goldman MJ, Ward MA, Mann DM: A prospective, population-based study of the demographics, epidemiology, management, and outcome of out-of-hospital pediatric cardiopulmonary arrest. Ann Emerg Med February 1999;33:174-184.]

Section snippets

INTRODUCTION

In the United States, an estimated 16,000 children die in their communities each year of unexpected pediatric cardiopulmonary arrest (PCPA). Although PCPA constitutes less than 10% of all cases of attempted out-of-hospital resuscitation, it also creates enormous social and economic losses because of a child’s greater life expectancy. Thus the number of years of life lost as a result of PCPA may rival that for all adult arrests.1, 2, 3, 4

Studies regarding out-of-hospital PCPA are rare and

MATERIALS AND METHODS

All children 17 years of age or younger who presented to EMS crews in an apneic and pulseless state were included in this study during a 3½-year study period (January 1, 1992, through June 30, 1995). Consistent with recent uniform reporting recommendations to distinguish those with respiratory arrest alone (apneic, but with pulses), only those presenting to EMS with cardiac arrest (no pulses/no breathing) were included in this study.⁴ Children who reportedly received some form of basic CPR by

RESULTS

During the 3½-year study, 300 consecutive patients (7.1 per month or an annual incidence of 19.7 per 100,000) met the inclusion criteria. This included 45 (15%) with retrospective evidence of rigor mortis. Of these, only 3 patients with an injury-related arrest (2 with child abuse and 1 with smoke inhalation) had evidence of rigor mortis. There were no decapitations, incinerations, or children with decomposition, and none were reported as going directly to area hospitals or to the county morgue.

DISCUSSION

Until recently, few studies have addressed out-of-hospital pediatric cardiopulmonary arrest, and the available data are limited by both design and statistical constraints.1, 2, 11, 13, 14, 15, 16, 17 The number of pediatric arrest patients is small when compared with the number of adult arrest patients, and population-based studies are lacking.1, 2, 3, 4 Although exceptions exist,14, 16 most studies have lacked the data-gathering mechanisms that allow for comprehensive measurement of

Acknowledgements

We thank the City of Houston Fire Department dispatchers, first-responder firefighters, EMTs, paramedics, and administrative support personnel who have made this study possible. We also thank Nina Meher-Homji, Beverly Holtgraver, Robert Anderson, and Laura Burke for preparation of the manuscript, as well as Elsa Snyder, MPH, for providing assistance with data collection and input. Finally, we thank Dr Ralph Feigin for his mentorship and his lifelong devotion to the health of children.

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^☆: Address for reprints: paul E Pepe, MD, MPH, Department of Emergency Medicine, Allegheny University Hospitals, Allegheny General, 320 East North Avenue, Pittsburgh, PA 15212-4772; 412-359-6180, fax 412-359-8874.

^☆☆: 47/1/95318

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A Prospective, Population-Based Study of the Demographics, Epidemiology, Management, and Outcome of Out-of-Hospital Pediatric Cardiopulmonary Arrest☆,☆☆

Abstract

Section snippets

INTRODUCTION

MATERIALS AND METHODS

RESULTS

DISCUSSION

Acknowledgements

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Am J Emerg Med

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Med Clin North Am

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

Ann Emerg Med

City of Houston Cardiac Arrest Surveillance Database

Appraisal of pediatric cardiopulmonary resuscitation

Can Med Assoc J

Cardiorespiratory arrest and resuscitation of children

Am J Dis Child

Outcome of children who are apneic and pulseless in the emergency department

Crit Care Med

Factors influencing outcome of cardiopulmonary resuscitation in children

Pediatr Emerg Care

Outcome of cardiopulmonary resuscitation in children

Pediatr Emerg Care

Pediatric cardiopulmonary arrests in a rural population

Pediatrics

Outcome and cost at a children’s hospital following resuscitation for out-of-hospital cardiopulmonary arrest

Arch Pediatr Adolesc Med

High-dose epinephrine in pediatric out-of-hospital cardiopulmonary arrest

Pediatrics

Outcome of out-of-hospital cardiac or respiratory arrest in children

N Engl J Med

Racial differences in the incidence of cardiac arrest and subsequent survival

N Engl J Med

Survival in the elderly following out-of-hospital cardiac arrest

Crit Care Med

Does age affect outcomes of out-of-hospital cardiopulmonary resuscitation?

JAMA