Characteristics and outcome of cardiorespiratory arrest in children
Introduction
Despite the advances in prevention, training in cardiopulmonary resuscitation, and early treatment, mortality after cardio-respiratory arrest (CRA) remains very high both in adults [1], [2], [3], [4], [5] and children [6], [7], [8], [9]. Until now, there are few prospective studies that analyse the causes, risk factors and outcomes of CRA in children [9]. Some studies showed that survival varies depending on the location of arrest, underlying disease, initial electrocardiographic (ECG) rhythm, the time elapsing between CRA and the initiation of resuscitation, and the duration of cardiopulmonary resuscitation (CPR) [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18]. However, comparison of the different studies is complicated as many are retrospective, with a small number of patients, and different definitions of CRA, methods of description and analysis of the results have been used. The Utstein style provides uniform guidelines for reporting characteristics and outcome for in-hospital and out-of-hospital CRA in children [19], [20]. To date, only one prospective study that analysed the outcome of in-hospital CRA in children in a single centre following the Utstein style guidelines has been reported [9].
The objective of the present study was to provide a prospective, multicentre, Utstein style report of paediatric out-of-hospital and in-hospital CRA to evaluate the factors associated with mortality, and to know the final outcome of survivors.
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Patients and methods
An invitation to participate in the study was sent to all the paediatric intensive care units (PICU), paediatric departments and out-of-hospital emergency medical systems in Spain [21]. A protocol was drawn up in accordance with the Utstein style guidelines [19], [20]. Patients aged from 7 days to 18 years were eligible for the study if they had presented in respiratory arrest (RA) defined as the absence of respiration requiring assisted ventilation, or cardiac arrest (CA) defined as the
Results
We collected 311 episodes of cardiorespiratory arrest (CRA) that were either primarily cardiac or primarily respiratory in origin. These occurred from 1 April 1998 to 30 September 1999 in 283 children with a mean age of 48 ± 54.4 months (range 7 days to 17 years) and mean weight of 17.1 ± 16 kg (2.3–80 kg). Subsequent re-arrest (range 2–6) occurred in the PICU in 17 patients. Characteristics of the patients and CRA, and the initial and final mortalities are summarised in Table 1 and Fig. 1.
Discussion
To our knowledge, this is the first prospective, multicentre study that used the Utstein style to report the aetiology and characteristics of out-of-hospital and in-hospital cardiac and respiratory arrest in children, and that analyses the factors relating to prognosis. There is only one previous study, performed in a single hospital, which has analysed in-hospital cardio-respiratory arrest following the Utstein style [9]. Although ours is not an epidemiological study, a large number of
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Other members of the Study Group: Jose A. Alonso (Virgen de la Salud Hospital, Toledo), Julio Melendo (Miguel Servet Hospital, Zaragoza), Corsino Rey (Asturias Central Hospital, Oviedo), Teresa Hermana (Cruces Hospital, Baracaldo), Josefina Cano (Virgen del Rocio Hospital, Seville), Francisco Romero (061 Emergency Service, Jaen), Servando Pantoja (Puerta del Mar Hospital, Cadiz), Carlos Lucena (061, Almeria), Pere Plaja (Palamós Hospital, Gerona), Ana Concheiro (San Juan de Dios Hospital, Barcelona), Alvaro Díaz (Tarrasa Hospital, Barcelona), Ricardo Martino (Príncipe de Asturias Hospital, Alcala de Henares), Maria V. Esteban (Princesa de España Hospital, Jaen), Nieves de Lucas (SAMUR, Madrid), Esther Ocete (Granada Clinical Hospital), Juan I Muñoz (Reina Sofía Hospital, Cordoba), Maria A. Rodríguez (Barbanza Provincial Hospital, Coruña), Susana Simó (061 Emergency Service, Barcelona), Eduard Solé (Arnaú de Villanova Hospital, Lerida), Enrio Jiménez (del Mar Hospital, Barcelona), Rosario Alvarez (Jarrio Hospital, Asturias), Víctor Canduela (Laredo Hospital, Cantabria), Antonio Fernández (San Agustin Hospital, Linares), Amelia Sánchez-Galindo (Juan Canalejo Hospital, La Coruña), R. Closa (Juan XXIII Hospital, Barcelona), P. Villalobos (Figueras Hospital, Gerona), Orenci Urraca (Nens Hospital, Barcelona), Federico Pérez (Josep Trueta Hospital, Gerona), Antonio Torres (San Juan de Dios Hospital, Ubeda), Miguel Labay (Obispo Polanco Hospital, Teruel), Ma Luisa Masiques (Mollet Hospital, Barcelona), Fátima Aborto (Juan Ramón Jiménez Hospital, Huelva), Narcisa Palomino (Ciudad de Jaén Hospital, Jaén), Monserrat Miquel (San Celoni Hospital, Barcelona), Antonio Gómez Calzado (Virgen Macarena Hospital, Seville), Jose M Bellón, Maria La Calle (Gregorio Marañón Hospital, statistical data analysis).