PROGNOSIS OF CARDIOPULMONARY RESUSCITATION
IN A PEDIATRIC HOSPITAL EMRGENCY DEPARTMENT
Kuang
Fengwu, Zhao Ping, Deng Yaobi
Division of
Pediatric Critical Care, Children¡¯s Hospital, Chongqing University of
Medical Sciences, China
Objective:
To determine the effectiveness of cardiopulmonary resuscitation (CPR) in
the emergency department (ED) and the factors associated with outcome.
Method:
We conducted a retrospective review of prospectively collected CPR data in
a 13 million metropolitan city served by a single children's hospital between
January 1, 1993 and December 31, 2000.
Results: A total of 399 children
suffering from cardiopulmonary arrest were sent to the ED and advanced life
support was attempted. Among them, profound bradycardia-arrest was recorded
in 191 cases, ventricular fibrillation was recorded in 3 cases and all
three had heart problems. 205 cases had prehospital heart arrest and the
duration of cardiac arrest was unknown. They had neither heart beat nor
breath when arrived at the Emergency department, the Dead-On-Arrival
s(DOA). 252 cases were intubated during CPR. After advanced life support,
182 children demonstrated return of spontaneous circu1ation and
hospitalized. 155 out of 194 (79.9%) ED-witnessed cardiac arrests were
successfully resuscitated. Only 27 out of 205 (13.2%) DOAs were successfully
resuscitated and 23 of them were neonates. 130 out of 229 (43.7%) neonates,
30 out of 71 (42.3% ) from 1 mo to 5mos old infants, 22 out of 99( 22.2% )
beyond 6mos old children were successfully resuscitated. There was no
statistical deference of successful resuscitation rate between neonates and
1mo to 5mos old infants (p>0.05). The successful resuscitation
rate of neonates or 1mo to 5mos old infants was significantly higher than
that of beyond 6mos old children (p<0.001). The successful
resuscitation rate of ED-witnessed cadiac arrest was significantly higher
than that of DOAs (p<0.001). The successful resuscitation rate of
was significantly higher than that beyond 6 mos old children, with p<0.001.
Conclusions: The most common EEG
activity in this group was profound bradycardia-arrest and ventricular
fibrillation was rare. Open the airway, tracheal intubation and chest
compression is the standard guidelines for pediatric CPR. Chest thump is not
recommended. A comparatively better prognosis of CPR in neonates, infants
and ED-witnessed cardiopulmonary arrests is predicted.