Outcome of Pediatric Resuscitation

Lewis JK, Minter MG, Eshelman SJ, Witte MK Annals of Emergency Medicine 1983 Vol 12 Pages 297-299

A one-year (February 20, 1979 to February 20, 1980) prospective study of 105 resuscitations in 74 children was done at the Milwaukee Chrildren's Hospital. Information was collected about every child who had a first arrest during the study year and who was the subject of a resuscitation effort. Those who were pronounced dead on arrival at hospital and had not been the subject of a resuscitation effort by hospital personnel were excluded. Resuscitation outcome was correlated to the location of arrest, level of monitoring at time of arrest, and type of arrest. The type of arrest was the only analyzed variable that influenced outcome. One hundred and five resuscitative attempts were made on the 74 children in the study. Twenty-three children (31%) had two or more arrests. Fifty-three (71.6%) died, two (2.7%) survived with severe neurologic impairment, and 19 (25.7%) recovered their pre-arrest level of health. This study indicates that outcome for children requiring resuscitation for respiratory arrest without cardiac arrest is reasonably good (25% mortality). However, the outcome for children requiring resuscitation for cardiac or cardiorespiratory arrest is poor (87% to 89% mortality or severe morbidity). Children who suffered a respiratory arrest without cardiac arrest had a better outcome than did adults. However, children who had a cardiac or cardiopulmonary arrest had the same poor outcome as did adults. The authors conclude that efforts to improve outcome should emphasize recognition and treatment of such irregularities that lead to cardiac arrest as respiratory insufficiency, dysrhythmia, and hypotension. Intervention before cardiac arrest is critical, because once a child suffers a cardiac arrest, the prognosis is bleak regardless of the degree of medical support.