Results of In-Patient Pediatric Resuscitation.

Gillis J, Dickson D, Rieder, M, Steward D, Edmonds J Critical Care Medicine 1986 Vol 14 Pages 469-471

The authors retrospectively reviewed the results of 42 cardio-pulmonary arrests occurring over 1 year (October 1982-October 1983) in the general ward at Toronto's Hospital for Sick Children. Data was compared to a similar study 10 years earlier in the same hospital. Patients were separated into those having pure respiratory arrests and those who also had cardiac arrest. In the most recent series, 42 attempted resuscitations were studied (9-respiratory & 33-cardiac). Overall 6-month survival was 17%; however only 9% of the cardiac arrest patients survived. 10 years earlier, the survival rate from cardiac arrest was 11%. In both studies, pure respiratory arrest had a significantly better outcome, and predictors of nonsurvival were a duration of arrest greater than 15 minutes and the administration of more than one IV bolus of epinephrine. In the most recent study, no patient survived either predictor. There was one neurologically damaged survivor in each study. The recent study confirms that the outcome of pediatric cardiac arrest is poor when arrest occurs in hospital. One explanation for the poorer outcome in pediatric vs. adult patients may be a different underlying rhythm in pediatric cardiac arrest. A recent review of 100 pediatric patients found that 78% experienced bradycardia leading to asystole, 6% with ventricular fibrillation and 16% with other tachyarrhythmias leading to bradycardiac arrest. 90% of the Toronto study patients had asystole. Restoration of a cardiac rhythm in these patients would be much more difficult than in most adult cardiac arrests which are due to ventricular fibrillation.