Pediatric Cardiopulmonary Resuscitation: A Collective Review,☆☆,

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Abstract

Little information is available about the effects of CPR in children, although it is known that the outcomes are dismal. Examples of unanswered questions include which advanced life support (ALS) procedures should be performed out-of-hospital, whether high-dose epinephrine improves survival, and the true prevalence of ventricular fibrillation as a presenting rhythm. Children differ from adults as to the cause and pathophysiology of cardiopulmonary arrest, but prehospital EMS and hospital resuscitation teams were initially designed for the care of adults. Because pediatric cardiopulmonary arrest is rare, prospective data are difficult to gather, and there are few large published studies. The purpose of this collective review was to review the current body of knowledge regarding survival rates and outcomes in pediatric CPR and, based on this review, to outline a course for future research.

[Young KD, Seidel JS: Pediatric cardiopulmonary resuscitation: A collective review. Ann Emerg Med February 1999;33:195-205.]

Section snippets

METHODS

Articles published between 1970 and February 1997 in US and foreign peer-reviewed journals were identified by MEDLINE searches for the keywords “cardiopulmonary resuscitation (CPR),” “cardiac arrest,” and “heart arrest” (Figure). Additional searches with the related keywords “endotracheal intubation,” “drowning,” “epinephrine,” “ventricular fibrillation,” and “asystole” were performed to identify more articles reporting on pediatric patients who received CPR. Titles and abstracts of articles

RESULTS

Forty-six studies with survival data on pediatric patients who received CPR were identified (Figure).

Figure. Methods for identification of articles.

Five studies were excluded because the data were reported in greater detail in another article by the same authors, leaving 41 articles.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41 Data from 5 articles overlapped with data reported in 2 other

DISCUSSION

There are still large gaps in our knowledge of pediatric CPR. Guidelines for pediatric ALS were not developed by the American Heart Association Emergency Cardiac Care Committee until 1986,50 and they have since been revised once, in 1992.51 This review of the literature demonstrates a poor survival rate for pediatric cardiac arrest patients, a rate that has not improved in the last decade. Because pediatric arrest is an uncommon event, prospective data are difficult to gather, and most research

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    Address for reprints:James S Seidel, MD, PhD, Harbor-UCLA Medical Center, Department of General and Emergency Pediatrics, 1000 West Carson Street, Box 21, Torrance, CA 90509;310-222-3506, fax 310-782-1763;E-mail [email protected] [email protected].

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