Abstract 202

Objective: Approximately 30% of pediatric patients resuscitated out-of-hospital after being found apneic but with a pulse can have good neurologic recovery ( N.Engl.J.Med. 1996; 335: 1473-1479). Resuscitation after submersion in sub-freezing temperature is also associated with a good outcome. In contrast, few patients who are resuscitated at home after being found pulseless survive with good neurologic recovery. We performed this systematic review to better estimate the outcome of out-of-hospital non-submersion cardiac arrest in children.

Methods: Previous studies were identified through MEDLINE (1966-Nov 1998), EMBASE, reference lists of potentially relevant articles and expert informants. The search terms were "cardiorespiratory, respiratory, cardiac, or heart arrest or CPR or cardiopulmonary resuscitation" AND "prehospital or out of hospital" AND "outcome or prognosis or efficacy". Inclusion criteria for studies were: age 0-18 years and out-of-hospital arrest. Authors were contacted for clarification if necessary. Data were abstracted by 2 reviewers in duplicate, independently. Pulselessness was documented by trained medical personnel. Arrests related to drowning/submersion, or with no attempted resuscitation were excluded. Outcomes were survival and neurologic status at hospital discharge or last follow up.

Results: The abstracts of 369 articles were reviewed. 22 articles met criteria for inclusion. Overall survival was 6% (60/1007 patients, 95% CI 4.5 to 7.4%). 19 articles (825 patients), reported the neurologic outcome of survivors; 16 survivors had full recovery to mild neurologic disability (1.9% of total, 95% CI 1.0 to 2.9 %) and 30 had moderate or greater disability (3.6% of total). Of 385 patients with the diagnosis of Sudden Infant Death Syndrome (SIDS), there was 1 survivor with good outcome; this patient had return of pulse and blood pressure prior to arrival at the emergency room (0.3%; 95%CI 0 to 0.8%). Of 268 trauma patients, there were 15 survivors (5.6%). At least 79% of patients had pre-hospital CPR. Of 147 patients with asystole reported as the initial rhythm there was 1 survivor (0.7%). Of 14 patients with ventricular fibrilation reported as the initial rhythm there were 2 survivors (14%).

Conclusions: The outcome of pediatric patients resuscitated after being found pulseless outside of the hospital without submersion injury is extremely poor. Prolonged resuscitation of SIDS patients unresponsive to pre-hospital attempts may be futile. Ventricular fibrillation may have a better outcome than asystole as a presenting rhythm.