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Cardiorespiratory arrest in children (out of hospital)
1Division of Paediatric Critical Care, University of Ottawa & Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Insights
This systematic review examines treatments for out-of-hospital cardiorespiratory arrest in children. It found evidence on airway management, bystander cardiopulmonary resuscitation, and medications like adrenaline.
Area of Science:
- Pediatric Emergency Medicine
- Cardiopulmonary Resuscitation
- Systematic Reviews
Background:
- Out-of-hospital cardiorespiratory arrest affects ~1/10,000 children annually in resource-rich nations.
- Two-thirds of pediatric arrests occur in infants under 18 months.
- Causes include undetermined (40%), trauma (20%), chronic disease (10%), and pneumonia (6%).
Purpose of the Study:
- To evaluate the effectiveness and safety of various treatments for non-submersion out-of-hospital cardiorespiratory arrest in children.
- To answer the clinical question regarding interventions for pediatric out-of-hospital cardiac arrest.
Main Methods:
- Conducted a systematic review of medical literature up to February 2007.
- Searched major databases including Medline, Embase, and The Cochrane Library.
- Included harms alerts from regulatory agencies like the FDA and MHRA.
Main Results:
- Identified 13 relevant systematic reviews, randomized controlled trials (RCTs), or observational studies.
- Performed a GRADE evaluation to assess the quality of evidence for different interventions.
- Synthesized information on the effectiveness and safety of various treatments.
Conclusions:
- Presents findings on airway management (bag-mask ventilation, intubation).
- Evaluates bystander cardiopulmonary resuscitation, direct-current cardiac shock, and hypothermia.
- Reviews the use of intravenous sodium bicarbonate, adrenaline (epinephrine), and parent resuscitation training.
Introduction:
Cardiorespiratory arrest outside hospital occurs in approximately 1/10,000 children a year in resource-rich countries, with two thirds of arrests occurring in children under 18 months of age. Approximately 40% of cases have undetermined causes, including sudden infant death syndrome. Of the rest, 20% are caused by trauma, 10% by chronic disease, and 6% by pneumonia.
Methods And Outcomes:
We conducted a systematic review and aimed to answer the following clinical question: What are the effects of treatments for non-submersion out-of-hospital cardiorespiratory arrest in children? We searched: Medline, Embase, The Cochrane Library and other important databases up to February 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
Results:
We found 13 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
Conclusions:
In this systematic review we present information relating to the effectiveness and safety of the following interventions: airway management and ventilation (bag-mask ventilation and intubation), bystander cardiopulmonary resuscitation, direct-current cardiac shock, hypothermia, intravenous sodium bicarbonate, standard dose of intravenous adrenaline (epinephrine), and training parents to perform resuscitation.
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