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Cardiorespiratory arrest in children (out of hospital)
1University of Ottawa Faculty of Medicine, 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, CPR, and other interventions to improve outcomes for pediatric cardiac arrest.
Area of Science:
- Pediatric Emergency Medicine
- Cardiology
- Critical Care
Background:
- Out-of-hospital cardiorespiratory arrest affects ~1/10,000 children annually in developed countries.
- Two-thirds of pediatric arrests occur in infants under 18 months.
- Causes include sudden infant death syndrome, trauma, chronic disease, and pneumonia.
Purpose of the Study:
- To systematically review the effects of treatments for non-submersion out-of-hospital cardiorespiratory arrest in children.
- To evaluate the effectiveness and safety of various interventions.
Main Methods:
- Systematic review of literature up to December 2009.
- Searched Medline, Embase, The Cochrane Library, and other databases.
- Included harms alerts from regulatory agencies (FDA, MHRA).
- Performed GRADE evaluation of evidence quality.
Main Results:
- Included 15 systematic reviews, RCTs, or observational studies.
- Evaluated evidence quality using GRADE methodology.
Conclusions:
- Presents information on interventions for pediatric out-of-hospital cardiorespiratory arrest.
- Covers airway management (bag-mask, intubation), bystander CPR, defibrillation, hypothermia, sodium bicarbonate, adrenaline, and parent 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 45% 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 aiming 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 December 2009 (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 15 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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