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Cardiorespiratory arrest in children (out of hospital)
Kristina Krmpotic1, Hilary Writer
1Memorial University of Newfoundland Faculty of Medicine, Janeway Children's Health and Rehabilitation Centre, St. John's, Newfoundland and Labrador, Canada.
Insights
This systematic overview examines treatments for pediatric out-of-hospital cardiorespiratory arrest. It categorizes the efficacy of nine interventions, including airway management and resuscitation training, to improve outcomes for children experiencing cardiac arrest.
Area of Science:
- Pediatric Emergency Medicine
- Cardiology
- Critical Care
Background:
- Out-of-hospital cardiorespiratory arrest affects approximately 1 in 10,000 children annually in developed nations.
- Two-thirds of pediatric arrests occur in infants under 18 months, with undetermined causes like SIDS being common.
- Known causes include trauma (20%), chronic disease (10%), and pneumonia (6%).
Purpose of the Study:
- To systematically review and categorize the efficacy of various treatments for non-submersion out-of-hospital cardiorespiratory arrest in children.
- To answer the clinical question regarding the effects of different interventions on pediatric cardiac arrest outcomes.
Main Methods:
- Conducted a systematic overview of existing literature up to November 2014.
- Searched major databases including Medline, Embase, and The Cochrane Library.
- Screened 81 records, reviewed 13 full publications, and incorporated three new systematic reviews.
Main Results:
- Evaluated the effectiveness and safety of nine distinct interventions.
- Included airway management (bag-mask ventilation, intubation), bystander cardiopulmonary resuscitation, and advanced treatments.
- Performed GRADE evaluations for specific PICO combinations to assess evidence quality.
Conclusions:
- Categorized the efficacy of nine interventions for pediatric out-of-hospital cardiorespiratory arrest.
- Interventions assessed include airway management, ventilation techniques, CPR, defibrillation, and medications like adrenaline (epinephrine).
- Findings provide insights into the effectiveness of targeted temperature management and parent-led resuscitation training.
Introduction:
Cardiorespiratory arrest outside hospital occurs in approximately 1/10,000 children per 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 overview, 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 November 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview).
Results:
At this update, searching of electronic databases retrieved 192 studies. After deduplication and removal of conference abstracts, 81 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 68 studies and the further review of 13 full publications. Of the 13 full articles evaluated, three systematic reviews were added at this update. We have also added eight studies to the Comment section. We performed a GRADE evaluation for three PICO combinations.
Conclusions:
In this systematic overview, we categorised the efficacy for nine interventions based on information about the effectiveness and safety of airway management and ventilation (bag-mask ventilation and intubation), bystander cardiopulmonary resuscitation, direct-current cardiac shock, high dose and standard dose intravenous adrenaline (epinephrine), intravenous sodium bicarbonate, intubation versus bag-mask ventilation, targeted temperature management, and training parents to perform resuscitation.
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