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Death and resuscitation in the pediatric emergency department
S J Teach1, P E Moore, G R Fleisher
1Division of Emergency Medicine, Children's Hospital of Buffalo, USA.
Insights
Pediatric emergency department (ED) arrests are rare events. Survival rates for these arrests are better than outpatient but worse than inpatient arrests.
Area of Science:
- Pediatric Emergency Medicine
- Critical Care
- Resuscitation Science
Background:
- Cardiopulmonary and respiratory arrest in pediatric emergency departments (EDs) are critical events.
- Understanding the characteristics and outcomes of these arrests is vital for improving patient care.
Purpose of the Study:
- To characterize the population of patients experiencing cardiopulmonary or respiratory arrest within a pediatric ED.
- To determine the incidence, causes, and survival rates of in-ED arrests.
Main Methods:
- Retrospective case series conducted between July 1987 and June 1993.
- Data collected from a single urban, tertiary care pediatric ED.
- Inclusion criteria: patients with pulse and respirations upon arrival who subsequently arrested in the ED.
Main Results:
- Thirty-two cases of arrest (18 cardiopulmonary, 14 respiratory) were identified, yielding an incidence of 1.2 arrests per 10,000 patient visits.
- Excluding do-not-resuscitate orders, 73% of patients had an initial response to resuscitation.
- Survival to ED discharge was 70%, and survival to hospital discharge was 50%. 80% of hospital survivors were discharged at baseline function.
Conclusions:
- In-ED pediatric cardiopulmonary or respiratory arrest is an infrequent occurrence.
- Survival rates for in-ED arrests are higher than for outpatient arrests but lower than for inpatient arrests.
- These findings highlight the importance of prompt and effective resuscitation within the ED setting.
Study Objective:
To describe a population of patients who arrived in a pediatric emergency department with pulse and respirations but then sustained cardiopulmonary or respiratory arrest while in the ED.
Design:
Retrospective case series of patients from July 1987 to June 1993.
Setting:
Urban, tertiary care pediatric ED.
Participants:
All patients who sustained cardiopulmonary or respiratory arrest while in the ED.
Results:
Thirty-two cases of cardiopulmonary (n = 18) or respiratory arrest (n = 14) were identified, for an incidence of 1.2 arrests per 10,000 patient visits. Causes of arrest varied widely. Excluding those patients with do-not-resuscitate orders (n = 2), an initial response to resuscitative efforts was obtained in 22 of 30 (73%) patients. Overall rates of survival to discharge from the ED and from the hospital were 21 of 30 (70%) and 15 of 30 (50%), respectively. Of those patients who survived to hospital discharge, 12 of 15 (80%) were discharged at a baseline level of overall function.
Conclusion:
Cardiopulmonary or respiratory arrest in the pediatric emergency department is rare. The rate of survival of such an arrest is superior to that in outpatient arrests but inferior to that in inpatient arrests.
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