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Paediatric cardiac arrest and resuscitation provided by physician-staffed emergency care units
P Suominen1, R Korpela, M Kuisma
1Department of Anaesthesia, University of Helsinki, Finland.
Insights
Physician-led emergency care for pediatric cardiac arrest showed poor survival rates, similar to paramedic systems. Physicians could better withhold resuscitation when prognosis is grim, a key difference in care delivery.
Area of Science:
- Emergency Medicine
- Pediatric Cardiology
Background:
- Paediatric cardiac arrest research is dominated by US-based studies using paramedic emergency care.
- This study examines outcomes in a physician-staffed emergency medical system.
Purpose of the Study:
- To evaluate paediatric cardiac arrest patient outcomes within a physician-led prehospital emergency care system.
Main Methods:
- Retrospective analysis of 100 paediatric cardiac arrest patients (<16 years) in Southern Finland over 10 years.
- Data included resuscitation attempts, cardiac rhythms, causes of arrest, and survival rates.
Main Results:
- 50 patients had no resuscitation; 50 received cardiopulmonary resuscitation (CPR).
- Sudden infant death syndrome was a common cause of arrest.
- Survival to discharge was 16% (8/50), with 6 survivors having mild/no disability.
- Short CPR duration (≤15 min) was linked to better survival.
Conclusions:
- Physician-staffed emergency care did not improve overall survival rates compared to paramedic systems.
- Physicians' ability to cease resuscitation on scene when prognosis is poor is a notable difference.
Background:
Most paediatric cardiac arrest studies have been conducted in the USA, where paramedics provide prehospital emergency care. We wanted to study the outcome of paediatric cardiac arrest patients in an emergency medical system which is based on physician staffed emergency care units.
Methods:
We analysed retrospectively the files of 100 prehospital cardiac arrest patients from Southern Finland during a 10-year study period. The patients were less than 16 years of age.
Results:
Fifty patients were declared dead on the scene (DOS) without attempted resuscitation, and cardiopulmonary resuscitation (CPR) was initiated in 50 patients. The sudden infant death syndrome was the most common cause of arrest in the DOS patients (68%) as well as in those receiving CPR (36%). Asystole was the initial cardiac rhythm in 70% of the patients in whom CPR was attempted. Resuscitation was successful in 13 patients, 8 of whom were ultimately discharged. Six of the patients survived with mild or no disability and 4 of them had near-drowning aetiology. In multivariate analysis, the short duration of CPR (< or = 15 min) was the only factor significantly associated with better survival.
Conclusions:
Although prehospital care was provided by physicians, the overall rate of survival was found to be equally poor as reported from systems with paramedics. The only major difference between physician- and paramedic-staffed emergency care units is the ability of physicians to refrain from resuscitation already on the scene when prognosis is poor.