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Use and effect of paediatric advanced life support skills for paediatric arrest in the A&E department
1Department of Accident and Emergency Medicine, Leicester Royal Infirmary NHS Trust, UK.
Insights
Outcomes for pediatric cardiac arrest are poor, even with advanced life support. Early intervention is key for survival in children experiencing cardiac arrest.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
Background:
- Paediatric advanced life support (PALS) is crucial for managing cardiac arrest in children.
- Assessing PALS effectiveness in prehospital and hospital settings is vital for improving outcomes.
Purpose of the Study:
- To evaluate the use and outcomes of PALS by the Leicestershire Ambulance and Paramedic Service (LAPS) and a university teaching hospital's A&E department.
- To identify factors influencing successful outcomes in pediatric cardiac arrest cases.
Main Methods:
- Retrospective review of prehospital, A&E, and inpatient records for pediatric patients (0-16 years) in cardiac arrest.
- Inclusion criteria: patients admitted to the resuscitation room between 1992-1995; cardiac arrest defined by Utstein template.
Main Results:
- 51 pediatric cardiac arrests identified; median age 3.2 years.
- 11.5% of patients survived to hospital discharge, with 4/5 having normal neurological development.
- Only one survivor from prehospital cardiac arrest resuscitated by LAPS, who later died from neurological injury.
Conclusions:
- Established prehospital pediatric cardiac arrest has a very poor outcome within this emergency medical services system.
- PALS teaching programs for hospital staff alone did not significantly improve outcomes.
- Timely initiation of advanced life support measures is the most critical factor for successful pediatric cardiac arrest outcomes.
Objectives:
To define the use of paediatric advanced life support by the Leicestershire Ambulance and Paramedic Service (LAPS) and the A&E department of a large university teaching hospital; and to identify the outcome and determine the factors that are consistent with a successful outcome.
Subjects And Methods:
The prehospital, accident and emergency (A&E), and inpatient notes of all patients aged 0-16 years who had been admitted to the resuscitation room at the Leicester Royal Infirmary in cardiac arrest between 1 January 1992 and 31 December 1995 were reviewed. Cardiac arrest was defined according to the Utstein template for reporting of prehospital data.
Results:
During the four year period, 51 cases of paediatric cardiac arrest were identified, with a median age of 3.2 years (range two days to 15 years). In eight patients, resuscitation was not attempted. Of the remaining 43, 15 (37%) were discharged from A&E to the intensive care unit. Five (11.5%) ultimately survived to discharge from hospital. Subsequent neurological development was recorded as normal in four of the five. Of the patients who had a prehospital cardiac arrest and were initially resuscitated by the LAPS there was only one survivor. He was discharged from hospital with severe neurological injury and died three months later.
Conclusions:
The outcome for established prehospital paediatric cardiac arrest, in a well defined emergency medical services system, is very poor at present. It does not seem to be affected by the institution of paediatric life support teaching programmes for hospital staff alone. The timing in instituting advanced life support measures remains the most critical factor affecting outcome in these patients.