Cardiac Resuscitation More Effective in Kids

[FL_Medic]

Medscape referance

Cardiac Resuscitation More Effective in Children and Teens Than in Adults

NEW YORK (Reuters Health) Mar 09 - Children and adolescents are more likely than adults to survive an out-of-hospital nontraumatic cardiac arrest, according to a large, prospective North American study published in the March 24 issue of Circulation. Infants, on the other hand, are slightly less likely to survive than adults.

Until now, it was believed that pediatric out-of-hospital cardiac arrest was associated with such high mortality, and such severe neurological sequelae when the child did survive, that some researchers have questioned whether resuscitation should even be attempted in children.

In their paper, however, lead author Dr. Dianne L. Atkins at the University of Iowa, Iowa City, and the Resuscitation Outcome Consortium Investigators blame this misconception on studies that accrued subjects over broad time periods and included traumatic arrests.

The Consortium study involves diverse geographic areas in the US and Canada involving an estimated 24 million population. The study team analyzed data for 25,405 adults and 624 patients < 20 years of age with out-of-hospital cardiac arrests over a 16-month period between 2005 and 2007. Of the 624 younger patients, 277 were < 1 year old, 154 were 1-11 years old, and 193 were 12-19 years old.

The population incidence per 100,000 person-years was 72.71 in infants, 3.73 in children, 7.37 in adolescents, and 126.52 for adults. Nineteen percent of pediatric patients were not treated, presumably because of perceived futility (e.g., dependent lividity, rigor mortis).

Among those who received EMS treatment, survival to hospital discharge was 10.4% for children, 12.6% for adolescents, and 3.5% for infants, according to the article. Among the adults overall, the rate of survival to hospital discharge was 4.5%.

The number needed to treat to save a life was 29 for infants, 10 for children and 8 for adolescents, as compared to 13 for adult out-of-hospital medical cardiac arrest.

Pediatric patients with ventricular tachycardia or ventricular fibrillation as the initial rhythm were much more likely to survive to discharge than those with asystole or pulseless electric activity (20% versus 5%; p = 0.004), the authors report.

They also note that, even though most arrests occurred in homes, only a third of patients were given bystander CPR. "These findings emphasize the need for new approaches to improve bystander CPR rates for children with out-of-hospital cardiac arrest."

Circulation 2009.