Abstract
BackgroundCardiorespiratory arrest (CRA) is a rare event in childhood. Our objective was to determine the characteristics of paediatric CRA and the immediate results of cardiopulmonary resuscitation (CPR) in Galicia, a community with a very scattered population.MethodsAll children (aged from newborn to 16 years old) who suffered an out-of-hospital CRA in Galicia and were assisted by the Public Foundation Medical Emergencies of Galicia-061 staff, from June 2002 to February 2005, were included in the study. Data were prospectively recorded following the Utstein's style guidelines.ResultsThirty-one cases were analyzed (3.4 CRA annual cases per 100.000 paediatric population). The arrest was respiratory in 16.1% and cardiac in 83.9% of cases. CRA occurred at home in 58.1% of instances. Time CRA to initiation of CPR was shorter than 10 minutes in 32.2% and longer than 20 minutes in 29.0% of cases. 22.6% of children received bystander CPR. The first recorded rhythm was asystole in 67.7% of cases. Bag-mask ventilation was used in 67.7% and in 83.8% oro-tracheal intubation was done. A peripheral venous access was achieved in 67.7% and intraosseous access was used in 16.1% of patients. 93.5% of children were treated with adrenaline. After initial CPR, sustained restoration of spontaneous circulation was achieved in 38.7% of cases. Six children (19.4%) survived until hospital discharge. Four of 5 children with respiratory arrest survived, whereas only 2 of 26 children with cardiac arrest survived until hospital discharge.ConclusionDespite the handicap of a highly disseminated population, paediatric CRA characteristics and CPR results in Galicia are comparable to references from other communities. Programs to increase bystander CPR, equip laypeople with basic CPR skills and to update life support knowledge of health staff are needed to improve outcomes.
Highlights
IntroductionOur objective was to determine the characteristics of paediatric Cardiorespiratory arrest (CRA) and the immediate results of cardiopulmonary resuscitation (CPR) in Galicia, a community with a very scattered population
Galicia's population distribution is characterized by an extreme dispersion, indicated by the fact that it accounts for 51.6% of all the Spain's population sites and that 54.2% of population lives in towns with less than 20.000 inhabitants [9]
During the study period 31 children suffered from an outof-hospital Cardiorespiratory arrest (CRA) and were assisted by the Galicia's EMS, that means 3.4 cases per 100.000 children and year
Summary
Our objective was to determine the characteristics of paediatric CRA and the immediate results of cardiopulmonary resuscitation (CPR) in Galicia, a community with a very scattered population. Cardiorespiratory arrest (CRA) is a rare event during childhood that needs early and adequate treatment in order to achieve survival without neurological damage [1,2,3,4,5,6]. Most studies about out-ofhospital paediatric CRA have been done in mainly urban areas; this factor could have influence on the results of cardiopulmonary resuscitation (CPR) and might not be extrapolated to predominantly rural areas or regions with highly dispersed population. The objective of the present study was to determine the characteristics of paediatric CRA and the immediate results of CPR in a Spanish region characterized by its scattered population A previous multicenter study of out-of-hospital CRA in Spain found that survival was higher when resuscitation was started soon by laypersons or paramedics, the neurological outcome of survivors was quite good (81.% had scores 1 or 2 in the Pediatric Cerebral Performance Scale at hospital discharge) and the best indicator of mortality was duration of resuscitation efforts [1].
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