Caring for Children with Poor Outcomes from Out-of-Hospital Arrests

Abstract

The evolution of emergency medical services over the past two decades in the United States has involved the training of lay people in basic life support, the creation of a “911” phone number and other rapid communication channels, the development of prehospital care by paramedic services, the staffing of adult and pediatrie emergency departments, the development of air transport, the development of hospital-to-hospital referral networks, and the regionalization of pediatrie intensive care units (ICU). These advances in life support raise the public level of awareness of available care as well as its expectations for improved outcome. For children, some improvements have been reported. Two studies on submersion injuries have shown good neurologic recovery in 72% and 67% of the subset of children who survived after receiving life support in the field [1,2]. The prognosis is still poor, however, for out-of-hospital arrests in children who require cardiac massage upon arrival to the emergency department [3], cardiotonic medications [1], or greater than 25 min of cardiopulmonary resuscitation [2].