The characteristics and evolution of extrahospitalary paediatric cardiac arrest in Galicia

Iglesias Vázquez JA, Rodríguez Núñez A, Cegarra García M, Barreiro Díaz MV, Blanco-Ons Fernández P, Sánchez Santos L

Background and aims: Cardiorespiratory arrest (CRA) is a rare

event in childhood, and its characteristics are not well known.

The aim of our present work was to assess the characteristics of

paediatric CRA and the immediate results of cardiopulmonary resuscitation

(CPR) in Galicia and to identify prognostic factors for survival.

Methods: All children aged from newborn to 16 years old who had suffered

outpatient CRA and had been assisted by the Medical Emergencies

of Galicia – 061 Public Foundation (Fundación Pública Urgencias

Sanitarias en Galicia – 061, FPUS-061) between June 2002 and February

2006 were included in the study. Data were prospectively recorded

according to the Utstein guidelines.

Results: The study population encompasses 31 cases of CRA (incidence

rate: 3.4 CRA’s per 100.000 children and year); 5 cases were respiratory in

origin (16.1%) and 26 (83.9%) were cardiac. There were 18 cases of at-home

CRA (58.1%). The CRA to CPR interval was less than 10 minutes in 10

cases (32.2%) and greater than 20 minutes in 9 (29.0%). The initial CPR

was performed by a bystander in 7 cases (22.6%). The first recorded cardiac

rhythm was asystolia in 21 cases (67.7%). Bag-and-mask ventilation

was applied in 25 cases (80.6%), and 27 (87%) were intubated. A peripheral

venous access was achieved in 21 cases (67.7%), and an intraosseous

one in 5 (16.1%). Twenty-nine patients (93.5%) received adrenalin. Spontaneous

circulatory recovery was recorded in 12 cases (38.7%), and 10 patients

(32.2%) did not respond to CPR. Out of the 21 children who arrived

at the hospital, 11 were dead on arrival (35.5%) and 10 (32.2%) were admitted.

Among the latter, died while admitted (12.9%) and 6 survived until

discharged (19.4%). No definite survival predictores could be identified.

Conclusions: The characteristics of paediatric CRA and the results of CPR

in Galicia are similar to those reported from other areas and communities in

our environment. Programs should be implemented to increase bystander

CPR, to improve basic CPR skills among the general population and to update

the life support training and skills among the health care personnel.

Barreiro Díaz MV, Blanco-Ons Fernández P, Cegarra García M, Iglesias Vázquez JA, Rodríguez Núñez A, Sánchez Santos L