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SPA Newsletter

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Volume 17 Number 3
Summer 2004 Newsletter
spa@societyhq.com

An evaluation of pediatric in-hospital advanced life support interventions using the pediatric Utstein guidelines: a review of 203 cardiorespiratory arrests.

J. Guay, L. Lortie.Can J Anesth 2004:51:4:373-378

Review: The aims of this study were to report data, according to the pediatric Utstein style, from a six-year experience of in-hospital pediatric CPR in a tertiary care center, and to evaluate the influence of advanced life support (ALS) interventions including various dosages of epinephrine on survival and functional outcome after pediatric CPR. The Utstein style is a uniform format of reporting pediatric cardiorespiratory arrest data, proposed jointly by the American Academy of Pediatrics, the AHA and the European Resuscitation Council.

The study from a tertiary care university-affiliated institution consisted of a retrospective review of the charts of all patients for whom a cardiorespiratory arrest code had been called during the six-year period. There were 234 cardiopulmonary arrests, with 31 being excluded, leaving 203 charts reviewed. At one year, 50 patients (26%) were alive, 142 were dead, and 11 had unknown status. Of the survivors, 45/50 were neurologically unchanged, and 5/50 had some neurological deterioration. Long-term survival was not achieved if endotracheal intubation was not accomplished after 20 minutes, if the total dose required for defibrillation was 18.5 j/kg or higher, and if the pre-arrest hemoglobin was lower than 5.7 grams. There was no correlation between survival or change in neurologic status with blood glucose levels. Two patients survived neurologically intact by one year despite resuscitation for 38 and 44 minutes respectively. An initial epinephrine dose 0.01 mg/kg, administered either IV or endotracheally, was supported in the study, with higher doses associated with decreased survival.

Comment: Despite the fact that this is a retrospective review, this study contains some interesting information. The AHA recommendation for the initial epinephrine dose being 0.01 mg/kg is supported, and this dose is equally effective if given IV or intratracheally. Recommendations for 0.1 mg/kg for intratracheal administration may not be necessary. Hyperglycemia may not be as deleterious to neurological status as previously thought, and should not be taken as a predictor of poor prognosis and used as an argument to withhold subsequent ALS interventions in children. Two neurologically intact survivors required resuscitation for longer than 30 minutes, suggesting that a longer minimum resuscitation duration may be required in children. Finally, this study suggests that while the one year survival following arrest in children is low, those that survive have a good chance of being neurologically intact.

Reviewed by: Cathy Bachman, MD

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