Cardiorespiratory arrest outside hospital occurs in approximately 1/10,000 children a year in resource-rich countries, with two-thirds of arrests occurring in children under 18 months of age. Approximately 45% of cases have undetermined causes, including sudden infant death syndrome. Of the rest, 20% are caused by trauma, 10% by chronic disease, and 6% by pneumonia.
Methods and outcomes
We conducted a systematic review aiming to answer the following clinical question: What are the effects of treatments for non-submersion out-of-hospital cardiorespiratory arrest in children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to December 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 15 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: airway management and ventilation (bag–mask ventilation and intubation), bystander cardiopulmonary resuscitation, direct-current cardiac shock, hypothermia, intravenous sodium bicarbonate, standard dose of intravenous adrenaline (epinephrine), and training parents to perform resuscitation.
Cardiorespiratory arrest outside hospital occurs in approximately 1/10,000 children a year in resource-rich countries, with two-thirds of arrests occurring in children under 18 months of age.
Approximately 45% of cases have undetermined causes, including sudden infant death syndrome. Of the rest, 20% are caused by trauma, 10% by chronic disease, and 6% by pneumonia.
Overall survival for out-of-hospital cardiorespiratory arrest in children is poor.
Overall survival for children who sustain cardiorespiratory arrest outside hospital not caused by submersion in water is about 4%.Of those who survive, between half and three-quarters will have moderate to severe neurological sequelae.
There is very poor evidence for any intervention in cardiorespiratory arrest in children. Placebo-controlled trials would be unethical, and few observational studies have been performed.
Immediate airway management, ventilation, and high-quality chest compressions with minimal interruption are widely accepted to be key interventions.
Ventilation with a bag and mask seems as effective as intubation. The most suitable method for the situation should be used.
Direct current cardiac shock is likely to be beneficial in children with ventricular fibrillation or pulseless ventricular tachycardia.
Ventricular fibrillation or pulseless ventricular tachycardia are the underlying rhythms in 10% of cardiorespiratory arrests in children, and are associated with a better prognosis than asystole or pulseless electrical activity.Defibrillation within 10 minutes of the arrest may improve the outcome.
Intravenous adrenaline is widely accepted to be the initial medication of choice in an arrest.
The standard dose of intravenous adrenaline is 0.01 mg/kg.Weak evidence suggests that higher dose adrenaline (0.1 mg/kg) is no more effective in improving survival.The effects of cooling a child after arrest are unknown.