Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Advanced Cardiac Life Support”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 361 records · Page 20Linked to original sources
PubMed1987

Neurologic benefits from the use of early cardiopulmonary resuscitation.

The efficacy of bystander CPR in resuscitation from cardiac arrest when defibrillation is available within five to six minutes has been questioned. Epidemiologic studies from different cities have shown conflicting results. We conducted a study to determine the effect of early CPR versus no CPR on resuscitability, 24-hour survival, and neurologic deficit in an animal model of cardiac arrest. Twenty-two mongrel dogs were subjected to five minutes of electrically induced ventricular fibrillation. In 11 dogs, closed-chest massage and ventilation with room air was begun immediately and was continued for five minutes. The other 11 dogs received no CPR. At five minutes defibrillation was attempted and advanced cardiac life support (ACLS) protocols were followed until the animal was resuscitated or died. No statistical difference in resuscitability or 24-hour survival between the two groups was demonstrated. Eight of 11 "early CPR" animals were resuscitated and survived 24 hours; six of 11 "no CPR" dogs were resuscitated, and five lived for 24 hours. A significant difference was demonstrated by the Student t test in neurologic deficit and ease of resuscitation. "Early CPR" dogs had no neurologic deficit, while "no CPR" dogs had a 41% deficit (P less than .01). "Early CPR" dogs were resuscitated in significantly less time once ACLS was started (29 versus 317 seconds), and required less electrical energy (100 versus 560 J), fewer countershocks (1.3 versus 4.0), and less epinephrine (0.1 versus 1.7 mg) than did "no CPR" animals. In this animal model of cardiac arrest, early CPR was shown to be beneficial to neurologic function and ease of resuscitation, even when ACLS was provided within five minutes.

Animals↗
PubMed1987

Interposed abdominal compression-CPR: its effects on parameters of coronary perfusion in human subjects.

Recent literature has emphasized the relationship between coronary perfusion during CPR and the success of resuscitation from prolonged arrest. In this study, aortic and right atrial pressures were monitored simultaneously during modifications of CPR. Three parameters associated with survival or coronary blood flow during CPR were measured: diastolic arterial pressure (DAP), diastolic arteriovenous difference (DAVD), and mean AV difference (MAVD). Standard advanced cardiac life support protocol was used although vasopressors were given by continuous infusion. In a series of two-minute trials, standard CPR, interposed abdominal compression (IAC) CPR, high-compression force (HCF) IAC-CPR, and HCF standard CPR were performed, with each patient serving as his own control. The DAP increased from 25 mm Hg during standard CPR to 43 during IAC CPR (P less than .001) and 50 during HC-IAC-CPR (P less than .001). The MAVD increased from 4 to 8 mm Hg during HCF-IAC-CPR (P less than .05). IAC-CPR had inconsistent effects on the DAVD. Three patients had a return of spontaneous circulation during the modifications of CPR after a mean of 43 minutes of asystole with standard CPR. In the seven autopsied patients, no significant abdominal injury was found. All forms of CPR studies produced DAVD in the majority of patients well below the minimum DAVD needed for resuscitation in animal models of prolonged arrest. Although the interposed abdominal compression seems to offer some advantages over standard CPR, these hemodynamic data suggest that it would be unlikely to improve survival rates appreciably.

Aged↗
PubMed1988

A comparison of epinephrine and methoxamine for resuscitation from electromechanical dissociation in human beings.

Electromechanical dissociation (EMD) is an organized electrical depolarization of the heart without synchronous myocardial fiber shortening and, therefore, without cardiac output. Patients in EMD have a poor prognosis for resuscitation and long-term survival. The beneficial effect in resuscitation of epinephrine, the adrenergic agent currently recommended, has been shown to depend on stimulation of alpha-adrenergic vasoconstriction. The beta-adrenergic inotropic and chronotropic effects of epinephrine are theoretically detrimental by increasing myocardial oxygen consumption and subendocardial ischemia. The purpose of our study was to determine whether the pure alpha agonist methoxamine was superior to epinephrine in human beings in EMD as determined by survival at one hour. These two agents were compared in a prospective, randomized, and double-blinded study involving 80 patients with EMD of various causes seen in the emergency department and internal medicine inpatient service. The advanced cardiac life support (ACLS) algorithm (current at the time of our study) for resuscitation from EMD was used, with the blinded study drug (epinephrine 1 mg or methoxamine 10 mg) administered where the algorithm calls for epinephrine. Calcium and isoproterenol also were used in the majority of cases according to ACLS standards but never prior to the use of methoxamine or epinephrine. Survival data are summarized as: survival less than one hour, 22 patients receiving methoxamine, 22 receiving epinephrine; one to six hours, 15 patients receiving methoxamine, 13 patients receiving epinephrine; six to 12 hours, one patient receiving epinephrine; more than 24 hours but not surviving to discharge, three patients receiving methoxamine, two patients receiving epinephrine; and survival to discharge, one patient receiving epinephrine.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Computerized mega code recording.

A system has been developed to facilitate recording of advanced cardiac life support mega code testing scenarios. By scanning a paper "keyboard" using a bar code wand attached to a portable microcomputer, the person assigned to record the scenario can easily generate an accurate, complete, timed, and typewritten record of the given situations and the obtained responses.

Educational Status↗
PubMed1989

Dose-dependent vasopressor response to epinephrine during CPR in human beings.

The optimal dose of epinephrine during CPR in human beings is unknown. We studied ten prehospital cardiac arrest patients (six men and four women; mean age, 54 +/- 5 years) to determine the vasopressor response and change in the end-tidal carbon dioxide concentration (PetCO2) after incremental (1-, 3-, and 5-mg) doses of IV epinephrine given five minutes apart during closed-chest CPR. All patients were in ventricular fibrillation on arrival of the paramedics and did not respond to standard advanced cardiac life support. CPR was performed with a computerized Thumper; all patients were intubated and ventilated at 12 times a minute at an FiO2 of 0.8. Radial artery pressure was measured with a 20 angiocath inserted by radial artery cutdown. Paramedic response time was 4.3 +/- 0.5 minutes; elapsed time to emergency department arrival was 40.0 +/- 9.5 minutes. Initial blood gases were paO2, 241 +/- 50 mm Hg; pH, 7.23 +/- 0.08; paCO2, 27 +/- 5 mm Hg; and HCO3, 11 +/- 2 mEq/L. Baseline systolic and diastolic blood pressures were 47 +/- 5 mm Hg and 18 +/- 2 mm Hg, respectively. Systolic blood pressure was directly related to the dose of epinephrine (P less than .0001), rising to 69 +/- 7 mm Hg, 74 +/- 8 mm Hg, and 85 +/- 8 mm Hg after 1-, 3-, and 5-mg doses of epinephrine, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Pressure↗
PubMed1989

Problem-based ACLS instruction: a model approach for undergraduate emergency medical education.

The optimal format for teaching advanced cardiac life support (ACLS) to medical students and other groups with little emergency medicine experience has not been studied extensively. We report an ACLS provider course that was taught to sophomore medical students using a self-directed, problem-based learning model. The traditional two-day provider course format was replaced by a series of clinical problems that emphasized various aspects of the ACLS curriculum. Students then met weekly with an ACLS instructor who served as a tutor to discuss the problem. A specific set of learning objectives for the entire ACLS curriculum was developed into a study unit index and given to students at the beginning of the course. Enhanced practice time was offered to students in the form of traditional teaching stations and skills laboratories. Students were tested using standard ACLS criteria. The students in the problem-based course achieved a higher pass rate on the written test and skills stations than senior medical students did in a standard two-day course during the same time period. The problem-based format with enhanced practice time would appear to be an effective alternative for groups that need to acquire the basic skills needed in a resuscitation attempt but have little previous experience in this area.

Curriculum↗
PubMed1989

Medical student retention of intubation skills.

Medical students are trained in airway management by endotracheal intubation in most medical schools. Unfortunately, little data exist examining retention, and no data exist that actually break down the steps of intubation to determine where students encounter problems. We studied 64 medical students trained to intubate as part of an American Heart Association advanced cardiac life support course and their performance two to three months after training. The rate of successful intubation (confirmed by visualization) was 70 +/- 12%. The most frequent errors during intubation were failure to check the light before intubation, use of the teeth as a fulcrum, and failure to check the cuff on the endotracheal tube. Knowledge of the most common errors will allow instructors to place greater emphasis on those areas during the initial instruction period with a focus on decreasing their occurrence in the future.

Clinical Competence↗
PubMed1995

End-tidal carbon dioxide during out-of-hospital cardiac arrest resuscitation: comparison of active compression-decompression and standard CPR.

STUDY OBJECTIVES: To compare the maximal end-tidal carbon dioxide pressure (ETCO2 peak) values obtained during standard (S-CPR) and active compression-decompression CPR (ACD-CPR) during prolonged resuscitation in out-of-hospital cardiac arrest. DESIGN: Prospective, randomized crossover study. SETTING: City with a population of 3.5 million, served by an emergency medical service system providing advanced cardiac life support. PARTICIPANTS: Patients with nontraumatic out-of-hospital cardiac arrest. INTERVENTIONS: Patients were randomly assigned to receive first, for a period of 3 minutes, either ACD-CPR or S-CPR; then the two methods were alternated. ETCO2 was continuously monitored and computed. MEASUREMENTS AND RESULTS: Sixteen patients (48 +/- 20 years old) were included; in 12, return of spontaneous circulation was achieved, and 5 were admitted alive to the hospital. A statistically significant increase in ETCO2 peak was obtained with ACD-CPR (27.6 +/- 3 mm Hg) compared with S-CPR (15.6 +/- 2.2 mm Hg). No major adverse effect possibly related to ACD-CPR was observed. CONCLUSION: This prospective study suggests that ACD-CPR may improve cardiac output compared with S-CPR.

Adult↗
PubMed1995

Comparison of prehospital monomorphic and polymorphic ventricular tachycardia: prevalence, response to therapy, and outcome.

OBJECTIVE: Monomorphic ventricular tachycardia (MVT) is the most common form of prehospital ventricular tachycardia (VT). Recent literature suggests that polymorphic ventricular tachycardia (PVT) is more common during cardiopulmonary arrest than previously thought but responds poorly to advanced cardiac life support (ACLS) therapy. We undertook this study to determine the prevalence, response to therapy, and outcome of both MVT and PVT in the prehospital sudden cardiac death victim. DESIGN: Retrospective prehospital chart review from 1987 to 1991. SETTING: Municipal, fire department-based, multitiered emergency medical system serving a population of approximately one million. PARTICIPANTS: Adult patients older than 18 years experiencing prehospital, nontraumatic cardiopulmonary arrest with VT occurring at any time during the resuscitation. VT was defined as PVT if the QRS-complex configuration was not stable when viewed in a single electrocardiographic lead (ie, episodic changing of the QRS-complex electrical axis, amplitude, or both or the presence of more than two QRS-complex morphologies). Outcome was defined in terms of both the presence or absence of spontaneous circulation at the end of the prehospital phase of care and ultimate outcome (survival to hospital discharge or death). Four hundred seventy-six patients met entry criteria; 37 patients were excluded because of incomplete medical records, and 439 patients were used for data analysis. INTERVENTIONS: ACLS therapy based on the 1987 American Heart Association guidelines. RESULTS: MVT occurred in 323 patients (73.6%), with 119 (36.8%) showing return of spontaneous circulation (ROSC) in the prehospital setting; 35 MVT patients (10.8%) survived to hospital discharge. PVT occurred in 116 patients (26.4%), with 48 (41.4%) showing ROSC in the prehospital setting; 15 PVT patients (12.9%) survived to hospital discharge. The use of ACLS therapy (defibrillation, endotracheal intubation, medication usage) between the two rhythm groups was not statistically different. The P values for ROSC, ultimate outcome, and use of ACLS therapy were all not significant. CONCLUSION: We conclude that PVT is a common rhythm occurring in prehospital cardiopulmonary arrest that responds as well as MVT to ACLS therapy. Until prospective data are available, standard ACLS therapy should be used in all forms of prehospital VT occurring during cardiopulmonary arrest.

Adult↗
PubMed1996

Magnesium sulfate for conversion of supraventricular tachycardia refractory to intravenous adenosine.

The use of magnesium sulfate infusion for the management of cardiac dysrhythmia has recently gained popularity. Magnesium sulfate has been advocated for the management of torsade de pointes and other ventricular dysrhythmias. We report the case of a 38-year-old firefighter with atrial tachycardia that was treated unsuccessfully according to Advanced Cardiac Life Support guidelines with IV adenosine. Subsequently, 2 g of magnesium sulfate was administered intravenously over 5 minutes with resulting conversion of the patients' supraventricular tachycardia to normal sinus rhythm, with complete resolution of symptoms.

Adenosine↗
PubMed1997

Adenosine in wide-complex tachycardia.

The use of adenosine as a therapeutic and diagnostic tool in wide-complex tachycardia is suggested in the current Advanced Cardiac Life Support (ACLS) guidelines. The ACLS guidelines are now 4 years old, and new information on the safety and efficiency of adenosine in wide-complex tachycardia is available. We review the ACLS recommendations in light of the current available literature. In general, the ACLS recommendations remain reasonable with some important caveats.

Adenosine↗
PubMed1997

Real-time ultrasound-guided femoral vein catheterization during cardiopulmonary resuscitation.

STUDY OBJECTIVE: To compare the use of real-time-ultrasound guidance with the standard landmark-oriented approach for obtaining femoral vein catheterization in patients requiring intravenous access during CPR. METHODS: Prospective, randomized, paired subject-controlled clinical trial in the setting of an urban teaching county hospital emergency department. The study comprised a convenience sample of 20 patients presenting with apnea and pulselessness in the ED. Each patient received bilateral femoral lines, one by ultrasound guidance and one by the landmark approach (control). Randomization determined which technique and which side would be attempted first. The following parameters were recorded: time to initial flash of blood, time to completion of catheterization, number of needle passes, and rate of arterial catheterization. CPR and Advanced Cardiac Life Support protocols were continued during both procedures. RESULTS: Real-time ultrasound-guided catheterization had a higher success rate (90% versus 65%, P = .058), a lower number of needle passes (2.3 +/- 3 versus 5.0 +/- 5, P = .0057), and a lower rate of arterial catheterization (0% versus 20%, P = .025) than the standard landmark-oriented approach. Ultrasound was also slightly faster in time to blood flash and in time to catheterization. An incidental finding of interest was that real-time ultrasound demonstrated the presence of femoral vein pulsations during CPR. CONCLUSION: Real-time ultrasound-guided femoral vein catheterization was faster and produced a lower rate of inadvertent arterial catheterization and a higher rate of success during CPR than the standard landmark-oriented approach. Also, ultrasound demonstrated that palpable femoral pulsation during CPR is venous rather than arterial.

Adult↗
PubMed1998

Factors influencing hospital transport of patients in continuing cardiac arrest.

STUDY OBJECTIVE: Prior research has established the futility of continued resuscitation efforts for patients in cardiac arrest who fail to respond to out-of-hospital advanced cardiac life support. Determination of both medical and nonmedical factors resulting in the transport of patients in continuing cardiac arrest to the hospital may encourage the development of new systems or strategies to increase the appropriateness of these transports. METHODS: The attending paramedic completed a prospective survey after unsuccessful resuscitation efforts in our urban, hospital-based, two-tier emergency medical services (EMS) system. All nontraumatic adult arrests were included unless they were clearly noncardiac in nature. RESULTS: Paramedics responded to 259 cardiac arrests between September 12, 1996, and April 31, 1997. Seventy-nine patients were pronounced dead without resuscitation efforts. Of the remaining 180 patients, 44 had return of spontaneous circulation and were transported to the hospital, 68 were pronounced dead in the field, and 68 were transported to the hospital in continuing cardiac arrest. The 68 patients transported while in cardiac arrest are the focus of this study. Rare problems with field termination were identified. Reasons for transport of the 68 patients in continuing cardiac arrest included arrest in ambulance or going to ambulance (n = 6), arrest in a public place (n = 17), environmental factors (n = 6), road hazard to paramedics (n = 1), possible reversible cause (n = 4), persistent ventricular dysrhythmia (n = 5), no intravenous access (n = 5), airway difficulties (n = 5), family unable to accept field termination (n = 3), cultural or language barrier (n = 1), EMS physician ordered transport (n = 1), and obesity (n = 1). A protocol allowing pronouncement of death in the ambulance and transport of the body to a designated area could have prevented lights-and-siren transport to the emergency department in 24 of the 68 cases. CONCLUSION: Factors other than medical ones often influence the decision to transport patients in continuing cardiac arrest. In our urban system, physician, medical examiner, and paramedic education and protocols were needed to aid decision-making in this situation.

Cardiopulmonary Resuscitation↗
PubMed1998

Alternative to the Science Citation Index impact factor as an assessment of emergency medicine's scientific contributions.

STUDY OBJECTIVE: The Science Citation Index "impact factor" is the only available quantitative estimate of a journal's scientific contributions. However, the derivation of this factor contains an intrinsic bias that underestimates the impact of emergency medicine journals. We wished to test the hypothesis that use of an alternative criterion standard would provide an improved profile of the scientific contributions of emergency medicine journals relative to those of other specialties. METHODS: We used an observational, longitudinal, comparative design in which all Index Medicus citations from Advanced Cardiac Life Support (ACLS) publications were aggregated by journal and then stratified by specialty. Proportions and proportionate trends, relative to total citations, were reported by specialty, facilitating comparison of emergency medicine with other disciplines. RESULTS: Among all eight ACLS publications (1974-1994) 4,062 citations met the inclusion criteria. Emergency medicine journals were referenced in 16% of eligible citations (99% confidence interval [CI], 14% to 17%), a figure exceeded only by internal medicine and cardiology journals. Emergency medicine was the only discipline to show a significant proportionate increase in contributions over the 20-year study period (P < .001 by chi 2 for linear trend analysis). CONCLUSION: Contrary to the implications of a low impact factor, an analysis of journal citations in ACLS publications over two decades suggests that emergency medicine has made significant contributions to a broad and important area of scientific inquiry.

Bias↗
PubMed1998

Bolus thrombolytic infusions during CPR for patients with refractory arrest rhythms: outcome of a case series.

Thrombolytic therapy has been accepted in the treatment of acute myocardial infarction. Given historical recommendations that thrombolytic therapy is contraindicated in patients receiving CPR, its potential clinical benefit for facilitating conversion of rhythm in patients in refractory cardiac arrest has not been investigated. We present three case reports in which patients with confirmed acute myocardial infarction had a witnessed cardiac arrest in the ED. Standard Advanced Cardiac Life Support measures failed in all three cases. A bolus infusion of tissue plasminogen activator was administered during CPR in refractory ventricular fibrillation (two cases) and pulseless ventricular tachycardia (one case). Patients were given tissue plasminogen activator and had defibrillation, followed by a spontaneous return of circulation, with resuscitation and subsequent discharge. No postarrest sequelae were observed as a result of thrombolytic use during the resuscitative process. We conclude that bolus thrombolytic infusions during CPR may facilitate spontaneous return of circulation in select patients with confirmed acute myocardial infarction, witnessed cardiac arrest in the ED, and refractory ventricular fibrillation or tachycardia.

Adult↗
PubMed1999

Is a pressor necessary during aortic perfusion and oxygenation therapy of cardiac arrest?

STUDY OBJECTIVE: Occlusion of the descending aorta and infusion of oxygenated ultrapurified polymerized bovine hemoglobin may improve the efficacy of advanced cardiac life support (ACLS). Because selective aortic perfusion and oxygenation (SAPO) directly increases coronary perfusion pressure, exogenous epinephrine may not be required. The purpose of this study was to determine whether exogenous epinephrine is necessary during SAPO by comparing the rate of return of spontaneous circulation and aortic and coronary perfusion pressures during ACLS-SAPO in animals treated with either intra-aortic epinephrine or saline solution. METHODS: A prospective, randomized, interventional before-after trial with a canine model of ventricular fibrillation cardiac arrest and ACLS based on external chest compression was performed. The ECG, right atrial, aortic arch, and esophageal pulse pressures were measured continuously. A descending aortic occlusion balloon catheter was placed through the femoral artery. Ventricular fibrillation was induced, and no therapy was given during the 10-minute arrest time. Basic life support was then initiated and normalized by standardization of esophageal pulse pressure and central aortic blood gases. After 3 minutes of basic life support, the aortic occlusion balloon was inflated, and 0.01 mg/kg epinephrine or saline solution was administered through the aortic catheter followed by 450 mL of ultrapurified polymerized bovine hemoglobin over 2 minutes. Defibrillation was then attempted. The outcomes and changes in intravascular pressures were compared. RESULTS: Aortic pressures were higher during infusions in animals treated with epinephrine. During infusion, the mean aortic relaxation pressure increased by 58+/-5 mm Hg in animals that had received epinephrine versus 20+/-11 mm Hg in those that had received saline placebo. The coronary perfusion pressure during infusion increased by 52+/-8 mm Hg in animals that had received epinephrine versus 26+/-10 mm Hg in those that had received saline. Only 2 of 7 animals in the placebo group had return of spontaneous circulation versus 7 of 8 in the epinephrine group. CONCLUSION: The addition of epinephrine to ACLS-SAPO increases vital organ perfusion pressures and improves outcome from cardiac arrest. There appears to be a profound loss of arterial vasomotor tone after prolonged arrest. This loss of vasomotor tone may make exogenous pressors necessary for resuscitation after prolonged cardiac arrest.

Adrenergic Agonists↗
PubMed1999

Hyperkalemia and ionized hypocalcemia during cardiac arrest and resuscitation: possible culprits for postcountershock arrhythmias?

STUDY OBJECTIVE: Early countershock of ventricular fibrillation (VF) has been shown to improve immediate and long-term outcome of out-of-hospital cardiac arrest. However, studies indicate that countershock of prolonged VF most commonly results in asystole or a nonperfusing bradyarrhythmia (pulseless electrical activity [PEA]), which rarely respond to current therapy. The cause of these postcountershock rhythm disturbances is not well understood but may be related to electrical injury of the globally ischemic myocardium or to local metabolic abnormalities that impair impulse formation and cardiac contraction. The purpose of this study was to evaluate changes in serum potassium and free calcium homeostasis during cardiac arrest and advanced cardiac life support (ACLS) interventions. METHODS: After sedation, intubation, anesthesia, and instrumentation, VF was induced in 13 dogs. After 7.5 minutes of VF, animals were immediately countershocked, standard closed-chest CPR was initiated, and epinephrine was administered (1 mg in repeated doses if necessary). RESULTS: Ten animals could not be resuscitated despite 20 minutes of ACLS interventions. In these animals, a progressive increase in serum potassium was observed from the onset of ACLS to the termination of resuscitation efforts (4.3+/-.6 to 6.0+/-.8 mEq/L, P<.01). A significant increase was observed within 10 minutes of beginning ACLS measures. This was accompanied by a decrease in ionized calcium concentration over the same period (4.95+/-.40 to 3.44 mg/dL, P<.01). The decrease in ionized calcium was significant within 5 minutes of ACLS interventions. Nine of these 10 animals had either postcountershock asystole or PEA at the termination of resuscitative efforts. The increase in potassium was not related to acidemia. Successfully resuscitated animals did not demonstrate these electrolyte changes. CONCLUSION: Ionized hypocalcemia and hyperkalemia occur during prolonged resuscitative efforts and may be related to dysfunctional transcellular ionic transport mechanisms. These cations play important roles in cardiac electrical and contractile activity and may play a role in refractory postcountershock rhythm disturbances.

Animals↗
PubMed1999

A prospective, population-based study of the demographics, epidemiology, management, and outcome of out-of-hospital pediatric cardiopulmonary arrest.

STUDY OBJECTIVES: To perform a population-based study addressing the demography, epidemiology, management, and outcome of out-of-hospital pediatric cardiopulmonary arrest (PCPA). METHODS: Prospective, population-based study of all children (17 years of age or younger) in a large urban municipality who were treated by EMS personnel for apneic, pulseless conditions. Data were collected prospectively for 3(1/2) years using a comprehensive data collection tool and on-line computerized database. Each child received standard pediatric advanced cardiac life support. RESULTS: During the 3(1/2)-year period, 300 children presented with PCPA (annual incidence of 19. 7/100,000 at risk). Of these, 60% (n=181) were male (P =.0003), and 54% (n=161) were patients 12 months of age or younger (152,500 at risk). Compared with the population at risk (32% black patients, 36% Hispanic patients, 26% white patients), a disproportionate number of arrests occurred in black children (51.6% versus 26.6% in Hispanics, and 17% in white children; P <.0001). Over 60% of all cases (n=181) occurred in the home with family members present, and yet those family members initiated basic CPR in only 31 (17%) of such cases. Only 33 (11%) of the total 300 PCPA cases had a return of spontaneous circulation, and 5 of the 6 discharged survivors had significant neurologic sequelae. Only 1 factor, endotracheal intubation, was correlated positively with return of spontaneous circulation (P =.032). CONCLUSION: This population-based study underscores the need to investigate new therapeutic interventions for PCPA, as well as innovative strategies for improving the frequency of basic CPR for children.

Adolescent↗