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PubMed2005

Potential impact of a targeted cardiopulmonary resuscitation program for older adults on survival from private-residence cardiac arrest.

OBJECTIVE: Traditional cardiopulmonary resuscitation (CPR) training programs do not target older adults who are most likely to witness private-residence cardiac arrests and do not reliably result in a bystander who is likely to perform CPR in the event of an arrest. This study was performed to compare targeted CPR training programs for older adults (older than 50 years) that 1) increase numbers of CPR-trained bystanders of private-residence cardiac arrest or 2) increase the percentage of trained bystanders of private-residence cardiac arrest who perform CPR. A simultaneous outcome was to estimate the minimal significant survival benefit associated with each of the training programs. METHODS: A probabilistic simulation model was developed in Fortran95 that incorporated key out-of-hospital cardiac arrest elements, including witnessed arrests, CPR-trained witness, CPR provision, and impact of CPR on ventricular fibrillation. Input data were derived from published or publicly available data, including a large prospective cohort study of outcomes in Oakland County, MI. Monte Carlo simulation (n = 10,000) and sensitivity analyses (n = 40) were used to assess median and the empiric 95% confidence intervals [CIs] for incremental survival with either intervention. RESULTS: The baseline model, calibrated to the characteristics of the input-data community, established that, for private-residence cardiac arrests, 40.8% of cardiac arrest bystanders were trained in CPR; however, only 25.7% performed CPR. This yielded 4.81% survival (95% CI = 4.72 to 4.89). Modeling the impact on the baseline training level with increased CPR performance among trainees indicated that 75% of private-residence trained bystanders would need to perform CPR in order to reach a minimally significant improvement in survival (5.02%; 95% CI = 4.94 to 5.15). Similarly, targeted CPR training that would result in a significant survival benefit (to 5.01%; 95% CI = 4.93 to 5.09) would require that 70.8% of bystanders be trained. CONCLUSIONS: CPR training programs that focus on yielding 75% of trainees who perform CPR in the event of witnessing an arrest would have equivalent results to mass CPR training programs that result in 70% of bystanders being trained in CPR. However, the minimal survival benefit associated with these programs (around 0.2%) may prove either method costly with minimal effect.

Aged↗
PubMed1981

Oxypurine release in cardiac disease. An indicator of general hypoxia in patients with cardiac arrest.

The excretion of hypoxanthine-xanthine and uric acid in urine and the concentrations in peripheral venous blood were determined in nine patients with cardiac arrest due to acute myocardial infarction (AMI), in ten control patients with AMI without cardiac arrest and in nine with angina pectoris. The patients with cardiac arrest showed a 6-fold increase in urinary excretion of hypoxanthine-xanthine 0-2 hours after cardiac arrest. No difference was observed in the uric acid excretion or the hypoxanthine-xanthine and uric acid concentrations in peripheral venous blood. The urinary excretion of hypoxanthine-xanthine increases considerably in connection with reversible cardiac arrest, indicating general tissue hypoxia. No relationship could be found between the duration of cardiac arrest and the increased hypoxanthine-xanthine excretion in the urine.

Coronary Disease↗
PubMed1993

Corticosteroid supplementation during cardiac arrest in rats.

HYPOTHESIS: Corticosteroids will improve the rate of resuscitation from cardiac arrest. DESIGN: Prospective blinded randomized placebo-controlled trial. INTERVENTION: An 8-min cardiac arrest was induced by KCl infusion and chest restriction in 36 male Sprague-Dawley rats with continuous EKG and arterial blood pressure monitoring. At the start of CPR the rats received one of three study drugs: normal saline (placebo); 0.05 mg hydrocortisone (Group A) and 0.25 mg hydrocortisone (Group B). Mechanical ventilation, chest compressions and ACLS drug administration were provided following a standardized algorithm. RESULTS: The resuscitation rate was significantly higher (P < 0.05) in Group B (92%) compared to Group A (50%) and placebo (50%). For the rats resuscitated, the duration of CPR (placebo = 163 s, Group A = 126 s, Group B = 120 s) and the amount of epinephrine used (placebo = 0.007 mg, Group A = 0.005 mg, Group B = 0.005 mg) did not reach statistical significance (P = 0.15 and P = 0.21). CONCLUSION: Hydrocortisone significantly increased the rate of ROSC from cardiac arrest. There also appears to be a trend of decreasing duration of CPR and epinephrine requirements with hydrocortisone. Further studies evaluating the mechanism of action and long term effects of hydrocortisone in cardiac arrest need to be conducted.

Animals↗
PubMed1994

Methodology for data collection to study prehospital cardiac arrest in New York City: the PHASE methodology. PreHospital Arrest Survival Evaluation Group.

STUDY OBJECTIVE: To describe an effective methodology for the investigation of prehospital cardiac arrest in large cities. DESIGN: Observational cohort study. SETTING: New York City emergency medical services system. PARTICIPANTS: All cardiac arrests dispatched by the 911 system between October 1, 1990, and March 31, 1991. INTERVENTIONS: Trained paramedics performed immediate postarrest interviews with prehospital and hospital care providers using a standardized data collection instrument. RESULTS: Of 3,239 consecutive, confirmed cardiac arrests in which resuscitation was attempted, 2,329 (72%) were of cardiac etiology. Information was sought for 15 of the 17 core events and times recommended by the Utstein Consensus Conference Data were obtained in more than 98% of cases for all except one of these core events and times. One core time yielded data in 96% of cases. All patients were followed until death or discharge home. None were lost to follow-up. CONCLUSION: Concurrent, interactive acquisition of prehospital cardiac arrest data in a large urban setting captured over 98% of the core data recommended for completion of the Utstein template. This methodology may be a suitable means of investigating prehospital cardiac arrest in large cities.

Adult↗
PubMed2006

Epinephrine increases mortality after brief asphyxial cardiac arrest in an in vivo rat model.

Epinephrine may be detrimental in cardiac arrest. In this laboratory study we sought to characterize the effect of epinephrine and concomitant calcium channel blockade on postresuscitation myocardial performance after brief asphyxial cardiac arrest. Anesthesized rats were disconnected from mechanical ventilation, resulting in cardiac arrest. Resuscitation was attempted after 1 min with mechanical ventilation, oxygen, chest compressions, and IV medication. In experimental series 1 and 2, animals were allocated to 10 or 30 microg/kg epinephrine or 0.9% saline. In series 3, animals received 30 microg/kg of epinephrine and were randomized to 0.1 mg/kg of verapamil or to 0.9% saline. In series 1 and 3, left ventricular function was assessed using transthoracic echocardiography. In series 2, left atrial pressure was measured. Epinephrine was associated with increased mortality (0/8 [0%] in controls, 4/12 [33.3%] in 10 microg/kg animals, and 16/22 [72.8%] in 30 microg/kg animals; P < 0.05), hypertension (P < 0.001), tachycardia (P = 0.004), early transient left atrial hypertension, and dose-related reduction in left ventricular end diastolic diameter (P < 0.05). Verapamil prevented mortality associated with large-dose epinephrine (0% versus 100%) and attenuated early diastolic dysfunction and postresuscitation hypertension (P = 0.001) without systolic dysfunction. Epinephrine appears to be harmful in the setting of brief cardiac arrest after asphyxia.

Animals↗
PubMed1997

Randomised trial of magnesium in in-hospital cardiac arrest. Duke Internal Medicine Housestaff.

BACKGROUND: The apparent benefit of magnesium in acute myocardial infarction, and the persistently poor outcome after cardiac arrest, have led to use of magnesium in cardiopulmonary resuscitation. Because few data on its use in cardiac arrest were available, we undertook a randomised placebo-controlled trial (MAGIC trial). METHODS: Patients treated for cardiac arrest by the Duke Hospital code team were randomly assigned intravenous magnesium (2 g [8 mmoles] bolus, followed by 8 g [32 mmoles] over 24 h; 76 patients) or placebo (80 patients). Only patients in intensive care or general wards were eligible; those whose cardiac arrest occurred in emergency, operating, or recovery rooms were excluded. The primary endpoint was return of spontaneous circulation, defined as attainment of any measurable blood pressure or palpable pulse for at least 1 h after cardiac arrest. The secondary endpoints were survival to 24 h, survival to hospital discharge, and neurological outcome. Analysis was by intention to treat. FINDINGS: There were no significant differences between the magnesium and placebo groups in the proportion with return of spontaneous circulation (41 [54%] vs 48 [60%], p = 0.44), survival to 24 h (33 [43%] vs 40 [50%], p = 0.41), survival to hospital discharge (16 [21%] vs 17 [21%], p = 0.98), or Glasgow coma score (median 15 in both). INTERPRETATION: Empirical magnesium supplementation did not improve the rate of successful resuscitation, survival to 24 h, or survival to hospital discharge overall or in any subpopulation of patients with in-hospital cardiac arrest.

Aged↗
PubMed1990

[Cardiac arrest during anesthesia and recovery period].

Cardiac arrests (CA) occurring during anaesthesia and recovery can be classified into three groups: CA not related to anaesthesia (NACA), CA related to anaesthesia (ACA), whether partially (PACA) or totally (TACA). In the French survey, NACAs were three times more frequent than ACAs. Nearly 25% of ACAs occurred at induction and consisted mainly in TACAs. Another quarter of ACAs occurred during maintenance and consisted mainly in PACAs. About 50% of ACAs occurred after the end of anaesthesia and had the highest mortality rate. Cardiac arrest corresponds to the status of a heart unable to generate the minimum aortic blood flow required for functioning of vital organs. For the brain, a zero-blood flow of more than 4 seconds results in coma. Consequently CA exists when the time interval between two subsequent efficient systoles is greater than 4 seconds. Anaesthetic agents can result in CA by 1) overdose (absolute, relative), 2) anaphylactoid/anaphylactic reactions, 3) specific effects (acetylcholine-like effect, hyperkalaemia and malignant hyperthermia for succinylcholine; vagal effect of vecuronium and atracurium; cardiotoxicity of bupivacaine) and 4) drug interaction. In hypoxic CA, severe neurologic impairment often still exists at the time of onset of CA. The anaesthesia machine and controlled ventilation can induce CA by hypoxic ventilation, overdose of anaesthetic vapour, excessive CO2 reinhalation, hypoventilation, disconnection, excessive pressure in airways. Cardiac hypothermia can be a cause of CA as well as a cause of unsuccessful CPR. Massive infusion of unwarmed fluids and IPPV with unheated gases generate a temperature gradient within the heart which may result in severe arrhythmias and CA.(ABSTRACT TRUNCATED AT 250 WORDS)

Anaphylaxis↗
PubMed2002

Application of a cardiac arrest score in patients with sudden death and ST segment elevation for triage to angiography and intervention.

The aim of this study was to test a previously validated, prognostic, cardiac arrest score in patients with ST segment elevation acute myocardial infarction (AMI) who suffered a witnessed cardiac arrest and survived to emergency department admission. A consecutive series constructed retrospectively from a sudden death database (n = 22) of patients with ST segment elevation AMI resuscitated from cardiac arrest underwent angiography and angioplasty of the culprit vessel within 24 hours of presentation. A cardiac arrest score was assigned to each case by explicit criteria present on evaluation. Primary outcomes were survival to hospital discharge and the degree of neurological recovery during the hospitalization. All patients underwent successful coronary angioplasty and 77% received adjunctive intraaortic balloon counterpulsation. The overall rate of survival to discharge was 41%. For cardiac arrest scores of 0, 1, 2, and 3, respectively, the rates of neurologic recovery were 0 (0%) of 4 (95% CI 0-53%), 3 (50%) of 6 (95% CI 15-85%), 2 (67%) of 3 (95% CI 13-98%), and 9 (100%) of 9 (95% CI 72-100%), and the rates of survival to discharge were 0 (0%) of 4, (95% CI 0-53%), 2 (33%) of 6 (95% CI 6-74%), 2 (67%) of 3 (95% CI 13-98%), and 9 (100%) of 9 (95% CI 72-100%), P < 0.01 for both outcomes over ascending scores. These results suggest appropriate patients for primary angioplasty after cardiac arrest are those with ST segment elevation AMI and an emergency department cardiac arrest score of > or = 2, thus predicting a 11 (92%) of 12 (95% CI 65-100%) chance of survival to discharge.

Adult↗
PubMed2003

Frequency of ventricular fibrillation as predictor of one-year survival from out-of-hospital cardiac arrests.

This study determined whether electrocardiographic analysis of ventricular fibrillation (VF) can predict 1-year survival from bystander-witnessed, out-of-hospital cardiac arrests of cardiac origin. VF was analyzed using fast-Fourier transformation in a community in which emergency medical technicians delivered shock with an automated external defibrillator before arrival to the hospital. The frequency of VF can predict survival 1 year after hospital discharge from shock-delivered, bystander-witnessed cardiac arrests of cardiac etiology.

Aged↗
PubMed2006

Outcomes from out-of-hospital cardiac arrest in Detroit.

OBJECTIVE: To determine the out-of-hospital cardiac arrest survival rate, and prevalence of modifiable factors associated with survival, in Detroit, Michigan, over a 6-month period of time in 2002. METHODS: A retrospective review of all out-of-hospital cardiac arrests responded to by the Detroit Fire Department, Division of Emergency Medical Services. All elements of the EMS runsheet were transcribed to a database for analysis. Patient hospital records were reviewed to determine survival to hospital admission. All survivors to hospital admission were surveyed later in the Michigan Department of Vital Records death registry search. RESULTS: During this study timeframe, there were 538 confirmed out-of-hospital cardiac arrests within the City of Detroit, of which 67 were excluded for being dead on scene [51 (12.5%)] or having no available hospital records [16 (3.0%)]. Of the remaining 471 patients, 443 (94.1%) died before hospital admission. Only 44 (9.9%) of the 471 patients had a first recorded rhythm of ventricular fibrillation (VF), and 339 (76.5%) were asystolic. Of the 28 patients who survived to hospital admission, only 2 (7.1%) were noted to have a first rhythm of VF, and 15 (53.6%) were asystolic. Only one patient survived to hospital discharge. CONCLUSIONS: In this urban setting, out-of-hospital cardiac arrest is an almost uniformly fatal event.

Adolescent↗
PubMedDate not supplied

Out-of-hospital cardiac arrest in octogenarians and nonagenarians.

BACKGROUND: Studies of elderly patients who have out-of-hospital cardiac arrest have contradictory results. The studies usually define elderly patients as those older than 70 years, and include relatively few octogenarians and nonagenarians. OBJECTIVES: To compare the survival after out-of-hospital cardiac arrest of octogenarians, nonagenarians, and younger patients and to determine the influence of age on survival after adjusting for factors known to influence out-of-hospital cardiac arrest outcome. METHODS: We conducted a retrospective cohort study in suburban King County, Washington, on 5882 patients who had out-of-hospital cardiac arrest from presumed cardiovascular disease between January 1, 1987, and December 31, 1998, and who received cardiopulmonary resuscitation from bystanders, emergency medical technicians, or both. The main outcome measure was survival to hospital discharge. RESULTS: In patients who had out-of-hospital cardiac arrest due to a cardiac cause, younger patients had higher hospital discharge rates than octogenarians, who in turn had higher hospital discharge rates than nonagenarians (19.4% vs 9.4% vs 4.4%; P<.001). However, survival to hospital discharge improved significantly for younger patients, octogenarians, and nonagenarians who had ventricular fibrillation or pulseless ventricular tachycardia (36% vs 24% vs 17%; P<.001). After multiple logistic regression analysis controlling for other factors, increased age was weakly associated with decreased survival to hospital discharge (odds ratio, 0.92; 95% confidence interval, 0. 85-0.99). CONCLUSIONS: Octogenarians and nonagenarians have lower survival to hospital discharge than younger patients, but age is a much weaker predictor of survival than other factors such as initial cardiac rhythm. Decisions regarding resuscitation should not be based on age alone. Arch Intern Med. 2000;160:3439-3443.

Aged↗
PubMed2001

Is there a difference between women and men in characteristics and outcome after in hospital cardiac arrest?

AIM: To describe the characteristics and outcome among patients suffering from an in-hospital cardiac arrest in women and men. METHODS: All patients who suffered an in-hospital cardiac arrest during a 4 year period in Sahlgrenska Hospital Göteborg, Sweden, where the cardiopulmonary resuscitation (CPR) team was called, were recorded and described prospectively in terms of characteristics and outcome. RESULTS: There were 557 patients suffering in-hospital cardiac arrest in whom the CPR-team was alerted. Among them, 217 (39%) were women. Women differed from men having a lower prevalence of earlier myocardial infarction, angina pectoris, renal disease and a higher prevalence of rheumatic disease. In terms of aetiology of the cardiac arrest, 47% men and 48% women were judged to have had a confirmed or possible AMI. More men than women were found in ventricular fibrillation/ventricular tachycardia (VF/VT) (57 vs. 41%; P<0.001), whereas more women were found in pulseless electrical activity (30 vs. 15%; P<0.0001). Cerebral performance categories (CPC)-score at discharge did not differ between men and women. Among women, 36.4% survived to discharge as compared with 38.0% among men (NS). Survival from VF/VT was 64.3% in women and 52.7% in men (NS). When correcting for dissimilarities at baseline, the adjusted odd ratio for being discharged alive from hospital among women as compared with men was 1.66 (95% confidence limit 1.06-2.62; P=0.028). CONCLUSION: Thirty nine percent of patients suffering in-hospital cardiac arrest for whom the CPR-team was alerted, were women. Women were less frequently found in VF/VT than men. After correcting for dissimilarities at baseline, female gender was associated with a small improvement in survival.

Aged↗
PubMed2004

Does attendance at an immediate life support course influence nurses' skill deployment during cardiac arrest?

OBJECTIVE: To determine if attendance at a Resuscitation Council (UK) immediate life support (ILS) course influenced the skill deployment of nurses at a subsequent cardiac arrests. METHODS: Data from all cardiac arrests occurring in two 12-month periods (before and 12 months after ILS course implementation) were collected. Semi-structured interviews were conducted with a sample of nurses who had completed ILS training within the past 12 months and who had subsequently attended a cardiac arrest. RESULTS: There were 103 patients defibrillated (after ILS implementation). Only one ward nurse defibrillated prior to the arrival of the crash team. There were 99 laryngeal mask airways (LMAs) inserted during the same period. Ward nurses performed two of these, one with the supervision of the resuscitation officer (RO). The interviews revealed that although many nurses felt confident after the course most felt that as time passed their confidence reduced to such a degree that they would not use their skills without supervision. Attendance at cardiac arrest soon after the course appeared to be a key element in maintaining confidence levels. CONCLUSION: ILS training alone may be insufficient to increase deployment of these skills by nurses who are not cardiac arrest team members. A more supportive approach, involving individual coaching of these individuals may need to be considered.

Cardiopulmonary Resuscitation↗
PubMed1993

The CASCADE Study: randomized antiarrhythmic drug therapy in survivors of cardiac arrest in Seattle. CASCADE Investigators.

The Cardiac Arrest in Seattle: Conventional Versus Amiodarone Drug Evaluation (CASCADE) study evaluated antiarrhythmic drug therapy in patients who had survived an episode of out-of-hospital ventricular fibrillation (VF) and who were thought to be at high risk for recurrence of VF. Therapy with empiric amiodarone was compared to therapy with other antiarrhythmic agents, guided by electrophysiologic testing and/or Holter recording. The study evaluated the endpoints of (1) cardiac death, (2) cardiac arrest from ventricular fibrillation with resuscitation, and (3) complete syncope followed by a shock from an automatic implanted defibrillator that restored consciousness. The study comprised 228 patients, 113 treated with amiodarone and 115 treated with conventional antiarrhythmic drug therapy. Most patients had coronary artery disease with a prior myocardial infarction, and one half of the population had a history of congestive heart failure. The mean left ventricular ejection fraction was 35%. Survival was better in patients treated with amiodarone than in patients treated with other antiarrhythmic agents. Patients treated with amiodarone were less likely to receive a shock from an implanted defibrillator, and syncope followed by a shock from a defibrillator was less common in patients treated with amiodarone. However, overall mortality was high, and side effects of therapy were common. Patients treated with amiodarone, even at the low doses used in this study, were still at risk for thyroid dysfunction (both hyperthyroidism and hypothyroidism) and for pulmonary toxicity.

Aged↗
PubMed1983

Unrecognized organic mental disorders in survivors of cardiac arrest.

Long-term survivors of cardiac arrest may suffer from mild cerebral impairment manifested primarily by personality changes and behavioral symptoms that can be mistaken for emotional responses to illness. The authors report six cases that illustrate the clinical problem of differentiating depression from organic brain dysfunction in this population. The diagnosis is facilitated by observation over time and by information from the spouse on baseline and current function. Chronicity, dysinhibition, apathy, and disturbances of judgment and insight indicate cerebral dysfunction. The accurate diagnosis of cerebral impairment after cardiac arrest is essential to the rehabilitation process.

Adult↗
PubMed2002

Characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to whether the arrest took place during office hours.

AIM: To describe the characteristics and outcome among patients suffering from in hospital cardiac arrest in relation to whether the arrest took place during office hours. PATIENTS: All patients suffering in hospital cardiac arrest in Sahlgrenska University hospital in Göteborg, Sweden between 1994 and 1999 in whom resuscitative efforts were attempted and for whom the time when the cardiopulmonary resuscitation (CPR) team was alerted. METHODS: Prospective recording of various factors at resuscitation including the time when the CPR team was alerted. Retrospective evaluation via medical records of patients previous history and final outcome. RESULTS: Among patients in whom the arrest took place during office hours (08:00-16:30 h) the overall survival rate was 49% as compared with 26% among the remaining patients (P<0.0001). The corresponding figures for patients found in ventricular fibrillation were 66 and 44% (P=0.0001), for patients found in asystole 33 and 22% (NS) and for patients found in pulseless electrical activity 14 and 3% (NS). When correcting for dissimilarities in previous history and factors at resuscitation the adjusted odds ratio for patients to be discharged alive who had the arrest during office hours was 2.07 (1.40-3.06) as compared with patients who had an arrest outside office hours. CONCLUSION: Among patients suffering from in hospital cardiac arrest and in whom CPR was attempted those who had the arrest during office hours had a survival rate being more than twice that of patients who had the arrest during other times of the day and night. These results indicate that the preparedness for optimal treatment of in hospital cardiac arrest is of ultimate importance for the final outcome and that an increased preparedness during evenings and nights might increase survival among patients suffering from in hospital cardiac arrest.

Aged↗
PubMedDate not supplied

Impact of prompt defibrillation on cardiac arrest at a major international airport.

OBJECTIVE: To describe the impact of a rapidly deployable, automated external defibrillator (AED)-equipped first-responder service at Boston's Logan International Airport on the rate of survival to hospital discharge after cardiac arrest. METHODS: A prospective observational outcome study was undertaken for cardiac arrests taking place on the airport grounds from January 1, 1995, to December 31, 1999. Patients were included if they were unresponsive, they had no palpable pulse and no spontaneous respirations, an AED was turned on, and the cardiac arrest took place on airport grounds. Airport fire rescue and emergency medical services (EMS) personnel submitted resuscitation records and AED memory modules for each cardiac arrest. Each author independently reviewed all cardiac arrest reports and code summaries to ensure accuracy and data integrity. Relevant dispatch and response times were determined from airport fire rescue and EMS dispatch records. Patient outcome was determined from hospital patient records. Descriptive statistics were calculated. RESULTS: The airport fire rescue crew responded to 53 cardiac arrests. Of those, 38 met inclusion criteria. In 36 of 38 cases (94.7%), the airport fire rescue crew was first to apply the defibrillator, and the first to deliver a shock in 28 of 32 cases (87.5%) where a shock was delivered. The median response time for the airport fire rescue crew was 2 minutes, with a mode of 1 minute. The EMS response times were 5:29 (95% CI 4:37-6:19) for basic life support crews and 8:07 (95% CI 7:17-8:57) for advanced life support crews. All patients who survived to hospital admission (n = 15) and hospital discharge (n = 8) received their first shock by the airport fire rescue crew. Eight patients (21.1%) survived to hospital discharge. In five of the eight survivors to hospital discharge, defibrillation by the airport crew alone achieved a return of spontaneous circulation. CONCLUSIONS: A rapidly deployable first-responder service permits early defibrillation minutes before arrival of EMS personnel. This rapid response positively impacts the return of spontaneous circulation and survival to hospital discharge after cardiac arrest.

Aged↗
PubMed2002

A critical analysis of outcome for children sustaining cardiac arrest after blunt trauma.

PURPOSE: Injury is the leading cause of cardiac arrest in children older than 1 year. Previous findings suggest that children who require cardiopulmonary resuscitation (CPR) administered by paramedics for any reason rarely survive to hospital discharge. The authors evaluated the outcome of children sustaining cardiac arrest after blunt trauma in a Regional Pediatric Trauma Center. METHODS: Children (age < 16) who underwent CPR in the field or in the emergency department (ED) after blunt trauma were identified from the trauma registry of a regional pediatric trauma center over a 3-year period (1997 to 2000). Patient demographics, rate of survival to discharge, factors influencing survival, and organ donation data were obtained from the trauma registry and medical record. Probability of survival (Ps) was calculated by TRISS analysis. RESULTS: Twenty-five children were identified with a history of cardiac arrest after blunt injury (mean age; 3.3 years; range, 0.1 to 10; mean ISS, 30.7; range, 13-75; mean RTS, 1.58). Mean calculated Ps was 22.7%. However, only 2 (8%) survived. Death in the majority (91%) of the 23 patients who died occurred secondary to brain or spinal cord injury, and only 2 (9%) occurred as the result of exsanguinating hemorrhage. CPR was first performed in the field in 10 patients (40%), en route in 6 (24%), and in the ED in 9 (36%). Of the children who survived, both had vitals in the field, and CPR was administered initially in the ED. Mean length of ED resuscitation before death was 80 minutes. Of the children who died, organ donation occurred in only 3 (13%). The 2 survivors had no head injury and were discharged within 3 weeks of injury. CONCLUSIONS: Cardiopulmonary resuscitation after blunt injury in children rarely results in survival. The majority of deaths occur as a result of isolated intracranial injury and not exsanguinating hemorrhage. Although all children should receive aggressive resuscitation after injury, the need for CPR in the field portends a poor outcome. Furthermore, these data would suggest that prolonged or heroic efforts for children sustaining cardiac arrest in the field are not indicated.

Accidents, Traffic↗