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Resuscitation. 2018 Nov 6. pii: S0300-9572(18)31080-3. doi: 10.1016/j.resuscitation.2018.11.002. [Epub ahead of print]

Early On-Scene Management of Pediatric Out-of-Hospital Cardiac Arrest Can Result in Improved Chances for Neurologically-Intact Survival.

Author information

1
Polk County Fire Rescue, 2470 Clower Lane, Bartow FL 33830 USA; Osceola Regional Medical Center - University of Central Florida Emergency Medicine Residency Program of Greater Orlando and University of Central Florida College of Medicine, 700 W. Oak Street, Kissimmee, FL, 34741, USA. Electronic address: Paul.Pepe@UTSW.edu.
2
Osceola Regional Medical Center - University of Central Florida Emergency Medicine Residency Program of Greater Orlando and University of Central Florida College of Medicine, 700 W. Oak Street, Kissimmee, FL, 34741, USA.
3
Polk County Fire Rescue, 2470 Clower Lane, Bartow FL 33830 USA; Departments of Emergency Medicine, Pediatrics, Internal Medicine, School of Public Health and Office of System Affairs, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Mail Code 8579, Dallas, TX, 75390-8579, USA.
4
Polk County Fire Rescue, 2470 Clower Lane, Bartow FL 33830 USA.

Abstract

AIM:

To evaluate the frequency of neurologically-intact survival (SURV) following pediatric out-of-hospital cardiac arrest (POHCA) when comparing traditional early evacuation strategies to those emphasizing resuscitation efforts being performed on-scene.

METHODS:

Before 2014, emergency medical services (EMS) crews in a county-wide EMS agency provided limited treatment for POHCA on-scene and rapidly transported patients to appropriate hospitals. After 2014, training strongly enhanced EMS provider comfort levels with on-scene resuscitation efforts including methods to expedite protocols on-site and control positive-pressure ventilation. Frequency of SURV (hospital discharge) was compared for the two years prior to initiating the immediate on-scene care strategy to the ensuing two years following implementation.

RESULTS:

Between 01/01/2012 and 12/31/2015, 94 children experienced POHCA. There were no significant differences before and after the on-scene focus in terms of age, sex, etiology, presenting electrocardiograph, drug infusions or bystander-performed cardiopulmonary resuscitation and total scene times actually remained similar (14.3 vs. 17.67 minutes). SURV increased significantly upon implementation of the immediate on-scene management strategy and was sustained over the next two years (0.0 % to 23%; p = 0.0013). Though statistically-indeterminate in this analysis, the improvement was associated with a shorter mean time to epinephrine administration among resuscitated patients (16.6 vs. 7.65 minutes).

CONCLUSION:

Facilitating immediate on-scene management of POHCA can result in improvements in life-saving. Although a historically-controlled evaluation, the compelling appearance of neurologically-intact survivors was immediate and sustained. Targeted training, more efficient, physiologically-driven procedures, and trusted encouragement from supervisors, likely played the most significant roles and not necessarily extended scene times.

KEYWORDS:

CPR; Cardiopulmonary Arrest; EMS; Emergency Medical Services; Epinephrine; Intraosseous; Pediatric Advanced Life Support; Pediatric Cardiac Arrest

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