Death and resuscitation in the pediatric emergency department.

STUDY

OBJECTIVE

To describe a population of patients who arrived in a pediatric emergency department with pulse and respirations but then sustained cardiopulmonary or respiratory arrest while in the ED.

DESIGN

Retrospective case series of patients from July 1987 to June 1993.

SETTING

Urban, tertiary care pediatric ED.

PARTICIPANTS

All patients who sustained cardiopulmonary or respiratory arrest while in the ED.

RESULTS

Thirty-two cases of cardiopulmonary (n = 18) or respiratory arrest (n = 14) were identified, for an incidence of 1.2 arrests per 10,000 patient visits. Causes of arrest varied widely. Excluding those patients with do-not-resuscitate orders (n = 2), an initial response to resuscitative efforts was obtained in 22 of 30 (73%) patients. Overall rates of survival to discharge from the ED and from the hospital were 21 of 30 (70%) and 15 of 30 (50%), respectively. Of those patients who survived to hospital discharge, 12 of 15 (80%) were discharged at a baseline level of overall function.

CONCLUSION

Cardiopulmonary or respiratory arrest in the pediatric emergency department is rare. The rate of survival of such an arrest is superior to that in outpatient arrests but inferior to that in inpatient arrests.