Outcome and Cost at a Children's Hospital Following Resuscitation for Out-of-Hospital Cardiopulmonary Arrest

doi:10.1001/archpedi.1995.02170140092017

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Vol. 149 No. 2, February 1995

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Outcome and Cost at a Children's Hospital Following Resuscitation for Out-of-Hospital Cardiopulmonary Arrest

Ricardo Ronco, MD; William King, DrPH; Diane K. Donley, MD; Samuel J. Tilden, MD

Arch Pediatr Adolesc Med. 1995;149(2):210-214.

Abstract

Objective
To determine the outcome and cost for children resuscitatedfollowing out-of-hospital cardiopulmonary arrest.

Design
Retrospective case series.

Setting
An organized prehospital emergency medical system within Birmingham,Ala, in a county with 150 493 children under the age of 15 years.

Patients
Sixty-three pediatric victims of out-of-hospital cardiopulmonaryarrest of any cause presenting to the emergency department ofa children's hospital.

Intervention
Standard resuscitative techniques were performed for all patientsuntil resuscitative efforts were discontinued in the hospitalemergency department or successful resuscitation was achieved.

Main Outcome Measures
Successful resuscitation, survival to hospital discharge, neurologicaloutcome, final disposition, and cost of hospital care.

Results
Of 63 children with out-of-hospital cardiopulmonary arrest treatedin the emergency department of a children's hospital, 60 werepulseless and apneic on arrival, 18 (28.6%) were successfullyresuscitated and admitted to the intensive care unit, and six(9.5%) were discharged from the hospital. Five of the survivorshad severe neurological deficits and one appeared normal. Onfollow-up, two patients had died (1 month and 7 months afterdischarge), three were in a vegetative state, and one was normal.The normal patient had successful defibrillation prior to arrivalat the emergency department. The average inpatient charge was$10 667 per patient for those who died and $100 000 for thosedischarged.

Conclusions
Aggressive treatment does not lead to intact survival for victimsof out-of-hospital cardiopulmonary arrest who present to thepediatric emergency department with a preterminal rhythm andabsence of spontaneous circulation. Resuscitation efforts inthe emergency department are commonly successful but lead todeath or severe neurological sequelae at discharge with extremelyhigh cost of care.

(Arch Pediatr Adolesc Med. 1995;149:210-214)

Author Affiliations

From the Department of Pediatrics, Divisions of Critical Care Medicine (Drs Ronco and Tilden), Emergency Medicine (Dr King), and Pediatric Neurology (Dr Donley), The University of Alabama at Birmingham.

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