Children and adults in cardiopulmonary arrest: Are advanced life support guidelines followed in the prehospital setting?

Study objective: To compare the proportions of children and adults in whom advanced life support (ALS) guidelines for prehospital management of cardiopulmonary arrest. Methods: We conducted a retrospective cross-sectional study of an urban EMS system and an urban ED. We studied 141 consecutive patients (47 children and 94 adults, matched by date of presentation) in cardiopulmonary arrest who were transported to the pediatric and adult EDs by AIS-trained prehospital providers (paramedics) between January 1992 and July 1995. We reviewed ambulance trip reports and ED records to determine when and which interventions were performed in the prehospital setting. Significance of differences between the groups was determined with Fisher's exact test and Student's t test. Results: In 47 children (median age, 1 year; range, 2 days to 15 years) and 94 adults (median age, 67 years; range, 16 to 95 years), pulselessness was documented at the time of the initial response of the ALS provider. Basic life support was performed in all patients. Among the 21 children and 7 adults who were not intubated, intubation was attempted in 13 children (62%) and in 6 adults (86%) (P=.26). Among the 29 children and 16 adults in whom intravascular access was not established, unsuccessful attempts to establish access were made in 1 child (3%) and in 15 adults (94%) (P=.0001). Among the 30 children and 91 adults who were intubated, in whom intravascular access was established, or both, epinephrine was not administered to 12 children (40%) and 6 adults (7%) (P<.0001). Conclusion: In our study population endotracheal intubation, intravascular access, and administration of epinephrine were attempted and performed significantly less frequently in children than in adults. Given the relative infrequency with which ALS providers encounter children in cardiopulmonary arrest, they need additional training to maintain their skills.