Universidade de São Paulo (USP), Pediatria, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Pronto Socorro do Instituto da Criança, São Paulo, SP, Brazil; Sociedade de Pediatria de São Paulo (SPSP), Departamento de Emergência, Coordenação Ressuscitação Pediátrica, São Paulo, SP, Brazil; Sociedade de Cardiologia de São Paulo, Curso de PALS (Pediatric Advanced Life Support), São Paulo, SP, Brazil.
Universidade de São Paulo (USP), Pediatria, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Pronto Socorro do Instituto da Criança, São Paulo, SP, Brazil.
J Pediatr (Rio J). 2020 Jul-Aug;96(4):409-421. doi: 10.1016/j.jped.2019.08.004. Epub 2019 Sep 30.
To analyze the main epidemiological aspects of prehospital and hospital pediatric cardiopulmonary resuscitation and the impact of scientific evidence on survival.
This was a narrative review of the literature published at PubMed/MEDLINE until January 2019 including original and review articles, systematic reviews, meta-analyses, annals of congresses, and manual search of selected articles.
The prehospital and hospital settings have different characteristics and prognoses. Pediatric prehospital cardiopulmonary arrest has a three-fold lower survival rate than cardiopulmonary arrest in the hospital setting, occurring mostly at home and in children under 1year. Higher survival appears to be associated with age progression, shockable rhythm, emergency medical care, use of automatic external defibrillator, high-quality early life support, telephone dispatcher-assisted cardiopulmonary resuscitation, and is strongly associated with witnessed cardiopulmonary arrest. In the hospital setting, a higher incidence was observed in children under 1year of age, and mortality increased with age. Higher survival was observed with shorter cardiopulmonary resuscitation duration, occurrence on weekdays and during daytime, initial shockable rhythm, and previous monitoring. Despite the poor prognosis of pediatric cardiopulmonary resuscitation, an increase in survival has been observed in recent years, with good neurological prognosis in the hospital setting.
A great progress in the science of pediatric cardiopulmonary resuscitation has been observed, especially in developed countries. The recognition of the epidemiological aspects that influence cardiopulmonary resuscitation survival may direct efforts towards more effective actions; thus, studies in emerging and less favored countries remains a priority regarding the knowledge of local factors.
分析儿科院前科复苏的主要流行病学特征及科学证据对生存率的影响。
这是一篇对截至 2019 年 1 月在 PubMed/MEDLINE 上发表的文献进行的叙述性综述，包括原始和综述文章、系统评价、荟萃分析、会议纪要和对选定文章的手动搜索。
院前科复苏和院内复苏具有不同的特点和预后。儿科院前科心搏骤停的生存率比院内心搏骤停低三倍，主要发生在家庭中和 1 岁以下儿童中。较高的生存率似乎与年龄进展、可除颤节律、紧急医疗护理、使用自动体外除颤器、高质量的早期生命支持、电话调度员辅助心肺复苏以及与目击心搏骤停密切相关。在院内环境中，1 岁以下儿童的发生率较高，死亡率随年龄增长而增加。生存率较高的情况为心肺复苏持续时间较短、发生在工作日和白天、初始可除颤节律以及之前有监测。尽管儿科心肺复苏的预后较差，但近年来生存率有所提高，院内具有良好的神经预后。
儿科心肺复苏科学取得了重大进展，尤其是在发达国家。认识到影响心肺复苏生存率的流行病学特征可能会促使人们采取更有效的行动；因此，在新兴和欠发达的国家开展研究仍然是了解当地因素的重点。
