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CPR vital for children in cardiac arrest

Wednesday, February 03, 1999

By Anita Srikameswaran, Post-Gazette Staff Writer

Take this message home, because that's where saving a child's life has to start.

More than 60 percent of childhood cardiac arrests occur at home in the presence of family members, but witnesses start CPR only in one out of five of these cases. If a child has no pulse and isn't breathing when paramedics arrive, the chance of survival without brain damage is very poor.

"In other words, if we don't get a pulse back at the scene, we don't get them back at all," said Dr. Paul Pepe, director of emergency services at Allegheny General Hospital and lead investigator in a study of pediatric cardiac arrest published this week in the Annals of Emergency Medicine.

The study covered 300 cases of children whom emergency medical technicians found without a pulse and not breathing in Houston, Texas, between 1992 and mid-1995.

Only one child survived without neurological problems and five others suffered some brain damage. The rest children died.

Autopsies were conducted, but in half of the deaths, doctors could only conclude that Sudden Infant Death Syndrome or "unknown" causes precipitated the cardiac arrest.

Pepe said that other data gathered from near-drownings showed that two-thirds of children who received immediate cardiopulmonary resuscitation, were breathing and had pulses by the time paramedics arrived. The children survived and didn't suffer any brain damage.

Shirley Armagost, 52, of Parker, Armstrong County, can attest to the importance of basic CPR skills.

One summer day in 1993, Armagost was painting cabinets in the back yard, while her grandson Tyler Armagost, then 2, rolled a ball on a deck that joined the house to an above-ground swimming pool.

When she glanced up again, he had vanished. She walked up to the house, thinking he had gone inside. No Tyler. She checked upstairs while Tyler's aunt ran outside to look for the boy.

"That's when I heard her screaming," Armagost said. "I went out on the porch and she came running up carrying him. His body was blue and he was dripping water."

Armagost went on autopilot. A decade earlier, she had been an emergency medical technician with the local fire department. She had worked on children, but never any that young, nor on her own grandchild.

"There was no pulse and he wasn't breathing," she said. "I kept working on him 'til the ambulance got there. It seemed like an eternity."

Tyler's pulse would beat faintly and then vanish during the ambulance ride and in the local emergency room. He was flown to Allegheny General Hospital and admitted into a trauma unit. A tube down his windpipe aided his breathing.

After four days in the hospital he pulled through. Tests a year later confirmed that Tyler had suffered no brain damage.

Armagost is grateful she remembered CPR.

"You don't know if it's going to be family or friend or in a mall, wherever, when you come across this," she said. "First aid is the best thing in the world."

The Houston study did not include children who had stopped breathing but still had pulses, which is a situation doctors see far more often. Children's hearts stop beating after their breathing stops, whereas in adults, the heart stops first. If caught early, a defibrillator can shock the adult heart into a normal beat, allowing the flow of oxygen to continue along with normal breathing.

If a child has no pulse, he likely has not been breathing for some time, said Dr. Lee Beerman, a pediatric cardiologist at Children's Hospital.

"So the dismal results of trying to resuscitate any of these children is very understandable," he said. "What I wanted to get out of the study is, what are the causes [of cardiac arrest]?"

The study hasn't added anything that helps answer that question, Beerman said.

An estimated 16,000 children die every year from cardiac arrest. Pepe's research team found that most victims were under 1 year old. The study also said that boys are at higher risk than girls and that African American children face a greater risk of death than those of other heritage.

"It begs more questions," Pepe said. "We need to look at this further."

The Houston findings suggest that a national registry be established to better establish the scope of the problem, he added. Developing new resuscitation techniques may help, as might research into the causes of pediatric cardiac arrest.

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