Background. This study reports the epidemiologic features, survival rates, and neurologic outcomes of the largest population-based series of pediatric out-of-hospital cardiopulmonary arrest patients with prospectively collected data. Methods. Secondary analysis of data from a prospective, interventional trial of out-of-hospital pediatric airway management conducted from 1994 to 1997 (Gausche M, Lewis RJ, Stratton SJ, et al. JAMA. 2000;283:783-790). Consecutive out-of-hospital patients from 2 large urban counties in California <12 years old or 40 kg in bodyweight who were determined by paramedics to be pulseless and apneic were included. Main outcome measures included survival to hospital discharge, patient demographics, arrest etiology, arrest rhythm, event intervals, and neurologic outcomes. Results. In 599 patients, 601 events were studied (54% were <1 year old, 58% were male). Return of spontaneous circulation was achieved in 29%; 25% were admitted to the hospital, and 8.6% (51) survived to hospital discharge. The most prevalent etiologies were sudden infant death syndrome and trauma; these resulted in relatively higher mortality. Respiratory etiologies and submersions followed; these resulted in relatively lower mortality. Twenty-six percent of the arrests were witnessed by citizens, and an additional 8% were witnessed by rescue personnel. Witnessed arrests had a higher survival rate (16%). Thirty-one percent of patients received bystander cardiopulmonary resuscitation, which was not demonstrated to result in improved survival rates. Arrest rhythms were asystole (67%), pulseless electrical activity (24%), and ventricular fibrillation (9%); children with the latter 2 rhythms had better survival rates. One third of the survivors (16 of 51) had good neurologic outcome, none of whom received >3 doses of epinephrine or were resuscitated for >31 minutes in the emergency department. Conclusions. The 8.6% survival rate after out-of-hospital pediatric cardiopulmonary arrest is poor. Administration of >3 doses of epinephrine or prolonged resuscitation is futile.

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Several minor painful procedures are commonly performed in the emergency department without pharmacological pain management. There remains a gap between what we know to be effective, easily implemented pain management strategies, and what is actually practiced. We must work to close this gap.

Health literacy interventions may reduce nonurgent emergency department visits and help mitigate emergency department overcrowding and the rising costs of health care.

The program seems to have resulted in reduction of the rate of epinephrine dosing errors in the prehospital treatment of children in cardiopulmonary arrest in Los Angeles County.

This study confirms that vitamin-mineral supplementation modestly raised the nonverbal intelligence of some groups of Western schoolchildren by 2 to 3 points but not that of most Western schoolchildren, presumably because the majority were already adequately nourished. This study also confirms that vitamin-mineral supplementation markedly raises the non-verbal intelligence of a minority of Western schoolchildren, presumably because they were too poorly nourished before supplementation for optimal brain function. Because nonverbal intelligence is closely associated with academic performance, it follows that schools with children who consume substandard diets should find it difficult to produce academic performance equal to those schools with children who consume diets that come closer to providing the nutrients suggested in the U.S. RDA. The parents of schoolchildren whose academic performance is substandard would be well advised to seek a nutritionally oriented physician for assessment of their children's nutritional status as a possible etiology.