Source: http://emj.bmj.com/content/28/5/411.

full retrieved on July 24, 2011 Reaction:

Among adults who have a cardiac arrest outside the hospital, the survival rate is known to be poor. However, less information is available on out-of-hospital cardiac arrest among children. This study was performed to determine the survival rate among children after out-of-hospital cardiac arrest and to identify predictors of survival. Cardiac arrest is the cessation of normal circulation of the blood due to failure of the heart to contract effectively. Out-of-hospital cardiac arrest (OHCA) is both a major public health problem and an important issue for the clinician. Out of hospital cardiac arrest is a sudden and dramatic, typically related to ventricular tachycardia, ventricular fibrillation or both. Brain death can occur in four to six minutes. Cardiac arrest is an important public health problem and often occurs in the out-of-hospital setting in patients without a prior history of heart disease. To improve survival in cardiac arrest, care must be optimized at each point along the cardiac arrest continuum, including a rapid emergency response, provision of cardiopulmonary resuscitation (CPR) by bystanders, delivery of high-quality chest compressions with minimal interruptions by first responders and rapid defibrillation. Recently published aspect that pediatric patients suffering a cardiac arrest in the prehospital setting differ greatly from those patients requiring resuscitation in the hospital. For instance, asystole as the initial cardiac rhythm is more common in prehospital cardiac arrest. Mortality is higher in prehospital cardiac arrest, with more of this attributed to neurologic causes in contrast to only few in-hospital. These differences have to be taken into account when assessing pediatric cardiac arrest studies and planning future clinical trials. As the outcome from pediatric cardiac arrest is poor, it would be preferable to recognize and prevent conditions, such as asphyxiation, that lead to cardiac arrest. However, in the prehospital setting, the onset of arrest is often unwitnessed, thus making prevention unlikely. As a secondary measure, the rate of bystander CPR needs to be increased.

Recommendation:
Suicide is the major cause of hanging among children. People who talk about suicide often commit suicide. All talk about suicide should be taken seriously. People often have opposing feelings about whether or not they want to die, so there is always hope that they can change their minds if they receive professional help. Many who attempt suicide are under the influence of drugs or alcohol. Be aware of this signal. Many attempts are impulsive acts, so be aware of the following warning signs. If we suspect a friend is contemplating suicide, take the initiative and just ask him, "Are you thinking about killing or harming yourself?" and "How are you going to kill yourself?" This will often get him to talk about it. Be straight with him; get right to the subject. Tell an adult, a teacher, a guidance counselor or his parents about our concern for our friend's safety. Creating a safer environment for children would greatly help in the prevention of accidental hanging. Some measures like avoiding any kind of loose cord around baby's cribs or push strollers, safety straps in high chairs and strollers should be fixed under adult supervision, following manufacturers' safety advice regarding age limits before buying toys, loosening electrical and telephone cords are potential strangulation risks for children learning to crawl and toddlers ,avoiding religious threads or necklaces used as part of traditional practices by some communities, child abuse concerns need to be raised if suspicious ligature marks are found ,printed leaflets summarizing home safety measures may be distributed by professionals in antenatal clinics and school and playgrounds should be made aware of possible strangulation risks and make sure adequate adult supervision is always provided.

Learning Derive:
I got interested with the article since it is my first time to hear about out-ofhospital cardiac arrest especially among children. It got my attention since we usually encounter cardiac arrest among adults but not among children. Cardiac arrest in children is usually due to suicide or accidental hanging at home. Usually, resuscitation among children is not immediately done and this is the leading cause of their death. Suicide being the major cause of hanging in children especially among teens did not really surprise me. I know some friends whose relatives committed suicide and when these relatives are found, they are already dead on arrival. It is really saddening because suicide by hanging is increasing among teen now a days. Support from parent, love ones and friends is really needed to help problematic teens surpass their problems. It is never to late to help some who is planning for suicide. I remember hearing my neighbor say about planning to commit suicide due to his big problem. His mom readily responded to him and eventually his problem was solved and he was saved from death. The mortality rate in hanging injuries is high. For children presenting in cardiac arrest, survival is unlikely and full neurological recovery has never been reported. However, all resuscitative efforts should be undertaken in patients with a residual circulation, because intact neurological survival is possible even in deeply comatose patients. This type of accident can reflect a lack of awareness of hanging hazards among the parents and childcare provider. There may also be a belief that, although strangulation injuries may occur, it will never occur to their own child. As nurses we can play a vital role in identifying home safety issues during visits to families, and also in recommending changes to individual families. Parents and childcare providers need to be more aware to the potential hazards and safety measures needs to be adhered to at home, and student nurses like us who are in contact with families can help by raising this issue with them.