It's rare for a child to stop breathing and for his heart to stop. But when it does happen, unlike adults, the result is almost always death, according to a troubling new Canadian study.
The research shows that 98 per cent of children who suffer cardiopulmonary arrest -- a sudden stoppage of the heart and lungs -- die. It also concludes that one of the principal reasons for this dismal record is that so few Canadians know CPR.
"To stand there and feel helpless when a child is in arrest is not a good feeling," Richard Gerein, an emergency department physician at the Children's Hospital of Eastern Ontario in Ottawa and lead author of the study, said in an interview.
"If more people knew CPR, it would make a difference."
The research, published in the medical journal Academic Emergency Medicine, examined 503 cases that occurred in Ontario children between 1991 and 2002. It is the largest study of its kind.
Dr. Gerein said that while many people cannot conceive of a child suffering cardiac arrest, in fact, about 150 Canadian children die of cardiac arrest each year. (By comparison, about 225 children die of cancer annually in Canada.) Dr. Gerein and his team found that most cases of cardiopulmonary arrest in children are caused by trauma --principally falls, drowning, strangulation and fire.
In many instances, quick action by bystanders could restart the heart. (There is only a five- to 10-minute window for resuscitation before death. According to earlier research, chances of survival triple when a bystander performs CPR.) But the new study found that adults attempted CPR in less than one-third of cases when they witnessed a child stop breathing.
However, two-thirds of cases of cardiac arrest were unwitnessed by adults. "I wouldn't say these cases were hopeless, but there wasn't the opportunity for CPR," Dr. Gerein said.
Aside from trauma, a leading cause of cardiopulmonary arrest is SIDS (sudden infant death syndrome), particularly in infants.
Dr. Gerein noted that while SIDS remains a mysterious condition, it is often preventable. In recent years, promoting the practice of having babies sleep on their backs has sharply reduced SIDS deaths.
Decreases in smoking have also contributed to the fall in cases. (Exposure to second-hand smoke is a risk factor for SIDS.)
The study also found a significant percentage of children felled by cardiac arrest suffered from chronic illnesses, ranging from asthma to heart malformations. Dr. Gerein said, as a result, caregivers of chronically ill children should be particularly interested in learning CPR.
Almost 300,000 people die of sudden cardiac arrest each year in North America. For an adult, the chances of surviving cardiac arrest range from 2.5 per cent to 12 per cent, depending on where you live in Canada.
CPR -- cardiopulmonary resuscitation -- is a combination of rescue breathing (blowing oxygen into a victim's lungs) and chest compressions (to keep the heart circulating oxygenated blood) that is an essential element of all basic first-aid training.
According to new guidelines, 15 chest compressions should be performed for each rescue breath. The compressions should be hard and fast, as should the breaths. Many victims of cardiac arrest should also be shocked with a defibrillator -- which are increasingly available in public locations.
