Use and effect of paediatric life support skills for paediatric arrest.

EDITOR,-The article on use and effect ofpaediatric life support skills for paediatric arrest in the accident and emergency (A&E) department has three conclusions': (1) the poor outcome, well supported in the literature2 3; (2) advanced life support training in the receiving hospital has not improved the outcome; and (3) the timing of initiation of life support is a critical factor affecting outcome. A large recent study of children presenting with apnoea with or without a cardiac output found that good prognostic indicators included a short time between arrest and arrival at hospital, a cardiac output at presentation, and a short duration of resuscitation in the A&E department (two or fewer doses of adrenaline or resuscitated within 20 minutes).' Training of pre-hospital personnel in life support thus would seem indicated, but this must highlight the importance of not unduly delaying transportation by untimely out of hospital interventions. Owing to the poor outcome of paediatric cardiopulmonary arrests, courses such as the Advanced Paediatric Life Support (APLS) and the Paediatric Advanced Life Support (PALS) have been developed, focusing on structured intervention in critically ill children with emphasis on early recognition and aggressive management to prevent cardiac arrest. The teaching, however, is aimed at hospital personnel so the Advanced Life Support Group (ALSG) have now also developed the Pre-hospital Paediatric Life Support (PHPLS) course, specifically designed to allow the continuity of care from the prehospital arena to the A&E department. It uses most of the core material of APLS but incorporates specific pre-hospital problems with emphasis on prompt transportation to hospital. The standard is comparable to APLS and it is suitable for any doctors, paramedics, and nurses working with critically ill children outside hospital. Further information can be obtained from Sue Wieteska, National Coordinator, ALSG, Second floor, The Dock Office, Salford Quays, Manchester M5 2XB.