threatening condition that has furthered recent work Research experts have developed the Utstein Criteria which includes standard definitions and terminology to enable more robust comparisons among patient groups Large, prospective studies with rigorous data collection of actual CPR events are needed to further guide interventions that could ultimately improve patient outcomes TABLE 9.3 OUTCOME FOR OUT-OF-HOSPITAL PEDIATRIC CARDIOPULMONARY ARREST PROGNOSIS Despite advances in medical care of the critically ill child and improved EMS systems, pediatric OHCA survival remains poor and has shown little improvement over time Less than 15% of children who suffer an OHCA survive, usually with significant neurologic injury ( Table 9.3 ) Unfortunately, about 70% of OHCAs are unwitnessed events and only about 50% of children receive bystander CPR, which contributes to their poor prognosis However, if a hospitalized child has respiratory arrest that is recognized rapidly and managed skillfully, immediate survival may be as high as 90% Overall, children resuscitated after an in-hospital arrest (IHA) have a more favorable outcome with more than 30% to 40% of children surviving to hospital discharge ( Table 9.4 ) Earlier recognition of prearrest phases, advances in medical care and education, and rapid response teams have likely contributed to the improved survival over time seen in IHA CLINICAL MANIFESTATIONS The clinical manifestations of persons requiring immediate life support are most often related to failure of oxygen delivery to the skin, brain, kidneys, and cardiovascular system One can identify most potential or existing life-threatening