A 30-month, retrospective study of CPR was under-taken in a 10-bed, medical/surgical pediatric ICU (PICU). The 121 episodes of CPR reviewed represented 81 of 1357 admissions and 7537 cumulative days of PICU care. Of the 121 CPR attempts, 64% were initially successful, 48% were associated with at least 24-h survival, and 31% were followed by discharge from PICU. Unlike pediatric arrests outside the hospital or on general pediatric wards, PICU arrests were seldom unanticipated, were commonly nonrespiratory in origin, and generally occurred in spite of aggressive support. Of 118 PICU deaths during the study period, 45 (38%) were associated with CPR. In the 73 remaining PICU deaths, CPR had been withheld because of an order not to resuscitate. CNS status before arrest was the most important factor influencing outcome. In this pediatric population, 29% were noncomatose survivors 24 h after more than 30 min of resuscitation.