Pediatric Cardiopulmonary Resuscitation: Advances in Science, Techniques, and Outcomes

Abstract

More than 25% of children survive to hospital discharge after in-hospital cardiac arrests, and 5% to 10% survive after out-of-hospital cardiac arrests. This review of pediatric cardiopulmonary resuscitation addresses the epidemiology of pediatric cardiac arrests, mechanisms of coronary blood flow during cardiopulmonary resuscitation, the 4 phases of cardiac arrest resuscitation, appropriate interventions during each phase, special resuscitation circumstances, extracorporeal membrane oxygenation cardiopulmonary resuscitation, and quality of cardiopulmonary resuscitation. The key elements of pathophysiology that impact and match the timing, intensity, duration, and variability of the hypoxic-ischemic insult to evidence-based interventions are reviewed. Exciting discoveries in basic and applied-science laboratories are now relevant for specific subpopulations of pediatric cardiac arrest victims and circumstances (eg, ventricular fibrillation, neonates, congenital heart disease, extracorporeal cardiopulmonary resuscitation). Improving the quality of interventions is increasingly recognized as a key factor for improving outcomes. Evolving training strategies include simulation training, just-in-time and just-in-place training, and crisis-team training. The difficult issue of when to discontinue resuscitative efforts is addressed. Outcomes from pediatric cardiac arrests are improving. Advances in resuscitation science and state-of-the-art implementation techniques provide the opportunity for further improvement in outcomes among children after cardiac arrest.

Retrospective review of emergency response activations during a 13‐year period at a tertiary care children's hospital

“…Instead, we found that an ERT activation was more likely to be requested during the day shifts (6 am-6 pm) which is a similar to that reported by Jones et al 8 Similarly, Jones et al 8 reported that the hourly rate of their medical emergency team activation was greater during the time between 8 am and 6 pm. Our overall survival rate (78%) to discharge after an ERT event was much higher than what has been reported by Topjian et al 9 (25%). This likely reflects our inclusion of all emergency response team activations, not just apneic and asystolic arrests.…”

Withholding or Termination of Resuscitation in Pediatric Out-of-Hospital Traumatic Cardiopulmonary Arrest

“…59 Inpatient results are improving, but the outcome for pediatric traumatic out-of-hospital arrests remains poor, although newer evidence suggests that children and adolescents with out-of-hospital arrest from other causes are more likely to survive than adults. 41,53,[59][60][61][62]78,84 Pediatric out-ofhospital deaths represent nearly onethird of pediatric deaths in the United States, 85 and in 1 urban study, 2% of pediatric EMS calls were attributed to pediatric out-of-hospital arrests. 63 Some of the more current studies of out-ofhospital arrest exclude trauma.…”

“…(Table 2). 56,59,72,81 A uniform system of describing disability was not used by all authors, although the most popular system was the pediatric cerebral performance category (PCPC; Table 3). 82 Thirty-six patients suffered an out-of-hospital traumatic cardiopulmonary arrest from penetrating injuries, and at least 9 of them had a resuscitative thoracotomy in an ED; all of these patients died regardless of whether thoracotomy was performed.…”

Death of a Child in the Emergency Department

“…Given that they can anticipate that death will be the most common outcome of cardiac arrest in a child, 8 ED providers must add care of bereaved family members to their list of skills and responsibilities.…”