Pediatric Post–Cardiac Arrest Care: A Scientific Statement From the American Heart Association

Abstract

Successful resuscitation from cardiac arrest results in a post–cardiac arrest syndrome, which can evolve in the days to weeks after return of sustained circulation. The components of post–cardiac arrest syndrome are brain injury, myocardial dysfunction, systemic ischemia/reperfusion response, and persistent precipitating pathophysiology. Pediatric post–cardiac arrest care focuses on anticipating, identifying, and treating this complex physiology to improve survival and neurological outcomes. This scientific statement on post–cardiac arrest care is the result of a consensus process that included pediatric and adult emergency medicine, critical care, cardiac critical care, cardiology, neurology, and nursing specialists who analyzed the past 20 years of pediatric cardiac arrest, adult cardiac arrest, and pediatric critical illness peer-reviewed published literature. The statement summarizes the epidemiology, pathophysiology, management, and prognostication after return of sustained circulation after cardiac arrest, and it provides consensus on the current evidence supporting elements of pediatric post–cardiac arrest care.

How can neurological outcomes be predicted in comatose pediatric patients after out-of-hospital cardiac arrest?

“…In the recent AHA scientific statement for pediatric postcardiac arrest care, brain MRI using conventional imaging and DWI in the first 3-7 days after ROSC was reported helpful for supplementing the clinical assessment and can be used to prognosticate outcomes along with other modalities. 5)…”

“…A recent scientific statement by the AHA summarized the consensus about prognostication for ROSC after cardiac arrest in pediatric patients. 5) This review delineates the usefulness of prognostication mo dalities for pediatric postresuscitation patients and provides practical multimodal approaches on how and when to use these modalities to ensure the reliable and accurate prediction of treatment outcomes. This review mainly referred to the AHA pediatric consensus statement, but the 2015 AHA or 2015 ERC/ ESICM adult guidelines were also referred to in the event that the pediatric data were lacking.…”

Post-cardiac arrest care in the neonatal intensive care unit

“…In 2019 the AHA released a scientific statement on pediatric post-arrest care (PCAC) that summarized the existing pediatric literature on post-cardiac arrest syndrome and provides recommendations for monitoring, therapeutic strategies, and neuroprognostication in the post-arrest period. 10 Although many pediatric studies of post-arrest care included neonates and infants admitted to pediatric units, these patients represented a small subset of the study populations. There is a critical evidence gap with respect to both premature and term neonates.…”

“…Current guidelines for comatose adult survivors of cardiac arrest suggest deferring neuroprognostication until 72 h post-arrest or until 72 h after return to normothermia in patients treated with therapeutic hypothermia. 10 Similarly, the AHA recommends that caution should be used in the interpretation of the clinical neurologic exam early after pediatric cardiac arrest. 10 We do not know if these guidelines should be extended to neonates.…”

“…10 Similarly, the AHA recommends that caution should be used in the interpretation of the clinical neurologic exam early after pediatric cardiac arrest. 10 We do not know if these guidelines should be extended to neonates. It may be inappropriate to counsel families regarding withdrawal of life-sustaining therapy earlier than 72 h after a neonatal cardiac arrest.…”