53 - Pediatric cardiopulmonary resuscitation

Summary

Appropriate pediatric CPR differs from that in adults, because children are anatomically and physiologically different from adults. In addition, the pathogenesis of the cardiac arrests and the most common rhythm disturbances are different in children. In contrast to adults, children rarely suffer sudden ventricular fibrillation (VF) cardiac arrest from coronary artery disease. The causes of pediatric arrests are more diverse and are usually secondary to profound hypoxia or asphyxia due to respiratory failure or circulatory shock. Prolonged hypoxia and acidosis impair cardiac function and ultimately lead to cardiac arrest. By the time the arrest occurs, all organs of the body have generally suffered significant hypoxic-ischemic insults.

Importantly, children of various ages exhibit developmental changes that affect cardiac and respiratory physiology before, during, and after cardiac arrest. For example, newborns undergoing transitional physiological changes during emergence from an environment of amniotic fluid to a gaseous environment certainly differ from adolescents. Similarly, newborns and infants have much less cardiac and respiratory reserve, and higher pulmonary vascular resistance than do older children. Moreover, many children who experience in-hospital cardiac arrest have pre-existing developmental challenges and other organ dysfunction. Finally, pediatrics is developmental medicine, and pediatric neurological tools that are appropriate at one age may not be accurate or valid at another age.

Perhaps the most profound difference between child and adult cardiac arrest is the devastating effect of the death of a child on a family. Coping with a sudden unexpected death is always difficult. When the victim is a child, the loss tends to be even more oppressive. We do not expect children to die before their parents and thus are not prepared for it.