Hostname: page-component-78c5997874-s2hrs Total loading time: 0 Render date: 2024-11-10T03:47:00.514Z Has data issue: false hasContentIssue false
  • English
  • Français

Cardiopulmonary resuscitation: special considerations for infants and children with cardiac disease

Published online by Cambridge University Press:  26 November 2007

Stacie B. Peddy ,
Mary Fran Hazinski ,
Peter C. Laussen ,
Ravi R. Thiagarajan ,
George M. Hoffman ,
Vinay Nadkarni  and
Sarah Tabbutt
Stacie B. Peddy*
Affiliation:
Department of Pediatrics, Division of Cardiology and, Critical Care Medicine at the Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine;, United States of America Department of Anesthesia, Critical Care Medicine at the Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine;, United States of America
Mary Fran Hazinski
Affiliation:
Department of Nursing, Monroe Carell Children’s Hospital, Vanderbilt University School of Medicine, United States of America
Peter C. Laussen
Affiliation:
Department of Anesthesia and, Boston Children’s Hospital, Harvard School of Medicine and, United States of America
Ravi R. Thiagarajan
Affiliation:
Department of Cardiology, Boston Children’s Hospital, Harvard School of Medicine and, United States of America
George M. Hoffman
Affiliation:
Department of Anesthesia and Critical Care Medicine, Children’s Hospital of Wisconsin, United States of America
Vinay Nadkarni
Affiliation:
Department of Anesthesia, Critical Care Medicine at the Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine;, United States of America
Sarah Tabbutt
Affiliation:
Department of Pediatrics, Division of Cardiology and, Critical Care Medicine at the Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine;, United States of America Department of Anesthesia, Critical Care Medicine at the Children’s Hospital of Philadelphia and the University of Pennsylvania School of Medicine;, United States of America
*
Correspondence to: Stacie B Peddy MD, The Cardiac Center, The Children’s Hospital of Philadelphia, 34th Street and Civic Center Blvd., Philadelphia PA 19104, USA. Tel: +267 426 7937; Fax: +215 590 5825; E-mail: peddy@email.chop.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Pulseless cardiac arrest, defined as the cessation of cardiac mechanical activity, determined by unresponsiveness, apneoa, and the absence of a palpable central pulse, accounts for around one-twentieth of admissions to paediatric intensive care units, be they medical or exclusively cardiac. Such cardiac arrest is higher in children admitted to a cardiac as opposed to a paediatric intensive care unit, but the outcome of these patients is better, with just over two-fifths surviving when treated in the cardiac intensive care unit, versus between one-sixth and one-quarter of those admitted to paediatric intensive care units. Children who receive chest compressions for bradycardia with pulses have a significantly higher rate of survival to discharge, at 60%, than do those presenting with pulseless cardiac arrest, with only 27% surviving to discharge. This suggests that early resuscitation before the patient becomes pulseless, along with early recognition and intervention, are likely to improve outcomes. Recently published reports of in-hospital cardiac arrests in children can be derived from the multi-centric National Registry of Cardiopulmonary Resuscitation provided by the American Heart Association. The population is heterogeneous, but most arrests occurred in children with progressive respiratory insufficiency, and/or progressive circulatory shock. During the past 4 years at the Children’s Hospital of Philadelphia, 3.1% of the average 1000 annual admissions to the cardiac intensive care unit have received cardiopulmonary resuscitation. Overall survival of those receiving cardiopulmonary resuscitation was 46%. Survival was better for those receiving cardiopulmonary resuscitation after cardiac surgery, at 53%, compared with survival of 33% for pre-operative or non-surgical patients undergoing resuscitation. Clearly there is room for improvement in outcomes from cardiac resuscitation in children with cardiac disease. In this review, therefore, we summarize the newest developments in paediatric resuscitation, with an expanded focus upon the unique challenges and importance of anticipatory care in infants and children with cardiac disease.

Keywords

Congenital heart diseasecardiac arrest
Type
Original Article
Information
Cardiology in the Young , Volume 17 , Supplement S4 , September 2007 , pp. 116 - 126
Copyright
Copyright © Cambridge University Press 2007

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Slonim, AD, Patel, KM, Ruttimann, UE, Pollack, MM. Cardiopulmonary resuscitation in pediatric intensive care units. Crit Care Med 1997; 25: 1951–1955.CrossRefGoogle ScholarPubMed
2. de Mos, N, van Litsenburg, RR, McCrindle, B, Bohn, DJ, Parshuram, CS. Pediatric in-intensive-care-unit cardiac arrest: incidence, survival, and predictive factors. Crit Care Med 2006; 34: 1209–1215.CrossRefGoogle ScholarPubMed
3. Suominen, P, Palo, R, Sairanen, H, Olkkola, KT, Rasanen, J. Perioperative determinants and outcome of cardiopulmonary arrest in children after heart surgery. Eur J Cardiothorac Surg 2001; 19: 127–134.CrossRefGoogle ScholarPubMed
4. Nadkarni, VM, Larkin, GL, Peberdy, MA, et al. . First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA 2006; 295: 50–57.CrossRefGoogle ScholarPubMed
5. Tabbutt S. Personal communication.Google Scholar
6. Laussen PC. Personal communication.Google Scholar
7. Wernovsky, G, Wypij, D, Jonas, RA, et al. . Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation 1995; 92: 2226–2235.CrossRefGoogle ScholarPubMed
8. Hoffman, TM, Wernovsky, G, Atz, AM, et al. . Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation 2003; 107: 996–1002.CrossRefGoogle ScholarPubMed
9. Tanel RE, Domingeuz T, Ravishankar C, Tabbutt S. Post-operative heart block after surgery for congenital heart disease: current outcomes and assessment of risk factors. Presented at the 5th World Congress on Pediatric Critical Care, 2007, Geneva, Switzerland.Google Scholar
10. Kirshbom, PM, Bridges, ND, Myung, RJ, Gaynor, JW, Clark, BJ, Spray, TL. Use of extracorporeal membrane oxygenation in pediatric thoracic organ transplantation. J Thorac Cardiovasc Surg 2002; 123: 130–136.CrossRefGoogle ScholarPubMed
11. Tabbutt S, Dominguez TE, Nicolson SC, et al. Incidence of early transcatheter or shunt intervention in 324 neonates. Presented at the 5th World Congress on Pediatric Critical Care, 2007, Geneva, Switzerland.Google Scholar
12. Allan, CK, Thiagarajan, RR, del Nido, PJ, Roth, SJ, Almodovar, MC, Laussen, PC. Indication for initiation of mechanical circulatory support impacts survival of infants with shunted single-ventricle circulation supported with extracorporeal membrane oxygenation. J Thorac Cardiovasc Surg 2007; 133: 660–667.CrossRefGoogle ScholarPubMed
13. Duncan, BW, Ibrahim, AE, Hraska, V, et al. . Use of rapid-deployment extracorporeal membrane oxygenation for the resuscitation of pediatric patients with heart disease after cardiac arrest. J Thorac Cardiovasc Surg 1998; 116: 305–311.CrossRefGoogle ScholarPubMed
14. Kolovos, NS, Bratton, SL, Moler, FW, et al. . Outcome of pediatric patients treated with extracorporeal life support after cardiac surgery. Ann Thorac Surg 2003; 76: 1435–1441.CrossRefGoogle ScholarPubMed
15. Morris, MC, Wernovsky, G, Nadkarni, VM. Survival outcomes after extracorporeal cardiopulmonary resuscitation instituted during active chest compressions following refractory in-hospital pediatric cardiac arrest. Pediatr Crit Care Med 2004; 5: 440–446.CrossRefGoogle ScholarPubMed
16. Alsoufi, B, Shen, I, Karamlou, T, et al. . Extracorporeal life support in neonates, infants and children after repair of congenital heart disease: modern era results in a single institution. Ann Thorac Surg 2005; 80: 15–21.CrossRefGoogle ScholarPubMed
17. Delmo Walter, EM, Stiller, B, Hetzer, R, et al. . Extracorporeal membrane oxygenation for perioperative cardiac support in children I: experience at the Deutsches Herzzentrum Berlin (1987–2005). ASAIO J 2007; 53: 246–254.CrossRefGoogle ScholarPubMed
18. Ungerleider, RM, Shen, I, Yeh, T, et al. . Routine mechanical ventricular assist following the Norwood procedure-improved neurologic outcome and excellent hospital survival. Ann Thorac Surg 2004; 77: 18–22.CrossRefGoogle ScholarPubMed
19. Aharon, AS, JrDrinkwater, DC, Churchwell, KB, et al. . Extracorporeal membrane oxygenation in children after repair of congenital heart lesions. Ann Thorac Surg 2001; 72: 2095–2101.CrossRefGoogle Scholar
20. Ravishankar, C, Dominguez, TE, Kreutzer, J, et al. . Extracorporeal membrane oxygenation after stage I reconstruction for hypoplastic heart syndrome. Pediatr Crit Care Med 2006; 7: 319–323.CrossRefGoogle Scholar
21. Hetzer, R, Potapov, EV, Stiller, B, et al. . Improvement in survival after mechanical circulatory support with pneumatic pulsatile ventricular assist devices in pediatric patients. Ann Thorac Surg 2006; 82: 917–925.CrossRefGoogle ScholarPubMed
22. Blume, ED, Naftel, DC, Bastardi, HJ, Duncan, BW, Kirklin, JK, Webber, SA. Outcomes of children bridged to heart transplantation with ventricular assist devices-a multi-institutional study. Circulation 2006; 113: 2313–2319.CrossRefGoogle ScholarPubMed
23. Booth, KL, Roth, SP, Thiagarajan, RR, Almodovar, MC, delNido, PJ, Laussen, PC. Extracorporeal membrane oxygenation support of the Fontan and bi-directional Glenn circulations. Ann Thorac Surg 2004; 77: 1341–1348.CrossRefGoogle Scholar
24. Hoffman, GM, Stuth, EA, Jaquiss, RD, et al. . Changes in cerebral and somatic oxygenation during stage 1 palliation of hypoplastic left heart syndrome using continuous regional cerebral perfusion. J Thorac Cardiovasc Surg 2004; 127: 223–233.CrossRefGoogle ScholarPubMed
25. Hoffman, GM, Ghanayem, NS, Tweddell, JS. Noninvasive assessment of cardiac output. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2005; 8: 12–21.CrossRefGoogle Scholar
26. Hoffman, GM. Pro: NIRS should be used for all cardiopulmonary bypass. J Cardiovasc Anesth 2006; 20: 606–612.CrossRefGoogle ScholarPubMed
27. Tabbutt, S, Helfaer, MA, Nicols, DG. Pharmacology of cardiovascular drugs. In: Nichols DG (ed). Critical heart disease in infants and children. Mosby, Elsevier, Philadelphia, 2006, pp 173–204.CrossRefGoogle Scholar
28. Hypothermia After Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 2002; 346: 549–556.CrossRefGoogle Scholar
29. Bernard, SA, Gray, TW, Buist, MD, et al. . Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002; 346: 557–563.CrossRefGoogle ScholarPubMed
30. Gluckman, PD, Wyatt, JS, Azzopardi, D, et al. . Selective head cooling with mild systemic hypothermia after neonatal encephalopathy: multicentre randomized trial. Lancet 2005; 365: 663–670.CrossRefGoogle Scholar
31. Shankaran, S, Laptook, A, Wright, LL, et al. . Whole-body hypothermia for neonatal encephalopathy: animal observations as a basis for a randomized, controlled pilot study in term infants. Pediatrics 2002; 110: 377–385.CrossRefGoogle ScholarPubMed
32. Hickey, RW, Kochanek, PM, Ferimer, H, Graham, SH, Safar, P. Hypothermia and hyperthermia in children after resuscitation from cardiac arrest. Pediatrics 2000; 106: 118–122.CrossRefGoogle ScholarPubMed
33. Tang, W, Weil, MH, Sun, S. The effects of biphasic and conventional monophasic defibrillation on post resuscitation myocardial function. J Am Coll Cardiol 1999; 34: 815–822.CrossRefGoogle Scholar
34. Liet, JM, Jacqueline, C, Orsonneau, JL, Gras-Leguen, C, Potel, G, Roze, JC. The effects of milrinone on hemodynamics in an experimental septic shock model. Pediatr Crit Care Med 2005; 6: 195–199.CrossRefGoogle Scholar
35. Garcia Gonzalez, MJ, Dominguez Rodriguez, A. Pharmacologic treatment of heart failure due to ventricular dysfunction by myocardial stunning: potential role of levosimendan. Am J Cardiovasc Drugs 2006; 6: 69–75.CrossRefGoogle ScholarPubMed
36. Egan, JR, Clarke, AJ, Williams, S, et al. . Levosimendan for low cardiac output: a pediatric experience. J Intensive Care Med 2006; 2: 183–187.CrossRefGoogle Scholar
37. Greeley, WJ, Ungerleider, RM, Smith, LR, Reves, JG. The effects of deep hypothermic cardiopulmonary bypass and total circulatory arrest on cerebral blood flow in infants and children. J Thorac Cardiovasc Surg 1989; 97: 737–745.CrossRefGoogle ScholarPubMed
38. Sunde, K, Pytte, M, Jacobsen, D, et al. . Implementation of a standardized treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation 2007; 73: 29–39.CrossRefGoogle ScholarPubMed