This is the part 1-overview of a 4 part series for pediatric cardiac arrest.
Cardiac arrest is defined as the cessation of blood circulation resulting from absent or ineffective cardiac mechanical activity. The cessation of blood circulation, if left untreated, will quickly lead to death resulting from organ and tissue ischemia.
Cardiac (cardiopulmonary) arrest is rare in infants and children, and in contrast to adult cardiac arrest, the cause of pediatric cardiopulmonary arrest typically does not have a primary cardiac cause.
Pediatric cardiac arrest is most often the end result of progressive respiratory failure or shock, and often times both respiratory failure and shock may be present.
In light of this, there needs to be a strong emphasis on early identification and treatment of respiratory distress/failure and shock in children. Once cardiac arrest occurs, the outcome is generally poor, even with appropriate and heroic resuscitation efforts.
Over 16,000 children experience cardiac arrest each year. Of these children, 82–84% present with an initial rhythm of asystole or pulseless electrical activity.
Of the 16,000 children, 7–10% initially present with ventricular fibrillation.
Eight percent of children who experience cardiac arrest in the out-of-hospital setting survive to hospital discharge, and 43% of children who experience cardiac arrest in the hospital survive to hospital discharge.
This difference in survival to hospital discharge is primarily linked to the early initiation of high-quality CPR in the hospital setting as compared with the out-of-hospital setting.
Children with bradycardia and poor perfusion, who are treated with chest compressions and ventilations before pulseless arrest develops, have the highest survival rate of 64%. This reinforces the fact that early recognition and treatment of symptoms are the keys to successful cardiopulmonary resuscitation in children.
Untreated progressive tissue hypoxia related to respiratory distress/failure or shock is the cause of the majority of cardiac arrests that occur in children. This type of cardiac arrest is referred to as hypoxic-asphyxial arrest.
Rapid pre-arrest treatment of respiratory distress/failure and shock using the pediatric systematic approach algorithm is the key to improving survival to hospital discharge.
When treated early, respiratory distress/failure and shock can generally be reversed. This early recognition and treatment is the focus of care for the seriously-ill or injured infant and child.
Both respiratory distress/failure and shock are covered in other sections of the website. This section will focus specifically on the recognition and treatment of cardiac arrest when a child has no pulse and no breathing, and the pediatric cardiac arrest algorithm is implemented.
Sudden Cardiac Arrest:
The occurrence of sudden cardiac arrest is significantly lower in children than in adults, and there is typically an underlying heart disease that is involved. The most common predisposing conditions include hypertrophic cardiomyopathy, myocarditis, drug intoxication, and coronary artery anomalies. Also, arrhythmogenic right ventricular dysplasia and long QT syndrome are the most common primary arrhythmic causes of sudden cardiac arrest.