a1 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
a2 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
a3 Department of Nursing, Monroe Carell Children’s Hospital, Vanderbilt University School of Medicine, United States of America
a4 Department of Anesthesia and, Boston Children’s Hospital, Harvard School of Medicine and, United States of America
a5 Department of Cardiology, Boston Children’s Hospital, Harvard School of Medicine and, United States of America
a6 Department of Anesthesia and Critical Care Medicine, Children’s Hospital of Wisconsin, United States of America
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.
c1 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: [email protected]