Pediatric Postresuscitation Management

Excerpt

The pediatric mortality rate following cardiac arrest and return of spontaneous circulation (ROSC) remains greater than 90%. Despite the low overall incidence of cardiac arrest (0.01%) in children, the importance of adequate high-quality care in these scenarios goes without saying. Several factors regarding pediatric post-resuscitation management need to be addressed in order to optimize patient survival and prevent organ dysfunction.

These factors include determining the etiology of the arrest and managing it appropriately, minimizing neurologic injury, and preventing further clinical decompensation. Additional important considerations include the emotional outcome of the child as well as the immediate and long-term grief experienced by the family.

The treatment recommendations regarding post-resuscitation management for providers are ever-evolving due to certain barriers in the pediatric population limiting research. The outcome of pediatric CPR is often poor, and can, theoretically, leave care after CPR unnecessary. Additionally, reliable reporting mechanisms and national information archives have historically been inconsistent, if available at all, limiting any meaningful data collection. The recent development of the National Register of Cardiopulmonary Resuscitation, sponsored by the American Heart Association, has facilitated more data collection on this subject, and updates in treatment recommendations.

The foundation of the 2015 published guidelines by the American Heart Association (AHA) on pediatric post-ROSC management is the prevalence of “post–cardiac arrest syndrome (PCAS)”. This scientific statement is the result of an analysis of the past twenty years of pediatric cardiac arrest, adult cardiac arrest, and pediatric critical illness peer-reviewed published literature. From this data, it was determined that all resuscitations from cardiac arrest result in predictable sequelae in the days to weeks following the arrest, including neurologic insult, myocardial dysfunction, systemic ischemia, and persistent precipitating pathophysiology. These AHA guidelines as well as other current guidelines highlight PCAS and pay particular attention to morbidity as it relates to temperature regulation and the circulation/perfusion status of patients following cardiac arrest.