Cardiopulmonary Arrest In Children

Unlike in adults, cardiopulmonary arrest in rare in children and less likely to be a primary cardiac event. Early onset of effective, high-quality CPR can improve survival. The American Heart Association periodically releases updates on pediatric, basic life support and pediatric, advanced life support. One can obtain the principles of pediatric resuscitation from enrolling in Pediatric Advanced Life Support courses (PALS), or Advanced Pediatric Life Support courses (APLS). Children in need of resuscitation can be divided into several categories that include pulseless arrest (which may be the result of asystole), pulseless electrical activity, or ventricular fibrillation/ventricular tachycardia without a pulse. Regardless of the etiology, early initiation of CPR along with cardiac monitoring will determine which pulseless arrest pathway to follow. For a pediatric pulseless arrest, the compressions to breaths ratio are 30:2 for a sole healthcare provider and 15:2 for two healthcare providers. Subsequent management of patients with asystole and pulseless electrical activity include epinephrine administration every three to five minutes, as needed. The dose of epinephrine is 0.01 mg/kg of the 1:10,000 solution. One can administer epinephrine in multiple ways: intravenously, intraosseously, or endotracheally. The endotracheal dose is ten-fold higher at 0.1 mg/kg. Pulseless electrical activity is often secondary to an underlying cause. PALS teaches the Hs and Ts. The Hs are Hypoxia, Hypovolemia, Hydrogen ion (acidosis), Hypo/Hyperkalemia, Hypothermia, and Hypoglycemia. In pediatric patients, hypoxia and hypovolemia are the most common causes. The Ts include Toxins, Tamponade (cardiac) Tension pneumothorax, Thromboembolic event, and Trauma. Although the H's and T's are often associated with pulseless electrical activity, it is prudent to consider causes of cardiac arrest, especially if you fail to achieve a return of spontaneous circulation with your current management.Ventricular fibrillation and pulseless ventricular tachycardia require similar initial principles, for example, early onset of CPR and early recognition of the rhythm. Quick access to a manual defibrillator or an Automated External Defibrillator (AED), can make the difference in survival. In pediatrics, the energy recommended for defibrillation is 2 J/kg. With the introduction of biphasic defibrillators, the practice of three stacked shocks had been removed from current recommendations. Please refer to the algorithms listed below.