Cardiopulmonary resuscitation in children.
OBJECTIVE
To summarize recent advances in pediatric cardiopulmonary arrest prevention, resuscitation and postresuscitation management.


RESULTS
Pediatric cardiac arrest has traditionally been considered a futile medical condition with dismal outcomes. Data in the 21st century indicate that more than 25% of children treated for in-hospital cardiac arrests survive to hospital discharge and more than 10% of children older than 1 year treated for out-of-hospital cardiac arrests survive to hospital discharge. These data establish that children are more likely to survive to hospital discharge than adults after both in-hospital and out-of-hospital cardiac arrests. Before arrest, exciting new studies demonstrate that the implementation of in-hospital pediatric medical emergency teams is associated with significant decreases in cardiac arrest incidence and overall pediatric hospital mortality. During arrest, ventricular fibrillation or ventricular tachycardia, once thought to be rare in children, occurs during 25% of inhospital pediatric cardiac arrests and at least 7% of out-of-hospital pediatric cardiac arrests. Survival to hospital discharge is much more likely after arrests with a first documented rhythm of ventricular fibrillation or ventricular tachycardia than after pulseless electric activity and asystole. However, ventricular fibrillation or ventricular tachycardia is not always a favorable rhythm, as survival to discharge is much less likely when ventricular fibrillation or ventricular tachycardia occurs during resuscitation from an arrest with the first documented rhythm of pulseless electric activity or asystole. Further, extracorporeal membrane oxygenation cardiopulmonary resuscitation appears promising under special resuscitation circumstances to improve outcome from highly selected in-hospital pediatric cardiac arrest victims. Further, postresuscitation interventions such as goal-directed therapies and therapeutic hypothermia have been demonstrated in adults and infants to improve outcome for selected cardiac arrest victims and are promising candidate targets for study in children.


CONCLUSIONS
Pediatric cardiac arrest is not a futile condition; many children are successfully resuscitated each year. The implementation of new prearrest, intraarrest and postresuscitative therapies has the potential to further improve survival rates following pediatric cardiac arrest.
Topjian
Alexis A
AA
University of Pennsylvania School of Medicine, Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA. topjian@email.chop.edu
Nadkarni
Vinay M
VM
Berg
Robert A
RA
D000293:Adolescent; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D005112:Extracorporeal Circulation; D006323:Heart Arrest / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D007223:Infant; D010101:Oxygen Consumption; D016896:Treatment Outcome; D014693:Ventricular Fibrillation