History Of Cardiopulmonary Resuscitation

Postgraduate Textbook of Pediatrics

Cardiopulmonary Resuscitation (CPR)

Utpal Bhalala, MD, FAAP*; Vijay Srinivasan, MD**

*Assistant Professor

Anesthesiology, Critical Care Medicine and Pediatrics

The Johns Hopkins University School of Medicine

Baltimore, MD, USA

**Assistant Professor

Pediatric Critical Care Medicine

The Children’s Hospital of Philadelphia

Philadelphia, PA, USA

Introduction and History:

Pathophysiology:

As compared to adults, children rarely suffer ventricular fibrillation (VF) cardiac arrest (CA) from coronary artery disease. The causes of pediatric arrests are varied and are usually from severe hypoxia or asphyxia as a result of respiratory failure or circulatory shock. Refractory hypoxia leads to lactic acidosis from anaerobic metabolism and both hypoxia and acidosis lead to myocardial depression, which ultimately leads to cardiac arrest. In the Indian subcontinent, infectious conditions such as pneumonia, diarrhea and sepsis which are associated with tissue hypoxia-asphyxia contribute to both out-of-hospital and in-hospital cardiac arrests in children.

Certain physiologic characteristics of children, which are different from adult have impact on their pre-arrest state, mechanism of arrest and post-arrest outcome. For example, children exhibit developmental changes that affect cardiac and respiratory physiology pre, intra and post-arrest. Neonates undergo transitional physiological changes from in-utero environment to an external, gaseous environment and therefore differ from adults. Neonates and infants have much less cardiac and respiratory reserve, and higher pulmonary vascular resistance compared to older children. Certain children have pre-existing developmental defects and other organ dysfunc...

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...PR like duration of anoxia or CPR; cause of the cardiac arrest and type of cardiac arrhythmia. Bilateral absent cortical somatosensory evoked potential (SSEPs) within one to three days post-arrest predict poor outcome. Burst suppression or generalized epileptiform discharges on EEG predict poor outcomes but not with a high accuracy. High serum neuron specific enolase (NSE) levels at days 1-3 after arrest accurately predict poor outcome, but there are inadequate data to support or refute the prognostic value of other serum and CSF biochemical markers, neuroimaging and ICP monitoring.

Prevention:

Almost every cardiac arrest in children is preventable. Since majority of cardiac arrest in children result from refractory hypoxia and/or shock, early recognition and aggressive management of respiratory and circulatory failure could potentially prevent cardiac arrest.