Paediatric Resuscitation

Sunita Goel
Paediatric Resuscitation - Prognosis
The outcome of cardiac arrest in children is typically poor, reflecting the fact that cardiac arrest does not occur until the child's physiological reserves has been exhausted. Since paediatric cardiac arrest follows a progressive deterioration of cardiorespiratory function, the degree of ischaemia, acidosis and organ dysfunction is greater than in acute arrest from ventricular defibrillation. This may reduce the likelihood of recovery. Certain situations are associated with better resuscitative outcomes

1. Witnessed arrest - shorter interval between arrest and starting basic life support improves survival
2. In hospital cardiac arrest - presumably because of more rapid treatment.
3. Bystander CPR
4. Emergency medical team arrival within 10 minutes
5. Resuscitation lasting less than 20 minutes
6. Fewer than 2 doses of adrenaline
7. Return of spontaneous circulation before arrival in hospital (exception hypothermic patient)
8. Ventricular fibrillation - 40% survival as compared with 3% from asystole

Neurologically intact survival is associated to prompt resuscitation and more likely with respiratory rather than cardiac arrest. Furthermore, the sequence of resuscitation actions should consider the most likely cause of the arrest. However, whether this method improves the outcome remains to be studied. There have been efforts to assess the cost benefit of paediatric resuscitation in the emergency department. As in adults, paediatric patients who fail to respond to prehospital resuscitation are unlikely to respond in the emergency department. There is a reluctance to limit the resuscitation to the pre-hospital setting because paediatric deaths are unexpected and tragic. Furthermore, it is generally thought that children do not receive optimal resuscitation prehospital advanced life support.

The end tidal CO2 detector has shown promise to differentiate the survivors from the non-survivors. An increase in end tidal CO2 is often the initial marker for return of spontaneous circulation. If the end tidal CO2 was higher than 10mm Hg at 20 minutes then ROSC did not occur. A disposable semi quantitative calorimetric end tidal CO2 detector has been studied in the paediatric population by Bhende and Thompson and has potential prognostic value. Furthermore, it is cheap, portable and requires no warm-up. The monitor categorizes the end tidal output into 3 ranges:

- Less than 0.5%
- 0.5% to 2.0%
- 2.0% to 5.0%

Patients who arrived in the operating room with readings less than 0.5% did not have return of spontaneous circulation. However, patients who had initial readings of 2.0% to 5.0% was positively associated with return of spontaneous circulation.

There is still no guidelines regarding how long and how aggressive one should resuscitate paediatric cardiac arrest patients although there is move away from protracted efforts, perhaps with the exception of hypothermic patients.

The complication rates from CPR are much lower in children than adults, reported at approximately 3%. Common significant adverse effects are rib fractures, pneumothorax, pneumoperitoneum, retinal haemorrhage and haemorrhage.

Paediatric Resuscitation Paediatric Resuscitation 01/25/2001
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