Paediatric Resuscitation

Sunita Goel
Paediatric Resuscitation - Introduction
Survival and neurologic outcome in paediatric cardiac arrest has not improved significantly in the past decade. The prognosis of cardiac arrest in children remains poor with 3 to 17% surviving to hospital discharge; few of the survivors have good neurological outcome. However, recent developments hold promise for improving the outcome in such patients

Paediatric resuscitation differs from those of an adult. However, data supporting these differences are lacking particularly because cardiac arrests are rare in children. Therefore, small sample size, inadequate power, lack of standardized terminology and retrospective nature of the studies has made comparison of outcome measures difficult. Paucity of resuscitation outcome data in paediatric population makes scientific justification of recommendations difficult. Hence, the optimal method of paediatric resuscitation is still unclear.

In 1995, a paediatric task force developed the Paediatric Upstein Style to provide uniform definitions, time intervals, intervention and outcome in a template form. This hopefully, allows for the meta-analysis of smaller studies and encourages larger randomized, multicentre, multinational clinical trials to validate the paediatric resuscitation protocol. The paediatric guidelines include respiratory and cardiac arrest because effective management of respiratory distress prevents progression to cardiac arrest. The terminologies that are derived from the guidelines for uniform paediatric advance life support are:

Cardiac arrest refers to the clinical state characterised by the absence of detectable cardiac activity.

Return of spontaneous circulation (ROSC) refers to the return of any spontaneous central palpable pulses regardless of duration. It can be intermittent or sustained. Sustained ROSC is defined as a duration sufficient to permit transfer of patient either from the site of arrest to the emergency department or for in house arrest, to the operating room or intensive care unit. It can also be defined as ROSC of more than or equal to 20 minutes.

The primary etiology of most paediatric cardiac arrest is respiratory arrest, which accounts for 56% to 78% of cases. Respiratory arrest alone has a significantly better outcome because the hypoxia is not sufficiently prolonged to cause cardiac arrest. The commonest rhythm in paediatric arrest is bradycardia leading to asystole, occurring in between 77% to 95% and is secondary to prolonged hypoxia. Ventricular tachycardia and fibrillation occurs between 4% and 23%. Primary dysrhythmic cardiac arrest should particularly be considered in patients with underlying cardiac disease or history suggestive of myocarditis.

Paediatric Resuscitation Paediatric Resuscitation 01/25/2001
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