Resuscitation

Cardiopulmonary resuscitation overview Cardiopulmonary arrest in infants and children is rarely a sudden event. The usual progression of arrest is respiratory failure, caused by hypoxia and hypercarbia, which eventually leads to asystolic cardiac arrest. Common etiologies that may lead to cardiopulmonary arrest include sudden infant death syndrome (SIDS), respiratory disease, sepsis, major trauma, submersion, poisoning, and metabolic/electrolyte imbalance. In contrast, primary cardiac arrest is relatively rare in the pediatric age group and is most frequently caused by congenital heart disease, myocarditis, and chest trauma with myocardial injury. Although asystole and pulseless electrical activity (PEA) are the primary rhythms in pediatric cardiac arrest, the patient may also have ventricular tachycardia (VT) or ventricular fibrillation (VF). The outcome of unwitnessed cardiopulmonary arrest in infants and children is poor. Only 8.4% of pediatric patients who have out-of-hospital cardiac arrests survive to discharge and most are neurologically impaired, while the in-hospital survival rate is 24%, with a better neurological outcome. The best reported outcomes have been in children who receive immediate high-quality cardiopulmonary resuscitation (resulting in adequate ventilation and coronary artery perfusion), and in those with witnessed sudden arrest (presenting with ventricular rhythm disturbance) that responds to early defibrillation. Emergency department priorities To optimize outcome, it is essential to recognize early signs and symptoms of impending respiratory failure and circulatory shock prior to the development of full cardiopulmonary arrest. All equipment, supplies, and drugs must be available and organized for easy access.