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Review
. 2008 Nov;122(5):1086-98.
doi: 10.1542/peds.2007-3313.

Pediatric cardiopulmonary resuscitation: advances in science, techniques, and outcomes

Alexis A Topjian  1 , Robert A Berg, Vinay M Nadkarni
Affiliations
Review

Pediatric cardiopulmonary resuscitation: advances in science, techniques, and outcomes

Alexis A Topjian et al. Pediatrics. 2008 Nov.

Abstract

More than 25% of children survive to hospital discharge after in-hospital cardiac arrests, and 5% to 10% survive after out-of-hospital cardiac arrests. This review of pediatric cardiopulmonary resuscitation addresses the epidemiology of pediatric cardiac arrests, mechanisms of coronary blood flow during cardiopulmonary resuscitation, the 4 phases of cardiac arrest resuscitation, appropriate interventions during each phase, special resuscitation circumstances, extracorporeal membrane oxygenation cardiopulmonary resuscitation, and quality of cardiopulmonary resuscitation. The key elements of pathophysiology that impact and match the timing, intensity, duration, and variability of the hypoxic-ischemic insult to evidence-based interventions are reviewed. Exciting discoveries in basic and applied-science laboratories are now relevant for specific subpopulations of pediatric cardiac arrest victims and circumstances (eg, ventricular fibrillation, neonates, congenital heart disease, extracorporeal cardiopulmonary resuscitation). Improving the quality of interventions is increasingly recognized as a key factor for improving outcomes. Evolving training strategies include simulation training, just-in-time and just-in-place training, and crisis-team training. The difficult issue of when to discontinue resuscitative efforts is addressed. Outcomes from pediatric cardiac arrests are improving. Advances in resuscitation science and state-of-the-art implementation techniques provide the opportunity for further improvement in outcomes among children after cardiac arrest.

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Figures

FIGURE 1
FIGURE 1
A, Direct cardiac compressions; B, thoracic pump compressions. RV indicates right ventricle; LV, left ventricle; Pulm. circ., pulmonary circulation. (Reproduced with permission from Paradis NA, Halperin HR, Kern KB, Wenzel V, Chamberlain DA. Cardiac Arrest: The Science and Practice of Resuscitation Medicine. 2nd ed. Cambridge: Cambridge University Press; 2007)
FIGURE 2
FIGURE 2
Coronary perfusion pressure (the difference between aortic pressure and right atrial pressure).
See this image and copyright information in PMC

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