CPR | Care Considerations for the Pediatric Post-Cardiac Arrest Patient

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CPR Care Considerations for the Pediatric
Post-Cardiac Arrest Patient
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This blog entry is based on content from a
podcast interview with Mary McBride, MD, FAAP,
MEd, Associate Professor of Pediatrics at
Northwestern University Feinberg School of
Medicine and pediatric cardiac intensivist at
Lurie Childrens Hospital in Chicago, and Alexis
Topjian, MD, MSCE, Pediatric Critical Care
Medicine Physician at Childrens Hospital of
Philadelphia. Listen to the full podcast titled
Care Considerations for the Pediatric
Post-Cardiisease. They typically will have
arrests that are more commonly associated with
asphyxia, so from respiratory illness. And
especially in the out-of-hospital population, we
will see more prolonged downtimes for really
young infants. Adults more commonly will have a
ventricular fibrillation or ventricular
tachycardia arrest, and so it will be shockable.
Really, children are much less likely to have a
shockable initial rhythm.
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We also have a special circumstances in our
childrens, so congenital heart disease is
common, and so we will see that complex interplay
of factors as well. I think as we look at
children, we really see their causes of arrest
are different, which impacts their resuscitation,
and then impacts the time period after their
resuscitation.ac Arrest Patient. Dr. McBride
What is post cardiac arrest syndrome? Dr.
Topjian I think we really focus oftentimes on
our immediate resuscitation. We get a pulse back
in our patients and were so happy to have a
pulse back, but at that time were really
entering a new phase of our resuscitation, and
thats the post cardiac arrest syndrome. The post
cardiac arrest syndrome begins from the earliest
moments after resuscitation, and its
traditionally thought of as four key components.
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The first is brain injury, which we know occurs
during the time of hypoxia and ischemia. Theres
a component of myocardial dysfunction, also due
to hypoxia ischemia. Then theres a systemic
ischemic reprofusion response. Then finally the
component of what preexisting pathophysiology, so
whatever led to your cardiac arrest in the first
place. This is sort of a complex interplay of
factors that we will talk about a little bit more
that tend to ebb and flow over time from the
earliest moments after resuscitation, and can
really go on for days and can have long lasting
effects on the patient that can impact
outcome. Dr. McBride How might this differ from
pediatrics to adults?
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Dr. Topjian I think kids are inherently
different than adults in several ways. Obviously
in size and development, but really the cause of
arrest is different between adults and children.
Children dont have much coronary artery disease.
They typically will have arrests that are more
commonly associated isease. They typically will
have arrests that are more commonly associated
with asphyxia, so from respiratory illness. And
especially in the out-of-hospital population, we
will see more prolonged downtimes for really
young infants. Adults more commonly will have a
ventricular fibrillation or ventricular
tachycardia arrest, and so it will be shockable.
Really, children are much less likely to have a
shockable initial rhythm. We also have a special
circumstances in our childrens, so congenital
heart disease is common, and so we will see that
complex interplay of factors as well. I think as
we look at children, we really see their causes
of arrest are different, which impacts their
resuscitation, and then impacts the time period
after their resuscitation.with asphyxia, so from
respiratory illness.
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And especially in the out-of-hospital population,
we will see more prolonged downtimes for really
young infants. Adults more commonly will have a
ventricular fibrillation or ventricular
tachycardia arrest, and so it will be shockable.
Really, children are much less likely to have a
shockable initial rhythm. We also have a special
circumstances in our childrens, so congenital
heart disease is common, and so we will see that
complex interplay of factors as well. I think as
we look at children, we really see their causes
of arrest are different, which impacts their
resuscitation, and then impacts the time period
after their resuscitation. Learn more about CPR.
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