Published online October 31, 2008
PEDIATRICS Vol. 122 No. 5 November 2008, pp. 1086-1098 (doi:10.1542/peds.2007-3313)

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STATE-OF-THE-ART REVIEW ARTICLE

Pediatric Cardiopulmonary Resuscitation: Advances in Science, Techniques, and Outcomes

Alexis A. Topjian, MD^a, Robert A. Berg, MD^a,b and Vinay M. Nadkarni, MD, MS^a

^a Department of Anesthesia and Critical Care Medicine, University of Pennsylvania, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
^b Department of Pediatrics, University of Arizona College of Medicine, Tucson, Arizona

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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Key Words: cardiopulmonary resuscitation • cardiac arrest • ECMO • extracorporeal membrane oxygenation • pediatric • pediatric advanced life support • PALS • therapies

Abbreviations: CPR—cardiopulmonary resuscitation • ECMO—extracorporeal membrane oxygenation • ROSC—return of spontaneous circulation • VT—ventricular tachycardia • VF—ventricular fibrillation • PEA—pulseless electrical activity • MET—medical emergency team • ITD—impedance threshold device • ACD—active compression-decompression • HIE—hypoxic-ischemic encephalopathy • NSE—neuron-specific enolase • SIDS—sudden infant death syndrome • AED—automated external defibrillator

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Accepted Jul 3, 2008.

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