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Cardiac performance in pediatric near-drowning
C A Hildebrand1, A G Hartmann, E L Arcinue
1Pediatric Intensive Care Unit, Huntington Memorial Hospital, Pasadena, CA 91105.
Insights
Cerebral resuscitation in near-drowned children can negatively impact cardiovascular function, potentially worsening outcomes. Monitoring cardiac index and pulmonary capillary wedge pressure is crucial for optimizing cerebral perfusion and neurologic recovery.
Area of Science:
- Pediatric Critical Care Medicine
- Neurology
- Cardiovascular Physiology
Background:
- Near-drowning incidents in children can lead to severe neurological compromise.
- Cardiopulmonary arrest (CPR) is a critical event in pediatric near-drowning cases.
- Intracranial hypertension is a significant concern following near-drowning events.
Purpose of the Study:
- To investigate the hemodynamic effects of cerebral resuscitative therapy in near-drowned children.
- To assess the impact of interventions like controlled hyperventilation, hypothermia, pentobarbital, and mannitol on cardiovascular function.
- To determine the necessity of cardiovascular support during cerebral resuscitation.
Main Methods:
- Retrospective analysis of 29 near-drowned children admitted to a Pediatric ICU.
- Hemodynamic monitoring (cardiac index, systemic vascular resistance index) in select patients.
- Implementation of cerebral resuscitative therapies for intracranial hypertension.
Main Results:
- Patients experiencing cardiopulmonary arrest often presented with low cardiac index and high systemic vascular resistance index post-CPR.
- Cerebral resuscitative therapy led to a decrease in systemic vascular resistance index, cardiac index, mean arterial pressure, and cerebral perfusion pressure.
- Fluid volume therapy and inotropic support were required to maintain adequate cerebral perfusion pressure.
Conclusions:
- Cerebral resuscitative therapies can induce significant hemodynamic depression in near-drowned children.
- These cardiovascular effects may potentially exacerbate the overall outcome.
- Continuous monitoring of cardiac index and pulmonary capillary wedge pressure is recommended to optimize cerebral perfusion and neurologic outcomes.
Abstract:
Between July 1985 and December 1986, 29 near-drowned children ranging in age between 6 months and 13 yr were admitted to the Pediatric ICU of Huntington Memorial Hospital. Eight patients suffered cardiopulmonary arrest and had an admission Glasgow Coma Score of 3 or 4. Hemodynamic monitoring was performed on five of these patients. Three received cerebral resuscitation with controlled hyperventilation, hypothermia, pentobarbital, and mannitol because of intracranial hypertension. After CPR, a low cardiac index (CI) and high systemic vascular resistance index (SVRI) were found. When cerebral resuscitative therapy was initiated later, it caused a reduction of SVRI, CI, mean arterial pressure, and cerebral perfusion pressure. Fluid volume therapy and inotropic cardiac support was necessary to maintain adequate cerebral perfusion pressure. These observations indicate that cerebral resuscitative therapy can affect cardiovascular function. The hemodynamic depressive effects might even worsen the outcome. For this reason, it is advisable to obtain CI and pulmonary capillary wedge pressure to optimize cerebral perfusion and potentially neurologic outcome.