Recent advances in pediatric cardiopulmonary resuscitation and advanced life support

Area of Science:

• Pediatric critical care medicine
• Emergency medicine
• Cardiology

Background:

• Pediatric cardiac arrest (CA) results from uncorrected shock and is often fatal.
• Outcomes are poor as CA occurs when physiological reserves are depleted.
• Optimal management strategies for pediatric CA remain uncertain after decades of research.

Purpose of the Study:

• To review current understanding and uncertainties in pediatric cardiac arrest management.
• To highlight areas needing further research in basic and advanced life support.
• To discuss pharmacologic agents and post-arrest care strategies.

Main Methods:

• Review of existing literature on pediatric cardiac arrest.
• Discussion of novel cardiopulmonary resuscitation techniques.
• Analysis of pharmacologic interventions and post-arrest shock management.

Main Results:

• Epinephrine is the preferred pharmacologic agent for pediatric cardiac arrest.
• The roles of bicarbonate and calcium are controversial.
• New techniques like interposed abdominal compression and active compression-decompression CPR warrant evaluation.

Conclusions:

• Post-arrest shock management is critical and challenging.
• Dobutamine is useful for normotensive post-arrest shock.
• Epinephrine infusions are vital for hypotensive post-arrest shock in children.