Sudden cessation of heartbeat and cardiac function, resulting in a loss of effective circulation.
Return of spontaneous circulation; rapid transport to hospital.
Pediatric cardiac arrest is a rare event. Most pediatric cardiac arrests occur in children younger than one year of age and 90% occur secondary to hypoxia due to respiratory failure. There are many rarer causes of pediatric cardiac arrest including sudden infant death syndrome (SIDS), submersion/near-drowning, trauma, and sepsis.
In contrast to cardiac arrest in adults, cardiopulmonary arrest in infants and children is rarely a sudden event and does not often result from a primary cardiac cause. In cases of sudden collapse in older paediatric patients and patients with congenital heart disease, a primary cardiac cause should be considered.
When an infant or child is found to be without a pulse, treatment should first be directed toward the following:
Oxygen should be thought of as the first-line drug in pediatric resuscitation. All other resuscitative measures must be done while oxygen is being administered as optimally as possible. Oxygen and effective ventilation will often prove to be the only resuscitation required in a child, however if there is no pulse then chest compressions must be started immediately and continued until return of spontaneous circulation.
Once oxygenation and high quality CPR have been established all infants and children in cardiac arrest should have a defibrillator attached to determine if a shockable rhythm is present. If there is a history of blunt trauma to the chest, electrocution, or the patient has a cardiac history, oxygen and CPR are still the priority but Paramedics should apply the AED with greater urgency as these patients may be more likely to demonstrate a shockable rhythm. If ventricular fibrillation is demonstrated, defibrillation should be attempted as soon as possible.
“In infants < 1 year of age a manual defibrillator is preferred. If a manual defibrillator is not available, an AED with a dose attenuator may be used. An AED without a dose attenuator may be used if neither a manual defibrillator nor one with a dose attenuator is available. The attenuating pads are preferred for children up to the age of 8 years” (Circulation 2010; 122; S886).
For pulseless VT or ventricular fibrillation, the available data suggests an initial dose of 2 J/kg when using manual defibrillators. If the initial shock fails and the patient is not hypothermic perform defibrillation at 4 J/kg.
Prompt and rapid transport of pediatric patients with cardiac arrest is important. Cardiopulmonary arrest in infants and children is rarely a sudden event. When it does occur, pediatric cardiac arrest frequently represents the terminal event of progressive respiratory failure or shock. Determining the actual time of arrest can be difficult and these circumstances are always emotionally charged so in most circumstance you should treat and transport.
Effective CPR can provide adequate oxygenation to the vital organs and should be the priority, as the patient is being rapidly transport to hospital where reversible causes can be sought and treated. Do not delay at the scene attempting to intubate if effective ventilation is achieved with BVM and CPR.
See Cardiac Arrest Management Overview: Causes of Cardiac Arrest