PEDIATRIC POST-RESUSCITATION MANAGEMENT

Course overview

MORTALITY RATES AFTER PEDIATRIC CARDIAC ARREST REMAIN HIGH AFTER INITIAL RESUSCITATION AND A RETURN OF SPONTANEOUS CIRCULATION. SEVERAL FACTORS MUST BE ADDRESSED TO OPTIMIZE SURVIVAL AND TO PREVENT SUBSEQUENT DETERIORATION AND/OR ORGAN DYSFUNCTION AND NEUROLOGIC SEQUELAE. PRIORITIES POST-RESUSCITATION INCLUDE ONGOING ASSESSMENT OF THE RESUSCITATION AND STABILIZATION PROCESS, DETERMINING AND MANAGING THE ETIOLOGY OF THE ARREST, MAINTAIN AND OR MINIMIZE BRAIN INJURY WITH TARGETED TEMPERATURE MANAGEMENT AND CONSIDERATION OF VASOACTIVE DRUGS, AND PREVENTING DECOMPENSATION WHILE MANAGING THE PATIENT IN THE EMERGENCY DEPARTMENT SETTING, AND/OR WHILE TRANSPORTING TO A HIGH LEVEL OF CARE (PEDIATRIC INTENSIVE CARE UNIT). AFTER A RETURN OF SPONTANEOUS CIRCULATION FURTHER STABILIZATION AND DIAGNOSTIC ASSESSMENTS ARE REQUIRED. A POST-ARREST REEVALUATION INCLUDES ASSESSING THE ADEQUACY OF PULSES, PERFUSION, BLOOD PRESSURE, AND ADEQUACY OF OXYGENATION AND VENTILATION. POST-ARREST MONITORING INCLUDES CONTINUOUS CARDIAC MONITORING, END-TIDAL CARBON DIOXIDE (CO2) MEASUREMENTS, POSSIBLE BRAIN MONITORING, AND TRENDING OF LAB WORK. POST-ARREST PATIENTS MAY BE HYPOTENSIVE, AND EARLY AND CONTINUOUS EPINEPHRINE INFUSIONS ARE PREFERRED FOR SEVERAL REASONS. CONSTANT CARDIAC MONITORING IS NEEDED TO EVALUATE FOR THE RECURRENCE OF PRECIPITATING ARRHYTHMIAS. ONGOING PHYSIOLOGY THAT MAY LEAD TO ARREST MUST ALSO BE ADDRESSED, FOR EXAMPLE HYPOXIA, ACIDOSIS, HYPO/HYPERKALEMIA. THIS ACTIVITY REVIEWS THE EVALUATION AND TREATMENT OF POST-RESUSCITATION PATIENTS AND DISCUSSES THE ROLE OF THE INTERPROFESSIONAL TEAM IN MANAGING THESE PATIENTS.