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TAS Emergencies and Critical Care ✅ > Cardiopulmonary Arrest ✅ > Flashcards

Cardiopulmonary Arrest ✅ Flashcards

1
Q

What is the incidence of cardiopulmonary arrest in children in developed countries?

A

1-20 per 100,000 children per year

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2
Q

In which children do the majority of cases of cardiopulmonary occur in?

A

Children under 1

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3
Q

How does the cause of cardiopulmonary arrest differ in children compared to adults?

A

In adults, it is often due to primary cardiac disease, which occurs with near-normal function of circulatory and respiratory system until moment of arrest. In children, most occur secondary to hypoxia due to respiratory failure or circulatory failure

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4
Q

What are the most common causes of circulatory failure leading to cardiopulmonary arrest in children?

A

Fluid loss or fluid maldistribution

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5
Q

What is the result of most cases of cardiopulmonary arrest in children being secondary to respiratory or circulatory failure?

A

End organ damage is often already present at the time of cardiac arrest, and is responsible for their prognosis

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6
Q

In what % of children is there a cardiac cause for cardiopulmonary arrest?

A

30%

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7
Q

Give 3 cardiac causes of cardiopulmonary arrest?

A
  • Congenital heart disease
  • Cardiomyopathy
  • Channelopathies
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8
Q

What is the result of survival from complex congenital heart disease improving?

A

Cardiopulmonary arrest in children is becoming more common

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9
Q

What might unrecognised cardiomyopathy or channelopathies cause?

A

Sudden unexpected ventricular fibrillation or pulseless VT

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10
Q

What should be done following an unexpected cardiac arrest or VT/VF arrest?

A

Referral to paediatric cardiologist

Family should also be referred

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11
Q

Why is it important to make a referral to a paediatric cardiologist after unexpected or VT/VF arrest?

A

Identifiable cause may be found following detailed investigations, and treatment can be given

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12
Q

What might be included in investigations for unexpected or VT/VF arrest?

A
  • Genetic studies

- Pharmacological provocation tests

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13
Q

Why should the family also be referred to a paediatric cardiologist in unexpected or VT/VF arrest?

A

They may also be at risk of sudden death

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14
Q

What is achieved in CPR?

A

Delaying cell damage and death in the heart and brain by facilitating partial flow of oxygenated bloods to these organs

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15
Q

What is the purpose of CPR?

A

To provide a window of opportunity to restore breathing and spontaneous blood circulation

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16
Q

What does CPR consist of?

A

Chest compressions and breaths

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17
Q

What is the ratio of chest compressions to breaths in children?

A

15:2 (except in newborns, when 3:1 ratio required)

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18
Q

What is the best compression rate for CPR?

A

100-120 per minute

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19
Q

What is the recommended depth of compression?

A

1/3 of depth of chest

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20
Q

Why is it important that there is minimal interruption of chest compressions?

A

As coronary perfusion pressure has been shown to be greater with prolonged continuous compressions

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21
Q

How do the outcomes from bystander CPR compare in children to adults?

A

In adults, improves survival even if compression only. In children, doesn’t improve survival if compression only

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22
Q

Why doesn’t compression only bystander CPR improve survival in children?

A

Most out-of-hospital cardiac arrests are hypoxic in origin, and so rescue ventilation is important

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23
Q

What is prolonged resuscitation generally associated with?

A

Bad neurological outcome

24
Q

What has a recent study into prolonged CPR in adults shown?

A

Neurological outcome is not directly correlated to duration of CPR

25
Q

What is the result of it being shown that neurological outcome is not directly correlated with duration of CPR in adults?

A

Resuscitation Council does not recommend a specific duration for CPR, and instead clinicians should determine duration on case-by-case basis

26
Q

When might prolonged resuscitation be appropriate?

A

When there is potential for a reversible cause

27
Q

Does prolonged resuscitation in children have the same outcomes as in adults?

A

No they are worse

28
Q

What improves the outcomes of prolonged resuscitation in children?

A
  • Profound hypothermia (<30C)

- Intermittent return of spontaneous circulation

29
Q

When is survival rate with prolonged resuscitation in children?

A

After 20-30 minutes

30
Q

What is true of survivors of prolonged resuscitation in children?

A

They are likely to have significant neurological deficits

31
Q

Where are there cases of survival from prolonged resuscitation with reasonable outcome?

A

In cardiac centres with ECMO

32
Q

What might children have following return of circulation?

A

Significant multi-organ dysfunction

33
Q

Where should children be taken after return of circulation?

A

Intensive care

34
Q

What does post-resuscitation care focus on?

A
  • Achieving and maintaining homeostasis, in order to optimise multi-organ recovery
  • Initiating investigation of underlying cause
  • Treating any identifiable cause
35
Q

Why is it important to manage oxygenation carefully in post-resus care?

A

There is increasing evidence that hyperoxaemia can be detrimental

36
Q

Why might hypoxaemia be detrimental?

A

Excessive tissue oxygen concentrations may increase the production of oxygen free radicals, which damage mitochondria and so may compound neuronal damage

37
Q

What % oxygen is used during resuscitation beyond the neonatal period?

A

100%

38
Q

What should be done with oxygen after return of spontaneous circulation?

A

Inspired oxygen should be titrated to achieve oxygen saturations of 94-98%

39
Q

What is the role of therapeutic hypothermia post cardiac arrest in children?

A

Remains unclear, but current guidelines suggest therapeutic cooling to 32-36 degrees for at least 24 hours

40
Q

Why should hyperthermia be avoided post-resuscitation?

A

Increased core temperature increases metabolic demand by 10-13% for each degree centigrade above normal

41
Q

How should hyperthermia be treated if it occurs post-resuscitation?

A

Active cooling to achieve normal core temperature

42
Q

Why should shivering be avoided post-resuscitation?

A

Increases metabolic demand

43
Q

What may be needed post-resuscitation to prevent shivering?

A

Sedation and neuromuscular blockade

44
Q

When has therapeutic hypothermia been shown to improve neurological outcome in children?

A

In newborns with hypoxic-ischaemic encephalopathy

45
Q

In what age groups are abnormal blood glucose levels associated with poor outcome following cardiorespiratory arrest?

A

All age groups

46
Q

Is abnormal blood glucose levels being associated with poor outcome post-arrest a causative or associated factor?

A

Unknown

47
Q

How should glucose levels be managed following the return of spontaneous circulation?

A

Plasma glucose levels should be monitored, and hypo/hyperglycaemia avoided

48
Q

Is tight glucose control recommended post-resus?

A

No

49
Q

Why is tight glucose control not recommended post-resus?

A

It increases the risk of hypoglycaemia without any survival benefit

50
Q

What is the survival rate for respiratory arrest without cessation of circulation?

A

More than 2/3

51
Q

When do the majority of children with respiratory arrest without circulatory arrest survive?

A

If they get to PICU

52
Q

What % of children who have respiratory arrest without circulatory arrest who get to PICU have a good neurological outcome?

A

90%

53
Q

What proportion of children with cardiopulmonary arrest get to PICU?

A

1/3

54
Q

What proportion of children with cardiopulmonary arrest who get to PICU survive to discharge?

A

1/3

55
Q

What % of children who survive cardiopulmonary arrest have moderate to severe neurological deficit?

A

90%

TAS Emergencies and Critical Care ✅ (8 decks)

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