Recent advances in pediatric cardiopulmonary resuscitation and advanced life support.

Abstract

The end point of uncorrected shock is cardiac arrest. Once cardiac arrest occurs, the outcome in children is typically poor, reflecting the fact that cardiac arrest does not occur until the child's physiologic reserves are exhausted. Despite more than 35 years of research in cardiac arrest, the optimal management and treatment remain uncertain. The optimal method of basic and advanced life support to restore cardiac function and preserve brain function is unclear, as is the appropriate application of pharmacologic agents to restart the heart and subsequently to manage postarrest shock. New techniques in basic life support merit evaluation in children, particularly interposed abdominal compression and active compression-decompression cardiopulmonary resuscitation. Epinephrine remains the pharmacologic agent of choice. The role of bicarbonate in the management of acidosis and the role of calcium in restarting the heart remain controversial. If and when the heart is restarted following cardiac arrest, the work is just beginning for the intensivist to manage the postarrest shock state. Dobutamine is useful in the normotensive child while epinephrine infusions are used to stabilize hypotensive, postarrest shock in the child.