An infant who is in cardiac arrest

Causes include respiratory infections such as pneumonia and bronchiolitis. Other respiratory causes include asthma, apnea, aspiration, smoke inhalation, and drowning.

Infectious causes also include sepsis and meningitis. Cardiac causes include congenital lesions, commotio cordis, arrhythmias, and cardiomyopathies. Traumatic causes include blunt trauma to the head or chest, ingestions, drowning, and child abuse. Based on data from the American Heart Association AHA , Emergency Medical Services assessed approximately out-of-hospital cardiac arrests involving individuals younger than 18 years of age.

Survival to hospital discharge after EMS-treated, non-traumatic cardiac arrest among youth younger than 18 years is 5. Nearly hospitalized children in the United States receive cardiopulmonary resuscitation CPR annually. According to data from the AHA, the outcome of unwitnessed cardiopulmonary arrest in infants and children is poor.

Only 8. The best-reported outcomes have been in children who receive immediate high-quality cardiopulmonary resuscitation resulting in ample ventilation and coronary artery perfusion , and in those with witnessed sudden arrest presenting with ventricular rhythm disturbance that responds to early defibrillation.

Due to the patient's acute condition, a rapid review of the charted medical history may be the entire history available. Focus on noting abnormalities that may be causing the arrest. The exam is limited to evaluation of the airway, breathing, and circulation during the initial arrest. Since outcomes are poor post-arrest, priority is placed upon early recognition of pre-arrest states. Recognizing the signs of impending respiratory failure and shock of any etiology is paramount.

The emergences of rapid response teams and early warning systems that have been incorporated into electronic medical record systems have helped. If a baby stops breathing, he or she is not getting the oxygen needed to stay alive. If breathing stops, the heart will also soon stop. This should be done before you leave the hospital.

Skip to Content. Urgent Care. In This Section. If the baby stops breathing or the heart stops beating If a baby stops breathing, he or she is not getting the oxygen needed to stay alive.

Turn the baby flat on his back on a hard surface. B: Lone rescuers can use 2 fingers for infant compressions. Fingers should be maintained in the upright position during compression. For neonates, this technique results in too low a position, ie, at or below the xiphoid; the correct position is just below the nipple line. Journal of the American Medical Association —, Copyright , American Medical Association.

After adequate oxygenation and ventilation, epinephrine is the drug of choice see First-line drugs First-line drugs Cardiopulmonary resuscitation CPR is an organized, sequential response to cardiac arrest, including Recognition of absent breathing and circulation Basic life support with chest compressions Epinephrine dose is 0.

Current guidelines advise immediate IO placement and epinephrine administration for nonshockable rhythms, as recent evidence indicates that restoration of spontaneous circulation ROSC and survival rate in children is correlated with the speed at which the first dose of epinephrine is received.

It may be repeated up to 2 times for refractory ventricular fibrillation Ventricular Fibrillation VF Ventricular fibrillation causes uncoordinated quivering of the ventricle with no useful contractions. It causes immediate syncope and death within minutes. Treatment is with cardiopulmonary Symptoms depend on duration and vary from none to palpitations to hemodynamic collapse and death.

Neither amiodarone nor lidocaine have been shown to improve survival to hospital discharge. Blood pressure BP should be measured with an appropriate-sized cuff, but direct invasive arterial BP monitoring is mandatory in severely compromised children.

Because BP varies with age, an easy guideline to remember the lower limits of normal for systolic BP 5th percentile by age is as follows:. Of significant importance is that children maintain BP longer because of stronger compensatory mechanisms increased heart rate, increased systemic vascular resistance.

Once hypotension occurs, cardiorespiratory arrest may rapidly follow. Size-variable equipment includes defibrillator paddles or electrode pads, masks, ventilation bags, airways, laryngoscope blades, endotracheal tubes, and suction catheters. Weight should be measured rather than guessed; alternatively, commercially available measuring tapes that are calibrated to read standard patient weight based on body length can be used.

Some tapes are printed with the recommended drug dose and equipment size for each weight. There is equipoise for institution of cooling after cardiac arrest. Other medications for specific special resuscitation circumstances may be appropriate, such as for hyperkalemia: calcium, bicarbonate, glucose, insulin, Kayexalate, hyperventilation.

Hypoxia and ischemia lead to hypotension, apnea, and bradycardia with poor perfusion most often resulting in PEA Pulseless Electrical Activity or asystole. The patient transitions to unresponsiveness, lack of breathing other than occasional gasp, and lack of response to verbal or physical stimuli. The pupils become dilated and fixed. Start chest compressions, call for help and rapidly determine if there is a shockable rhythm.

If not shockable, then continue CPR, order epinephrine and seek treatable causes such as toxins antidotes , electrolyte imbalances, physical impediments to cardiac refill pneumothorax, pericardial tamponade , hypothermia, or pulmonary embolism. Usually a blood gas, lactate, electrolytes, glucose, complete blood count, magnesium, calcium, and core temperature, and chest radiograph are appropriate.

For this reason, ventilation does not have to be vigorous. Over-ventilation pressurizes the chest, decreases venous return, raises intrathoracic pressure and decreases coronary perfusion pressure. On the downside, overconstriction of peripheral or lung microvessels may cause further local ischemia and hypoperfusion of vital tissues and organs. Cumulative higher doses of epinephrine have been associated with worse survival and neurologic outcome, however the causative relationship has not been definitively proven.

Provides evidence evaluation worksheets and discussion for key topics involving pediatric resuscitation diagnosis, treatment, drugs, equipment, and techniques. Updated in October Revises every 5 years. Full recommendations for diagnosis, treatment, drugs, equipment, and techniques.