Early chest compressions, defibrillation can save children undergoing sudden cardiac arrest
MedWire News: Early chest compressions and defibrillation help to save children who collapse with cardiac arrest after exercise or exertion, suggest results from an observational study.
"Primary pediatric cardiac arrest has traditionally been considered a futile medical condition with dismal outcomes," write Kevin Enright (University of Sydney, New South Wales, Australia) and colleagues in Pediatric Emergency Care.
"This view, however, is changing as defibrillation-responsive cardiac arrest rhythms, once thought to be rare in children, are being reported to occur in between 15% and 25% of cases."
To assess whether resuscitation techniques can influence outcomes in such children, Enright and team carried out a prospective observational study of all children presenting to the emergency department (ED) of the Children's Hospital at Westmead, Sydney, with an out-of-hospital primary cardiac arrest following exertion or exercise over a 5-year period (2005-2010).
In total, nine children (seven boys; two girls) were admitted to the ED with cardiac arrest over this period. Of these, six survived and had a full recovery and three died.
The children were aged 10.7 years on average and all were found to have an underlying cardiac disorder; long QT syndrome (n=1), commotion cordis (n=1), myocarditis (n=2), catecholaminergic polymorphic ventricular tachycardia (n=3), or hypertrophic cardiomyopathy (n=2).
Six of the children (three survivors) had at least one syncopal or presyncopal episode or other symptoms, such as chest pain, before their arrest. All of the children were either taking part in some sort of sporting activity (eg, swimming, rugby, football) or physical exertion (eg, running/walking) prior to their collapse.
All six of the survivors had received chest compressions within 5 minutes and defibrillation within 10 minutes of cardiac arrest, whereas two of the children that died had delayed defibrillation (over 10 minutes) and one had defibrillation but delayed chest compression (over 5 minutes).
Notably, all of the survivors had an electrically cardiovertable rhythm on cardiac arrest.
Epinephrine was only used in one patient who survived, and the researchers believe that the "traditional approach to resuscitation using epinephrine does not work well in this group of patients and, in particular, those with catecholamine-sensitive cardiac disorders, which will be the majority of such cases."
They say that the current resuscitation guidelines that recommend using epinephrine may be detrimental to these children, and suggest that future guidelines should "give special consideration" to this group of children.
By Helen Albert