Cardiac arrest in children and young adults: we are making progress.
ABSTRACT Thirty years ago, sudden cardiac arrest (SCA) in children and young people was called a rare event.(1,2) Etiologies were thought to be primarily respiratory and resuscitation efforts were directed at restoring ventilation or oxygenation. Most studies were limited by incomplete data collection including in-hospital and out-of hospital arrest, and small study size. Outcomes were so dismal that resuscitation was considered futile by some(3,4) In 1995, Mogayzel et al(5) published a ground-breaking article on ventricular fibrillation in children ages 5-18. They documented that ventricular fibrillation occurred at some time during a resuscitation in 19% of cardiac arrests in children in the Seattle/King County area and 17% were discharged with good neurologic outcomes, compared to 2% of those with asystole. This study coincided with the availability of automated external defibrillators (AEDs) in the community, and led to a re-consideration of the need for early assessment of rhythm in pediatric cardiac arrest and development of AEDs with pediatric modifications. Over the last 20 years, there has been increasing documentation of cardiac arrest in children.(6-9) A major shortcoming in most of these studies is inclusion of all non-traumatic causes cardiac arrest when incidence is calculated. This has been a major deficiency in pediatric cardiac arrest literature as most include non-cardiac etiologies such as suffocation, drowning, drug overdose.(6,7,10) Inclusion of multiple etiologies in the incidence data rendered them difficult to interpret when attempting to establish the appropriateness of CPR techniques, screening and prevention programs, treatment algorithms, and especially outcomes. (SELECT FULL TEXT TO CONTINUE).