Pediatric emergency medicine trisk 0186 0186
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CHAPTER 9 ■ CARDIOPULMONARY
RESUSCITATION
SAGE MYERS, DANA ARONSON SCHINASI, FRANCES M. NADEL, SHANNON M. GAINES
GOALS OF EMERGENCY THERAPY
Cardiopulmonary resuscitation (CPR) is a series of interventions aimed at
restoring and supporting vital function after apparent death. The immediate goal
of resuscitation is to reestablish substrate delivery to meet the metabolic needs of
the myocardium, brain, and other vital organs. The overall goal is to return the
child to society without morbidity related to the underlying disease or the
resuscitation process. Given the poor prognosis of children who develop
cardiopulmonary arrest, primary prevention efforts are crucial in improving
childhood mortality. This chapter will focus on the management of the critically
ill child and neonate based on the 2015 American Heart Association (AHA) CPR
Resuscitation Guidelines, Pediatric Advanced Life Support (PALS) principles, the
literature, and our experience.
INCIDENCE
It is estimated that of the more than 6,000 children who suffer an out-of-hospital
cardiac arrest (OHCA) annually, only 5% to 12% will survive, most with
significant neurologic injury. U.S. mortality rates related to age in years for 2017
are shown in Table 9.1 . There has been little improvement in pediatric OHCA
outcomes over the past two decades. Of note, mortality rates of children less than
1 year old approach the rates of people over 54 years old. Table 9.2 describes the
leading causes of death for children and young adults. After the first year of life,
unintentional injury is the most common cause of death and therefore,
preventable.
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