When cardiac arrest occurs, the heart is no longer contracting effectively and circulation has stopped. Consequently, oxygen is no longer delivered to any part of the body. While children and adults suffer the same cardiac arrhythmias—or irregular heartbeats—the causes of these conditions tend to vary. In adults, cardiac arrhythmias are most often directly caused by cardiac events, such as a myocardial infarction or heart attack. In children and infants, however, the causes behind cardiac arrhythmias are much more likely to be non-cardiac.
Pediatric advanced life support (PALS) guidelines outline a systematic approach to emergency assessment for critically injured children and infants, allowing practitioners from multiple healthcare disciplines to identify cardiac arrest and relevant etiologies in children. Clinicians with PALS certification learn to recognize the three most common causes of cardiac arrest in children, which include trauma, poisoning and various respiratory disorders.
Trauma results from any bodily wound or shock produced by sudden physical injury. In children and infants, trauma generally results from accidents, injuries or impact, and suggests a considerable degree of injury. Trauma also indicates a compromised state, in which the pediatric patient is particularly susceptible to secondary complications, including shock, cardiac arrest, and in some cases even death.
In the United States, a child is poisoned every 30 seconds. Most incidents are accidental and occur by ingestion rather than inhalation or skin contact, and while many poisonings can be treated at home with instructions provided by poison control centers, other poisonings are serious enough to warrant emergency medical treatment. Poisoning can result in a loss of consciousness, difficulty breaking, seizures, cardiac arrest and death.
- Respiratory disorders
Respiratory conditions can quickly deteriorate into respiratory failure and cardiopulmonary failure, and may subsequently lead to cardiac arrest (with or without a period of respiratory distress). Respiratory disorders most often resulting in cardiac arrest include airway obstruction, smoke inhalation, drowning, infection and sudden infant death syndrome (SIDS).
A clinical diagnosis of cardiac arrest is made in a child or infant who has stopped breathing, has no pulse and/or has lost consciousness. The foundation of effective cardiac arrest management for children or infants lies in the quality of the basic life support (BLS) provided. PALS guidelines dictate that any child with a pulseless arrest should receive CPR, chest compressions and ventilation (until an advanced airway is placed), rhythm check and shock delivery. However, prevention of cardiac arrest through recognition and treatment of its antecedent conditions is more effective than treating the cardiac arrest. Only about nine percent of children who arrest out of the hospital will survive, while 27 percent of children who experience cardiac arrest in the hospital will survive to discharge.
For more information about PALS guidelines, see our PALS certification and recertification course overviews.
The information included in this article is based on the 2005 guidelines for CPR, first aid and advanced cardiovascular care. Read more about the 2010 changes to the online PALS course.