Post-resuscitation care

Abstract

Pediatric cardiac arrest is an infrequent but potentially devastating event. While return of spontaneous circulation (ROSC) is the immediate objective, the ultimate goal is survival with meaningful neurologic outcome. Once a perfusing rhythm is established, the pediatric cardiac arrest victim requires expert critical care to optimize organ function, prevent secondary injury, and maximize the child’s potential for recovery. Common post-resuscitation conditions include acute lung injury, myocardial dysfunction, hepatic and renal insuffi-ciency, and hypoxic-ischemic encephalopathy. This constellation is described by the term “post-cardiac arrest syndrome” and resembles the systemic inflammatory response seen in sepsis or major trauma. Children may have single organ failure or multi-organ dysfunction, and the need for critical care therapies may delay accurate evaluation of neurologic status and limit prognostic ability. Pediatric post-resuscitation therapies are not typically evidencebased given the paucity of randomized trials and heterogeneous nature of the patient population. Goals of care include normalizing physiologic and metabolic status, preventing secondary organ injury, and diagnosing and treating the underlying cause of the arrest. Therapeutic hypothermia has been shown to mitigate the severity of brain injury for adults following sudden arrhythmia induced cardiac arrest and neonates following resuscitation from hypoxic-ischemic encephalopathy at birth, but the role of targeted temperature control in pediatric post-arrest care is an area of active investigation. There is no single diagnostic test or set of criteria to accurately predict neurologic outcome, providing a challenging situation for critical care specialists and families alike.