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Abstract
The etiology of cardiac arrest in the pediatric patients has changed over the past 20 years as practice has evolved in the care of these patients. The cardiovascular and respiratory factors are the major causes of cardiopulmonary arrest in pediatric population during anesthesia.
The most common causes of cardiac arrest in pediatric anesthesia are cardiac diseases, hypovolemia, medication related, pharmacologic toxicity, airway obstruction, aspiration, difficult airway, inhalational agent overdose (halothane) and human errors.
CPR should be carried out as early as possible to maintain adequate circulation and oxygenation to the brain and various body organs so neurologic recovery depends not only on providing adequate oxygen delivery but also avoiding excessive oxygen requirement. CPR consists of provision of a patent upper airway, exhaled air ventilation and circulation of blood by closed chest compression.
Endotracheal intubation remains the gold standard approach to secure the airway of pediatric patients of cardiopulmonary arrest. Bradycardia is the most frequent rhythm preceding cardiac arrest in children, ventricular fibrillation(VF) and ventricular tachycardia(VT) are less common.
Atropine alone is frequently not sufficient to produce return of circulation so epinephrine continues to be the key of successful CPR for a systolic and pulseless cardiopulmonary arrest so do not waste time with repeated doses of atropine. Amiodarone may be considered in the treatment of refractory ventricular fibrillation (VF).
All pediatric patients during anesthesia should be monitored for: pulse rate and rhythm, oxygen saturation, end tidal CO2 , core temperature, blood pressure, urine output and some cases need arterial PH and gases.
Once spontaneous cardiac output has returned after pediatric cardiac arrest , frequent clinical reassessment must be carried out to detect deterioration or improvement with therapy.