Sahu Sandeep, Kishore Kamal, Lata Indu
Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, UP, India.
J Emerg Trauma Shock. 2010 Jul;3(3):243-50. doi: 10.4103/0974-2700.66524.
Pediatric cardiac arrest is not a single problem. Although most episodes of pediatric cardiac arrest occur as complications and progression of respiratory failure and shock. Sudden cardiac arrest may result from abrupt and unexpected arrhythmias. With a better-tailored therapy, we can optimize the outcome. In the hospital, cardiac arrest often develops as a progression of respiratory failure and shock. Typically half or more of pediatric victims of in-hospital arrest have pre-existing respiratory failure and one-third or more have shock, although these figures vary somewhat among reporting hospitals. When in-hospital respiratory arrest or failure is treated before the development of cardiac arrest, survival ranges from 60% to 97%. Bradyarrthmia, asystole or pulseless electric activity (PEA) were recorded as an initial rhythm in half or more of the recent reports of in-hospital cardiac arrest, with survival to hospital discharge ranging from 22% to 40%. Data allowing characterization of out of hospital pediatric arrest are limited, although existing data support the long-held belief that as with hospitalized children, cardiac arrest most often occurs as a progression of respiratory failure or shock to cardiac arrest with bradyasystole rhythm. Although VF (Ventricular fibrillation, is a very rapid, uncoordinated, ineffective series of contractions throughout the lower chambers of the heart. Unless stopped, these chaotic impulses are fatal) and VT (Ventricular tachycardia is a rapid heartbeat that originates in one of the ventricles of the heart. To be classified as tachycardia, the heart rate is usually at least 100 beats per minute) are not common out-of-cardiac arrest in children, they are more likely to be present with sudden, witnessed collapse, particularly among adolescents. Pre-hospital care till the late 1980s was mainly concerned with adult care, and the initial focus for pediatric resuscitation was provision of oxygen and ventilation, with initial rhythm at the time of emergency medical services arrival being infrequently recorded. In the 1987 series, pre-hospital pediatric cardiac arrest demonstrated asystole in 80%, PEA in 10.5% and VF or VT in 9.6%. Only 29% arrests were witnessed, however, and death in many victims was caused by sudden infant death syndrome.
小儿心脏骤停并非单一问题。尽管大多数小儿心脏骤停事件是作为呼吸衰竭和休克的并发症及进展而发生的。心脏骤停也可能由突发且意外的心律失常导致。通过更具针对性的治疗，我们可以优化治疗结果。在医院里，心脏骤停常作为呼吸衰竭和休克的进展而发生。典型的情况是，医院内心脏骤停的小儿患者中，半数或更多存在预先存在的呼吸衰竭，三分之一或更多存在休克，不过这些数字在各报告医院之间略有差异。当在心脏骤停发生前对医院内的呼吸骤停或呼吸衰竭进行治疗时，生存率在60%至97%之间。在近期关于医院内心脏骤停的报告中，半数或更多记录到初始心律为缓慢性心律失常、心脏停搏或无脉电活动（PEA），出院生存率在22%至40%之间。尽管现有数据支持长期以来的观点，即与住院儿童一样，心脏骤停最常作为呼吸衰竭或休克进展为心脏骤停伴缓慢性心脏停搏心律，但有关院外小儿心脏骤停特征的数据有限。尽管室颤（VF，是心脏下腔室中一系列非常快速、不协调且无效的收缩。除非停止，这些混乱的冲动是致命的）和室性心动过速（VT，是起源于心脏一个心室的快速心跳。要被归类为心动过速，心率通常至少为每分钟100次）在小儿院外心脏骤停中并不常见，但它们更可能出现在突然发生且有目击者的虚脱情况中，尤其是在青少年中。直到20世纪80年代末，院前护理主要关注成人护理，小儿复苏的最初重点是提供氧气和通气，很少记录紧急医疗服务到达时的初始心律。在1987年的系列研究中，院前小儿心脏骤停显示心脏停搏占80%，无脉电活动占10.5%，室颤或室性心动过速占9.6%。然而，只有29%的心脏骤停有目击者，许多受害者的死亡是由婴儿猝死综合征导致的。
