Department of Cardiology, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
Cardiac Intensive Care Unit, Heart and Lung Directorate, Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK.
Eur J Pediatr. 2023 Oct;182(10):4289-4308. doi: 10.1007/s00431-023-05055-4. Epub 2023 Jun 19.
Children with cardiac disease are at a higher risk of cardiac arrest as compared to healthy children. Delivering adequate cardiopulmonary resuscitation (CPR) can be challenging due to anatomic characteristics, risk profiles, and physiologies. We aimed to review the physiological aspects of resuscitation in different cardiac physiologies, summarize the current recommendations, provide un update of current literature, and highlight knowledge gaps to guide research efforts. We specifically reviewed current knowledge on resuscitation strategies for high-risk categories of patients including patients with single-ventricle physiology, right-sided lesions, right ventricle restrictive physiology, left-sided lesions, myocarditis, cardiomyopathy, pulmonary arterial hypertension, and arrhythmias. Cardiac arrest occurs in about 1% of hospitalized children with cardiac disease, and in 5% of those admitted to an intensive care unit. Mortality after cardiac arrest in this population remains high, ranging from 30 to 65%. The neurologic outcome varies widely among studies, with a favorable neurologic outcome at discharge observed in 64%-95% of the survivors. Risk factors for cardiac arrest and associated mortality include younger age, lower weight, prematurity, genetic syndrome, single-ventricle physiology, arrhythmias, pulmonary arterial hypertension, comorbidities, mechanical ventilation preceding cardiac arrest, surgical complexity, higher vasoactive-inotropic score, and factors related to resources and institutional characteristics. Recent data suggest that Extracorporeal membrane oxygenation CPR (ECPR) may be a valid strategy in centers with expertise. Overall, knowledge on resuscitation strategies based on physiology remains limited, with a crucial need for further research in this field. Collaborative and interprofessional studies are highly needed to improve care and outcomes for this high-risk population. What is Known: • Children with cardiac disease are at high risk of cardiac arrest, and cardiopulmonary resuscitation may be challenging due to unique characteristics and different physiologies. • Mortality after cardiac arrest remains high and neurologic outcomes suboptimal. What is New: • We reviewed the unique resuscitation challenges, current knowledge, and recommendations for different cardiac physiologies. • We highlighted knowledge gaps to guide research efforts aimed to improve care and outcomes in this high-risk population.
患有心脏病的儿童比健康儿童更有可能发生心脏骤停。由于解剖学特征、风险状况和生理学原因，提供充分的心肺复苏（CPR）可能具有挑战性。我们旨在回顾不同心脏生理条件下复苏的生理学方面，总结当前建议，提供当前文献的最新更新，并强调知识空白，以指导研究工作。我们特别审查了高风险类别患者的复苏策略的当前知识，包括单心室生理、右侧病变、右心室限制性生理、左侧病变、心肌炎、心肌病、肺动脉高压和心律失常患者。心脏骤停在患有心脏病的住院儿童中约占 1%，在入住重症监护病房的儿童中占 5%。该人群中心脏骤停后的死亡率仍然很高，范围从 30%到 65%不等。在研究中，神经结局差异很大，出院时观察到 64%-95%的幸存者有良好的神经结局。心脏骤停和相关死亡率的危险因素包括年龄较小、体重较低、早产、遗传综合征、单心室生理、心律失常、肺动脉高压、合并症、心脏骤停前机械通气、手术复杂性、较高的血管活性-正性肌力评分以及与资源和机构特征相关的因素。最近的数据表明，体外膜氧合心肺复苏（ECPR）可能是具有专业知识的中心的有效策略。总体而言，基于生理学的复苏策略知识仍然有限，该领域急需进一步研究。高度需要协作和跨专业研究，以改善这一高危人群的护理和结局。已知： • 患有心脏病的儿童发生心脏骤停的风险很高，由于独特的特征和不同的生理学，心肺复苏可能具有挑战性。 • 心脏骤停后的死亡率仍然很高，神经结局不理想。新内容： • 我们回顾了不同心脏生理条件下独特的复苏挑战、当前知识和建议。 • 我们强调了知识空白，以指导旨在改善这一高危人群护理和结局的研究工作。
