What is Cardiopulmonary Arrest in Children (Heart Attack)?
Contrary to adults, it’s very unusual for children to have a sudden stop in heart and lung function, known as cardiopulmonary arrest, primarily due to heart complications. Performing effective CPR as soon as possible can boost their chances of survival. The American Heart Association regularly provides updates on CPR and advanced life support techniques for children. You can learn about these techniques by enrolling in Pediatric Advanced Life Support or Advanced Pediatric Life Support courses.
Children who need immediate medical help can fall into several categories based on their heart activity. For instance, their heart might completely stop beating, fail to pump blood despite electrical activity, or have an abnormal heart rhythm without pumping blood.
No matter the reason, it’s important to start CPR and monitor the child’s heart as soon as possible to understand which CPR technique to use. If there’s only one healthcare provider, the ratio of compressions to breaths is 30:2. If there are two healthcare providers, the ratio is 15:2. After that, children with a stopped heart or a heart failing to pump blood need the drug epinephrine every three to five minutes as needed. It can be given in one of three ways: through a vein, into the bone, or into the windpipe.
Pediatric Advanced Life Support courses teach about common causes of significant medical events in children known as the Hs and Ts. ‘Hs’ are Hypoxia (lower oxygen in the body), Hypovolemia (loss of blood volume), Acid build-up (referred to as Hydrogen ion), Hypo/Hyperkalemia (abnormal potassium levels), Hypothermia (extreme cold), and Hypoglycemia (low blood sugar). Out of these, lack of oxygen and low blood volume are the usual causes in children. ‘Ts’ include Toxins (poisonous substances), Tamponade (heart fluid build-up), Tension pneumothorax (a major lung problem), Blood clots (known as Thromboembolic event), and Trauma. When a child’s heart fails to pump blood despite electrical activity, it’s often due to these issues.
For abnormal heart rhythms, it’s crucial to start CPR as soon as possible and recognize the kind of rhythm quickly. Quick access to a machine that can jolt the heart back to a normal rhythm (known as a defibrillator) can improve their chance of survival. For children, the energy used to shock the heart should be 2 Joules per kilogram of their body weight. For recent models of these machines that use two electric current directions, the practice of giving three shock treatments in succession is no longer recommended.
What Causes Cardiopulmonary Arrest in Children (Heart Attack)?
There are many reasons why a child might experience cardiac arrest, or a sudden stopping of the heart. These can be grouped into several categories, like issues with breathing, heart problems, infections, and injuries.
The most common reasons are related to breathing. These could be things like infections in the lungs (like pneumonia, asthma), or problems from inhaling smoke or water from nearly drowning.
Infections that can trigger cardiac arrest include blood infections (sepsis) and infections in the brain and spinal cord (meningitis). Heart-related causes can involve birth defects in the heart, heart rhythm problems (arrhythmias), or diseases that make the heart muscle weak (cardiomyopathies).
Injuries that could lead to cardiac arrest include severe injuries to the head or chest, choking on or swallowing something harmful, nearly drowning, or severe physical abuse. Other factors might include Sudden Infant Death Syndrome (SIDS), where a baby under the age of 1 suddenly dies without a clear reason, or Sudden Unexpected Infant Death Syndrome (SUID), which is when a child under the age of 1 dies suddenly and unexpectedly.
According to the Centers for Disease Control and Prevention (CDC), in 2015 there were approximately 3700 sudden unexpected deaths in the United States. Many instances of sudden death in young athletes were due to heart diseases.
Risk Factors and Frequency for Cardiopulmonary Arrest in Children (Heart Attack)
According to information from the American Heart Association, around 3628 cases of cardiac arrests occurring outside of hospitals were reported in individuals under 18. The survival rate for those treated by emergency medical services for non-traumatic cardiac arrest is 5.4%. Every year, nearly 6000 kids in American hospitals are given CPR.
In incidents of cardiovascular-related deaths in young athletes (those under 18), 29% were black, 54% were high school students, and 82% were exerting themselves physically during a competition or training.
Unattended heart stops (cardiopulmonary arrests) in infants and children generally have poor outcomes, with only 8.4% surviving till their hospital discharge. A majority of these surviving kids, unfortunately, have neurological impairments. However, the survival rate gets better (24%) if the cardiac arrest occurs in a hospital, and neurologically, the outcomes are better. The most successful outcomes are usually in children who get high-quality CPR immediately, especially if the cardiac arrest occurs suddenly and is witnessed, and if the child’s heartbeat rhythm abnormality can be rectified with early defibrillation.
- Approximately 3628 cardiac arrests occurred outside of a hospital setting in individuals under 18, according to data from the American Heart Association.
- The survival rate post non-traumatic cardiac arrest is 5.4% for youths treated by EMS.
- Each year in the U.S, Nearly 6000 kids in hospitals are given CPR.
- Of the cardiovascular-related deaths in athletes under 18, 29% were black, 54% were high school students, and 82% were physically active during a competition or training.
- The survival rate following unattended cardiopulmonary arrests in kids is low, with only 8.4% surviving till hospital discharge, and most survivors have neurological damage.
- The in-hospital survival rate for such cases is 24% and carries better neurological outcomes.
- Immediate, high-quality CPR and early defibrillation in witnessed sudden arrests often lead to the best results.
Signs and Symptoms of Cardiopulmonary Arrest in Children (Heart Attack)
In situations where a patient’s condition is rapidly worsening, there may only be time to quickly scan their medical history. The most important details to note are any irregularities that could be causing their health to deteriorate.
The immediate physical examination will focus on checking the patient’s airway, breathing, and circulation, as these are crucial for survival.
Testing for Cardiopulmonary Arrest in Children (Heart Attack)
When someone has a health emergency like cardiac arrest, the chances of recovery are often not so good. Because of this, doctors put a lot of emphasis on identifying warning signs that a problem might be about to happen. Like predicting a storm, spotting the signs of potential breathing failure or any type of shock early is really crucial.
To assist in this early recognition, hospitals have teams called ‘rapid response teams’ that can quickly react to any emergencies. There are also ‘early warning systems’ that are part of the electronic health record systems used in hospitals. These systems help identify any significant changes in a patient’s health, ensuring they get the necessary help as soon as possible.
Treatment Options for Cardiopulmonary Arrest in Children (Heart Attack)
In preparation for a pediatric emergency, various steps need to be taken before the child patient arrives. These involve getting ready a team experienced in handling emergencies, a well-equipped room for resuscitation, necessary equipment suitable for children, and personnel trained in handling children’s emergency cases.
Roles on the emergency team should be assigned beforehand and might include:
- The team leader who guides the team throughout the process.
- Someone to handle the airway management.
- An individual in charge of chest compressions, a crucial part of cardiopulmonary resuscitation (CPR).
- A person assigned to ensure vascular access, which means they’re responsible for establishing IV or IO lines (these are ways to give medication, fluids or to draw blood).
- A staff member assigned to give drugs required during the resuscitation procedure.
- Someone to gather the needed history from family and pre-hospital personnel.
- A family liaison—this role involves communicating with the family throughout the resuscitation process and keeping them informed.
- A recorder and timekeeper to keep track of the sequence and timing of events.
- A security officer, for crowd control if available.
Depending on the number of staff available, a single person might need to handle more than one role.
To help with medication doses and equipment sizes customized for children, the ‘Broselow system’ is commonly used. This includes a color-coded system where the color correlates with the child’s weight or height to help determine medication doses and equipment sizes efficiently and accurately.
What else can Cardiopulmonary Arrest in Children (Heart Attack) be?
These are some of the conditions that can affect the heart:
- Angina pectoris (pain in the chest due to restricted blood supply to the heart)
- Aortic stenosis (narrowing of the heart’s aortic valve)
- Coronary artery atherosclerosis (hardening of the arteries supplying the heart)
- Dilated cardiomyopathy (disease of the heart muscle resulting in an enlarged heart)
- Ebstein anomaly (a rare heart defect present at birth)
- Hypertrophic cardiomyopathy (a condition where the heart muscle becomes abnormally thick)
- Myocardial infarction (otherwise known as a heart attack)
- Tetralogy of Fallot (a combination of four heart defects present at birth)
- Torsade de Pointes (a specific type of abnormal heart rhythm)
- Ventricular fibrillation (an emergency condition where the heart shakes instead of properly beating)
