This blog entry is based on content from a podcast interview with Mary McBride, MD, FAAP, MEd, Associate Professor of Pediatrics at Northwestern University Feinberg School of Medicine and pediatric cardiac intensivist at Lurie Children’s Hospital in Chicago, and Alexis Topjian, MD, MSCE, Pediatric Critical Care Medicine Physician at Children’s Hospital of Philadelphia. Listen to the full podcast titled Care Considerations for the Pediatric Post-Cardiac Arrest Patient.
Dr. McBride: What is post cardiac arrest syndrome?
Dr. Topjian: I think we really focus oftentimes on our immediate resuscitation. We get a pulse back in our patients and we’re so happy to have a pulse back, but at that time we’re really entering a new phase of our resuscitation, and that’s the post cardiac arrest syndrome. The post cardiac arrest syndrome begins from the earliest moments after resuscitation, and it’s traditionally thought of as four key components.
The first is brain injury, which we know occurs during the time of hypoxia and ischemia. There’s a component of myocardial dysfunction, also due to hypoxia ischemia. Then there’s a systemic ischemic reprofusion response.
Then finally the component of what preexisting pathophysiology, so whatever led to your cardiac arrest in the first place.
This is sort of a complex interplay of factors that we will talk about a little bit more that tend to ebb and flow over time from the earliest moments after resuscitation, and can really go on for days and can have long lasting effects on the patient that can impact outcome.
Dr. McBride: How might this differ from pediatrics to adults?
Dr. Topjian: I think kids are inherently different than adults in several ways. Obviously in size and development, but really the cause of arrest is different between adults and children. Children don’t have much coronary artery disease. They typically will have arrests that are more commonly associated with asphyxia, so from respiratory illness.
And especially in the out-of-hospital population, we will see more prolonged downtimes for really young infants. Adults more commonly will have a ventricular fibrillation or ventricular tachycardia arrest, and so it will be shockable. Really, children are much less likely to have a shockable initial rhythm.
We also have a special circumstances in our children’s, so congenital heart disease is common, and so we will see that complex interplay of factors as well. I think as we look at children, we really see their causes of arrest are different, which impacts their resuscitation, and then impacts the time period after their resuscitation.