Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease: A Scientific Statement From the American Heart Association.

Cardiac arrest occurs at a higher rate in children with heart disease than in healthy children. Pediatric basic life support and advanced life support guidelines focus on delivering high-quality resuscitation in children with normal hearts. The complexity and variability in pediatric heart disease pose unique challenges during resuscitation. A writing group appointed by the American Heart Association reviewed the literature addressing resuscitation in children with heart disease. MEDLINE and Google Scholar databases were searched from 1966 to 2015, cross-referencing pediatric heart disease with pertinent resuscitation search terms. The American College of Cardiology/American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. The recommendations in this statement concur with the critical components of the 2015 American Heart Association pediatric basic life support and pediatric advanced life support guidelines and are meant to serve as a resuscitation supplement. This statement is meant for caregivers of children with heart disease in the prehospital and in-hospital settings. Understanding the anatomy and physiology of the high-risk pediatric cardiac population will promote early recognition and treatment of decompensation to prevent cardiac arrest, increase survival from cardiac arrest by providing high-quality resuscitations, and improve outcomes with postresuscitation care.

Resucitación utilizando desfibrilador externo automático en el Uruguay / Resuscitation with automated external defibrillator (AED) in Uruguay

Objetivo: comunicar las características de presentación y la sobrevida de un grupo de pacientes que sufrieron una muerte súbita (MS) y fueron asistidos con resucitación cardíaca básica (RCB) y desfibrilador externo automático (DEA) antes de la llegada de una emergencia médica móvil (EMM). Método: se realizó un estudio descriptivo-analítico de todos los paros cardíacos (PC) asistidos con DEA entre el 1° de enero de 2005 y el 1° de setiembre de 2013 en Uruguay. Se evaluaron las características de los pacientes, de los PC y la evolución posterior. Resultados: los DEA instalados en lugares públicos y con personal entrenado fueron utilizados en 37 eventos. En un caso de fibrilación ventricular (FV), el DEA no indicó descarga. En 23 pacientes (62,2%) se logró RCE y 14 (43%) sobrevivieron y retornaron a una vida activa. De los 27 PC en FV, 19 (70%) lograron retorno a la circulación espontánea (RCE) y 14 (52%) sobrevivió y se reintegró a sus tareas habituales. Los factores asociados a supervivencia al egreso hospitalario y reintegro a sus actividades fueron: la edad (57±9,9 en sobrevivientes versus 67±18,5 en fallecidos, p=0,041) y haber recibido RCB antes de 2 minutos versus > de 2 minutos (p=0,025). Conclusiones: los DEA instalados en lugares públicos y con personal entrenado fueron utilizados efectivamente en 36 eventos. Los resultados observados fueron similares a los reportados en series internacionales. La menor edad y la RCB antes de 2 minutos se asociaron a mejores resultados.

Purpose: to communicate the presentation features and survival of sudden death victims that were assisted with cardiopulmonary resuscitation (CPR) and automatic external defibrillator (AED) before the arrival of prehospital emergency medical system (PHEMS) in Uruguay. Method: case series study of all out of hospital cardiac arrest (OHCA) victims assisted with an AED from January 1, 2005 to September 1, 2013 in Uruguay. Patient’s features, cardiac arrest rhythm and evolution were evaluated. Results: 37 events in places with public access AED and trained people were reported. An AED decided ¨non shockable¨ in one ventricular fibrillation (VF) episode. Return of spontaneous circulation (ROSC) rate was 62,2% and 43% of the victims survived and returned to normal life. There were 27 VF cases. ROSC rate and survival for VF cases was 70% and 52% respectively. Every survivor of VF cases returned to normal life. Survival to Hospital discharge and return to normal life were associated with: VF (p=0,085), age (57 vs. 67 years, p=0,041) and bystander CPR before 2 minutes (p=0,025). Conclusion: public access AED were were effectively utilized in 36 cases. The results are similar to international reports and superior to those observed in the OHCA series assisted by PHEMS in our country. Lower age and bystander CPR before 2 minutes were associated with better outcomes.

A case of survival after cardiac arrest and 3½ hours of resuscitation.

Although survival rates after cardiac arrest remain low, new techniques are improving patients' outcomes. We present the case of a 40-year-old man who survived a cardiac arrest that lasted approximately 3½ hours. Resuscitation was performed with strict adherence to American Heart Association/American College of Cardiology Advanced Cardiac Life Support guidelines until bedside extracorporeal membrane oxygenation could be placed. A hypothermia protocol was initiated immediately afterwards. The patient had a full neurologic recovery and was bridged from dual ventricular assist devices to a total artificial heart. On hospital day 160, he underwent orthotopic heart and cadaveric kidney transplantation. On day 179, he was discharged from the hospital in ambulatory condition. To our knowledge, this is the only reported case in which a patient survived with good neurologic outcomes after a resuscitation that lasted as long as 3½ hours. Documented cases of resuscitation with good recovery after prolonged arrest give hope for improved overall outcomes in the future.