Pediatric Out-of-Hospital Cardiac Arrest

Case Presentation 1: A 9-year-old boy suddenly collapsed during a basketball game. Emergency medical services was called, but bystander cardiopulmonary resuscitation (CPR) was not provided. Emergency medical services personnel arrived 14 minutes later. After 30 minutes of CPR, successful defibrillation, and several doses of epinephrine, he had return of spontaneous circulation. On arrival in the pediatric intensive care unit, left ventricular ejection fraction was 30% by echocardiography and improved to 50% after hemodynamic support with a dobutamine infusion. To minimize further neurological injury, his temperature was maintained at 36°C to 37°C with a cooling blanket and an explicit normothermia protocol.1 An electroencephalogram (EEG) 2 hours after admission showed a burst-suppression pattern consistent with severe neurological injury,2 and continuous EEG monitoring revealed nonconvulsive status epilepticus on the following day.Case Presentation 2: A 2-year-old boy was found at the bottom of a swimming pool by his mother. Because he was blue and lifeless when removed from the pool, his mother started chest compressions and mouth-to-mouth rescue breathing. His sister called 9-1-1, and emergency medical services arrived within 6 minutes. They continued CPR another 1 to 2 minutes until they saw the boy cough and move his arms and feet. When he arrived in the emergency department, he was breathing spontaneously and had return of spontaneous circulation with good pulses and poor perfusion. His initial arterial pH was 6.95 with a pco 2 of 35 mm Hg and lactate of 5.4 mmol/dL. Supportive care was provided, including mechanical ventilation and a dobutamine infusion for postarrest myocardial dysfunction, and neurological status was monitored closely.More than 5000 children experience a nontraumatic pediatric out-of-hospital cardiac arrest (OHCA) each year in the United States.3 Critical factors that influence survival include the environment in which the arrest occurs, the child's preexisting condition, …