Sudden Cardiopulmonary Arrest in Children

Introduction:

Sudden cardiopulmonary arrests are heart emergencies in which the heart stops beating suddenly and unexpectedly. We must be aware that cardiac arrests can happen to anyone at any age. It is not something we expect to see in children, but it does happen to children in rare cases. Heart-related emergencies can lead to death if emergency care is not initiated immediately. Children of all ages are affected and succumb to sudden cardiac arrests in the United States (US). Awareness of the common symptoms of cardiac (heart-related) emergencies is necessary to seek immediate treatment. The chances of survival improve with prompt medical care.

What Is a Cardiac Arrest in Children?

Cardiac or cardiopulmonary arrest is a sudden and abrupt loss of heart function. Cardiac arrest differs from a heart attack, though heart attacks can cause cardiac arrests. Unlike adults, cardiac arrests are rare in children, and usually, there are underlying medical conditions such as respiratory failure or shock. The faulty electrical and mechanical activity of the child's heart muscles causes irregular heartbeats in cardiac arrests. If left untreated, the heart stops pumping blood efficiently. As a result, the blood flow to different body parts decreases. Major organs, including the brain, do not get sufficient oxygen. The lack of oxygen-rich blood flow causes the child to collapse. The child’s heart must be restarted quickly with immediate medical interventions to prevent further damage to the vital organs. It is a life-threatening condition and can cause permanent brain damage and death without emergency medical treatment.

What Are the Common Causes of Cardiac Arrests in Children?

Cardiopulmonary arrests are generally associated with the following:

Five H’s:

• Hypovolemia: Low liquid or fluid component of the blood is seen in cardiac arrest in children.

• Hypoxemia: Low oxygen level in the blood is a common cause of cardiac arrest in children.

• Hydrogen Ion (Acidosis): Increased acid levels in the body.

• Hypokalemia or Hyperkalemia: The potassium level in the blood is altered (low or high).

• Hypothermia: Reduced body temperature.

Five T’s:

• Tension Pneumothorax: Air is trapped in the space between the chest wall and the lungs compromising cardiopulmonary function.

• Tamponade: The heart cannot beat properly as the space around the heart is filled with blood or other fluid, putting pressure on the heart. As a result, the blood pressure drops significantly.

• Toxins: Blocked airway and respiratory arrest leading to death can occur due to reduced consciousness after using toxic substances such as alcohol and certain drugs such as Opiates and Benzodiazepines.

• Thrombosis: Blood clots can block the blood vessels of the lungs (pulmonary) and the heart, leading to cardiopulmonary arrest.

Cardiac arrests occur when the child’s heart muscles quiver rapidly and irregularly. Various underlying issues and pre-existing conditions cause cardiac arrests in children.

These can be divided into:

1. Respiratory Problems (Related to Breathing): The respiratory causes of cardiac arrests in children include smoke inhalation, asthma, breathing irregularities, and drowning.

2. Heart Diseases: Heart abnormalities present from birth, heart structure problems that occur during development, irregular heartbeats, and hereditary or acquired disease of the heart muscles can lead to cardiac arrests.

3. Severe Infections: Severe infections such as lung infections, infections in the blood (sepsis), and infections around the brain can cause cardiac arrests.

4. Trauma and Severe Injury: Sudden injury, blunt impacts, or trauma to the head and chest can affect the heart leading to cardiac arrests in children.

5. Other Causes: Cardiac arrest may occur in cot death or sudden infant death syndrome (SIDS) and sudden unexpected infant death syndrome (SUID).

What Are the Symptoms of Cardiac Arrest?

Often, there are no warnings before a sudden cardiac arrest. About 30 to 50 percent of children show warning signs. However, due to a lack of awareness, they are ignored by their parents or caregivers. The most common warning signs to look for include the following:

• Change in exercise tolerance and excessive fatigue during exercise.

• Chest discomfort or pain during exercise.

• Extreme dizziness or fainting during athletic activity.

• Racing heart and unexplained shortness of breath during exercise.

The caregivers must immediately take the child to see a doctor if a child has any potential warning signs of cardiac arrest. A child heart specialist (pediatric cardiologist) evaluation can help the parents or caregivers to assess the child’s condition and plan an emergency response in case of a cardiac arrest to save the child. If the child experiences any of the following symptoms, immediately call for help and initiate emergency care:

• Unconsciousness.

• Loss of pulse.

• Breathlessness or gasps for breath.

• Sudden collapse.

• No breathing.

• Chest discomfort.

• Increased heart rate.

• Irregular (fluttering) heartbeat.

What to Do if a Child Has a Sudden Cardiac Arrest?

If you suspect a child has cardiac arrest symptoms, immediately call the emergency medical services. In case of cardiac arrest, we must follow the following steps immediately till emergency service arrives to save the child:

1. Check for the child's response after ensuring scene safety.

2. Call for help immediately (emergency medical services).

3. Arrange for an automated external defibrillator (AED), an automated device used to deliver electric shocks (defibrillation) through the chest to the heart of a person with shockable rhythms and can be used by all with minimum training.

4. Check the patient's breathing. If the person is not breathing or gasping, begin cardiopulmonary resuscitation (CPR) with compression. The cardiopulmonary resuscitation procedure helps to pump blood and helps to restore the heartbeat. The aim is to keep the blood flowing to the brain until further help arrives.

5. Compress or push in the center of the child’s chest (100 to 120 pushes per minute, around four to five centimeters deep). After every push, we must allow the chest to return to its normal position.

6. Check the child’s airway and deliver rescue breaths every 30 compressions (if trained in cardiopulmonary resuscitation). Just continue chest compressions if not trained.

7. Use the automated external defibrillator for rhythm check and shock delivery and continue cardiopulmonary resuscitation until help arrives. Automated external defibrillators for adults can be used for children as young as one year, but special defibrillators for children are available for use and are preferred.

Emergency medical services provide advanced cardiac care and life support as soon as they arrive. They perform cardiopulmonary resuscitation protocols depending on the child’s age and condition. The equipment size, drug dose, and cardiopulmonary parameters vary with the child’s age and weight. Along with cardiopulmonary resuscitation and defibrillation (wherever required), the emergency personnel optimizes ventilation (oxygen supply). Bag-valve-masks are used, or tubes are inserted to deliver oxygen and assist in breathing. Vital signs are monitored, and intravenous access is obtained. Emergency drugs such as Epinephrine are given. Advanced life support provided by the emergency medical services and hospital post-cardiac arrest care helps the child survive.

Conclusion:

Heart emergencies such as sudden cardiopulmonary arrests are seen in children. Unlike adults, cardiac arrests are rare in children, and usually, there are underlying medical conditions such as respiratory failure or shock. In cardiac arrests, the heart stops beating and fails to provide oxygen-rich blood to all body parts and organs, including the brain. It is life-threatening and can cause permanent brain damage and death without emergency care. If a child shows symptoms of cardiac arrest and collapses, immediately call for emergency medical treatment and initiate cardiopulmonary resuscitation (if trained). The chances of survival improve with prompt medical care.