Although more than 80 years of research in cardiac
resuscitation produced many important findings and greatly enhanced our understanding of the arrest state, outcome following pediatric
cardiac arrest remains poor.
Resuscitation guidelines have recently been published, but they may not reflect optimal
therapy. Closed-chest compression-induced cardiac output may be higher in pediatric patients, particularly infants, than that previously reported in adults. To achieve higher cardiac outputs, direct cardiac compression is important; the recommended compression location has therefore been changed based on recent data. The optimal rate of compression, however, is uncertain, so further research is needed. Alternative vascular access sites, such as the endotracheal and intraosseous route for
drug administration may permit more rapid
drug delivery, but data suggest that a larger
epinephrine dose than currently recommended should be used. It may also be helpful to dilute the
drug in
normal saline before endotracheal administration. Although experimental data suggest that a pure
alpha-adrenergic agonist may be beneficial in a
cardiac arrest, recent data show that
epinephrine remains the
drug of choice. Finally, the role of
sodium bicarbonate in both the arrest and postarrest setting has become controversial. Recent data suggest that
bicarbonate may be detrimental and that
therapy of
acidosis is best directed at improving perfusion, oxygenation, and ventilation. Alternative forms of
therapy for
acidosis, such as THAM and dichloroacetate may prove beneficial in the postarrest setting.