The
resuscitation of children from
cardiac arrest and
shock remains a challenging goal. The pharmacologic principles underlying current recommendations for intervention in pediatric
cardiac arrest have been reviewed. Current research efforts, points of controversy, and accepted practices that may not be most efficacious have been described.
Epinephrine remains the most effective
resuscitation adjunct. High-dose
epinephrine is tolerated better in children than in adults, but its efficacy has not received full analysis. The preponderance of data continues to point toward the ineffectiveness and possible deleterious effects of overzealous
sodium bicarbonate use.
Calcium chloride is useful in the treatment of ionized
hypocalcemia but may harm cells that have experienced asphyxial damage.
Atropine is an effective agent for alleviating
bradycardia induced by increased vagal tone, but because most
bradycardia in children is caused by
hypoxia, improved oxygenation is the intervention of choice.
Adenosine is an effective and generally well-tolerated agent for the treatment of
supraventricular tachycardia.
Lidocaine is the
drug of choice for ventricular dysrhythmias, and
bretylium, still relatively unexplored, is in reserve. Many pediatricians use
dopamine for
shock in the postresuscitative period, but
epinephrine is superior. Most animal research on
cardiac arrest is based on models with
ventricular fibrillation that probably are not reflective of
cardiac arrest situations most often seen in pediatrics.