Cardiac arrest and post resuscitation of the brain
Cardiac arrest and post resuscitation of the brain
Primary out-of-hospital cardiac arrest in childhood is rare but survival is a little better for children than for adults, although the prognosis for infants is very poor. Hypoxic-ischaemic encephalopathy after in-hospital cardiac arrest in children undergoing complicated treatment for previously untreatable conditions is now a common problem and is probably increasing. An additional ischaemic insult worsens the prognosis for other encephalopathies, such as that occurring after accidental or non-accidental head injury. For near-drowning, the prognosis is often good, provided that cardiopulmonary resuscitation (CPR) is commenced immediately, and the child gasps within 40 minutes of rescue and regains consciousness soon afterwards. The prognosis is much worse for the nearly drowned child admitted to casualty or the emergency room deeply unconscious with fixed dilated pupils, requiring continuing CPR and with an arterial pH <7, especially if there is little recovery by the time of admission to the intensive care unit. The use of adrenaline, sodium bicarbonate and calcium appears to worsen prognosis. Neurophysiology, specifically serial electroencephalography and evoked potentials, is the most useful tool prognostically, although neuroimaging and biomarkers may play a role. In a series of 89 patients studied after cardiac arrest in three London centres between 1982 and 1985, 39% recovered consciousness within one month. Twenty seven percent died a cardiac death whilst in coma, and the outcome in the remainder was either brain death or vegetative state. EEG and initial pH were the best predictors of outcome in this study. Seizures affected one third and were associated with deterioration and worse outcome. The advent of extracorporeal membrane oxygenation (ECMO) and the positive results of hypothermia trials in neonates and adults have rekindled interest in timely management of this important group of patients.
Electroencephalography, Evoked potentials, Extracorporeal membrane oxygenation, Hypothermia, Hypoxic-ischaemic encephalopathy, In-hospital cardiac arrest, Near drowning, Out-of-hospital cardiac arrest, Prognosis
379-389
Kirkham, Fenella
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
September 2011
Kirkham, Fenella
1dfbc0d5-aebe-4439-9fb2-dac6503bcd58
Kirkham, Fenella
(2011)
Cardiac arrest and post resuscitation of the brain.
European Journal of Paediatric Neurology, 15 (5), .
(doi:10.1016/j.ejpn.2011.04.009).
Abstract
Primary out-of-hospital cardiac arrest in childhood is rare but survival is a little better for children than for adults, although the prognosis for infants is very poor. Hypoxic-ischaemic encephalopathy after in-hospital cardiac arrest in children undergoing complicated treatment for previously untreatable conditions is now a common problem and is probably increasing. An additional ischaemic insult worsens the prognosis for other encephalopathies, such as that occurring after accidental or non-accidental head injury. For near-drowning, the prognosis is often good, provided that cardiopulmonary resuscitation (CPR) is commenced immediately, and the child gasps within 40 minutes of rescue and regains consciousness soon afterwards. The prognosis is much worse for the nearly drowned child admitted to casualty or the emergency room deeply unconscious with fixed dilated pupils, requiring continuing CPR and with an arterial pH <7, especially if there is little recovery by the time of admission to the intensive care unit. The use of adrenaline, sodium bicarbonate and calcium appears to worsen prognosis. Neurophysiology, specifically serial electroencephalography and evoked potentials, is the most useful tool prognostically, although neuroimaging and biomarkers may play a role. In a series of 89 patients studied after cardiac arrest in three London centres between 1982 and 1985, 39% recovered consciousness within one month. Twenty seven percent died a cardiac death whilst in coma, and the outcome in the remainder was either brain death or vegetative state. EEG and initial pH were the best predictors of outcome in this study. Seizures affected one third and were associated with deterioration and worse outcome. The advent of extracorporeal membrane oxygenation (ECMO) and the positive results of hypothermia trials in neonates and adults have rekindled interest in timely management of this important group of patients.
This record has no associated files available for download.
More information
Accepted/In Press date: 17 April 2011
e-pub ahead of print date: 2 June 2011
Published date: September 2011
Keywords:
Electroencephalography, Evoked potentials, Extracorporeal membrane oxygenation, Hypothermia, Hypoxic-ischaemic encephalopathy, In-hospital cardiac arrest, Near drowning, Out-of-hospital cardiac arrest, Prognosis
Identifiers
Local EPrints ID: 429224
URI: http://eprints.soton.ac.uk/id/eprint/429224
ISSN: 1090-3798
PURE UUID: 9a9aade0-9c7c-42e0-ba12-1673af31feeb
Catalogue record
Date deposited: 22 Mar 2019 17:30
Last modified: 18 Mar 2024 02:54
Export record
Altmetrics
Download statistics
Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.
View more statistics
