Purpose of Review
Cardiac arrest (CA) is a rare, but devastating complication in the pediatric cardiac ICU (CICU). Less than half of children that suffer CA in the CICU will survive, while survivors often suffer permanent neurologic injury. Despite monumental investment into improving the quality of CA resuscitation and post-arrest care, morbidity and mortality remain very high. Until recently, prevention of CA was deemed by many to not be feasible. Cohorts that are high risk for CA in the CICU will be discussed, and recent CA prevention efforts as a potential mechanism for improving outcomes in the CICU will be reviewed.
Recent Findings
Over the last couple of years, a few studies and quality improvement projects have emerged with exciting and provocative data suggesting that CA can be prevented in the pediatric ICU. Common themes of these studies include transparent identification of patients at high risk for CA and development of processes that foster shared situational awareness and communication among all bedside clinicians to recognize the pre-arrest phase and employ patient-specific deterioration mitigation plans, and/or rescue a patient from imminent arrest with a patient-specific dose of epinephrine available at the bedside.
Summary
Recent data suggests some CA in the CICU is preventable. CICU teams should be aware of the straightforward concepts of situational awareness for CA prevention and strongly consider adapting them for implementation in their CICUs. NO CPR is better than high-quality CPR.
