Archives of disease in childhood
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The causes and outcome of cardiopulmonary arrests were studied in a paediatric hospital over a 12 month period. Forty five resuscitation attempts were made involving 41 children and one adult. Twenty eight (68%) of the children were under 1 year of age and 10 (24%) were neonates. ⋯ There were no survivors from resuscitation attempts longer than 30 minutes. At 12 months after cardiopulmonary resuscitation 15 (37%) of the children were still alive. The 11 children who had been neurologically normal before the arrest showed no evidence of neurological damage after successful cardiopulmonary resuscitation.
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The pulmonary gas exchange (rate of oxygen consumption, VO2 and rate of carbon dioxide production, VCO2), heart rate, and transcutaneously measured oxygen saturation were measured during the first five minutes after birth in healthy newborn infants. Fifteen full term infants who were vaginally delivered, 15 full term infants born by caesarean section, and 10 preterm infants born by caesarean section were studied. ⋯ During periods of calm breathing, VO2 and VCO2 were significantly higher in vaginally delivered infants than in those born by caesarean section, with low gas exchange levels in infants born by caesarean section during the second minute after birth. Decreased ventilation was reflected by a significant drop in oxygen saturation within 30-45 seconds.
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Extracorporeal membrane oxygenation (ECMO) is a life support technique based on modifications of heart-lung bypass technology. It is used to support severe but potentially reversible pulmonary or cardiopulmonary failure. ⋯ The number of non-neonatal paediatric patients receiving pulmonary support with ECMO worldwide is, however, small, and survival rates average less than 50%. Initial experience in 15 patients aged 3 months to 5 years with a high survival and low morbidity is reported.
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Futile cardiopulmonary resuscitation (CPR) may prevent humane care of the dying child and deprive parents of the opportunity to express their love, grief, and dedication at a critical moment, while appropriate and successful CPR may restore intact their child. Attempted resuscitation of corpses or children with terminal illness indicates inadequate knowledge, discrimination, and decision making. ⋯ Time limits on occasions may curtail the full process of consultation and decision making. Applications of skills and resources in the right time and place requires understanding of the medical logistics and study of the potential for good outcome.