Diagnostic tests
A blood gas, lactate, electrolytes, glucose, complete blood count, magnesium, calcium, and core temperature, and a chest x-ray are usually appropriate.
Pathophysiology
Good quality manual pediatric CPR (hard, rapid, minimally interrupted, not over ventilated) usually provides approximately 1/3 of normal cardiac output. For this reason, ventilation does not have to be vigorous. Excessive ventilation pressurizes the chest, decreases venous return, increases intrathoracic pressure, and decreases coronary perfusion pressure.
Exhaled CO2 of >15 mm Hg usually indicates good pulmonary mexico email list blood flow with CPR and is translated into good systemic flow and coronary perfusion pressure of >25 mm Hg (associated with ROSC).
If diastolic blood pressure is low and cannot be improved to >30 mm Hg with CPR quality adjustment, a vasopressor (such as epinephrine) may help achieve these goal-directed parameters. On the negative side, overconstriction of peripheral or pulmonary microvessels can cause local ischemia and hypoperfusion of vital tissues and organs.
Higher cumulative doses of epinephrine have been associated with worse survival and neurological outcome, however, a causal relationship has not been definitively demonstrated.
Epidemiology
Generally, hypoxia and ischemia caused by respiratory failure or distress are the main cause of cardiac arrest in infants and children.
