Arrêt cardiaque chez l'enfant : définition, épidémiologie, prise en charge et pronostic

International guidelines have been edited for cardiac arrest resuscitation in children. The incidence is 10 to 15 fold lower than in adults. The leading cause of out-of-hospital cardiac arrest is respiratory, and shock-resistant cardiac rhythms are more frequent than in adults. Near half of the in-hospital cardiac arrests occur in the perioperative setting. Loss of consciousness and respiratory movements associated with no perception of heart beats. Head extension is performed to ensure airways patency and insuflation is associated to lower sternum 100-120/min compressions with thumbs or palms according to the size of the child. Ventilation in 100 % oxygen may worsen neurological prognosis. Cardiac shock is performed with a 4 J/kg current intensity. Intraosseous infusion is possible whenever intravenous infusion is not. Ten μg/kg boluses of epinephrine can be repeated every 3-5 minutes but sodium bicabonates are contraindicated. EtCO2 and SpO2 are monitored during resuscitation. There are no defined criteria to terminate resuscitation in case of failure. When cardiac activity recovers, the hemodynamic status may remain unstable for hours and ischaemic encepalopathy may develop. Induced-hypothermia has no demonstrated benefit in children. In-hospital cardiac arrests convey a higher incidence of recovery of cardiac activity. International guidelines support the presence of relative during resuscitation. Learning resuscitation in paediatrics needs to be developed through simulation.