Cardiac Arrest in Children and Young Adults

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Thirty years ago, sudden cardiac arrest (SCA) in children and young people was called a rare event.1,2 Causes were thought to be primarily respiratory, and resuscitation efforts were directed at restoring ventilation or oxygenation. Most studies were limited by incomplete data collection, including in-hospital and out-of-hospital arrest, and small study size. Outcomes were so dismal that resuscitation was considered futile by some.3,4 In 1995, Mogayzel et al5 published a ground-breaking article on ventricular fibrillation in children ages 5 to 18 years of age. They documented that ventricular fibrillation occurred at some time during a resuscitation in 19% of cardiac arrests in children in the Seattle/King County area, and 17% were discharged with good neurological outcomes compared with 2% of those with asystole. This study coincided with the availability of automated external defibrillators in the community and led to a reconsideration of the need for early assessment of rhythm in pediatric cardiac arrest and development of automated external defibrillators with pediatric modifications. Over the last 20 years, there has been increasing documentation of cardiac arrest in children.6–9 A major shortcoming in most of these studies is inclusion of all nontraumatic causes of cardiac arrest when incidence is calculated. This has been a major deficiency in pediatric cardiac arrest literature, because most include noncardiac causes such as suffocation, drowning, and drug overdose.6,7,10 Inclusion of multiple causes in the incidence data rendered them difficult to interpret when attempting to establish the appropriateness of cardiopulmonary resuscitation (CPR) techniques, screening and prevention programs, treatment algorithms, and especially outcomes. Article see p 1363 In this issue of Circulation , Meyer et al11 have made a significant contribution to our understanding of cardiac arrest in children and young adults <35 years …