What are the common causes and management of cardiac arrest in a 2-year-old?

From the Guidelines

Cardiac arrest in a 2-year-old is most commonly caused by respiratory failure, which progresses to cardiac arrest if not promptly treated, with common causes including drowning, choking, severe asthma, pneumonia, sepsis, congenital heart defects, and trauma, as stated in the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. The management of cardiac arrest in a 2-year-old begins with immediate recognition and activation of emergency services.

• Start CPR with 30 chest compressions followed by 2 rescue breaths, compressing the chest at least 1/3 of its depth (about 2 inches) at a rate of 100-120 compressions per minute.
• Once emergency responders arrive, they will establish advanced airway management, provide oxygen, and attach a cardiac monitor to determine if the rhythm is shockable. Some key points to consider in the management of cardiac arrest in children include:
• The Pediatric Chain of Survival, which has been updated to include a sixth link emphasizing the importance of recovery and post-resuscitation care 1.
• The differences between out-of-hospital cardiac arrest (OHCA) and in-hospital cardiac arrest (IHCA), with OHCA often requiring immediate bystander CPR and activation of emergency services.
• The importance of identifying and treating reversible causes of cardiac arrest, including hypoxia, hypovolemia, hypothermia, electrolyte abnormalities, tension pneumothorax, cardiac tamponade, toxins, and thrombosis. The most recent and highest quality study, the 2020 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1, provides the best evidence for the management of cardiac arrest in children, and should be followed in clinical practice. Key aspects of post-resuscitation care include:
• Temperature management
• Ventilatory support
• Treatment of the underlying cause of cardiac arrest Early recognition of deterioration and prompt intervention are crucial for improving outcomes in pediatric cardiac arrest, as highlighted in the 2020 guidelines 1 and the Pediatric Chain of Survival 1.

From the Research

Common Causes of Cardiac Arrest in 2-Year-Olds

• Respiratory arrest is a common cause of cardiac arrest in pediatric patients, including 2-year-olds, as stated in 2
• Other potential causes of cardiac arrest in children include cardiac diseases, airway diseases, epilepsy, hemorrhage, and drug toxicity, as mentioned in 3

Management of Cardiac Arrest in 2-Year-Olds

• Aggressive treatment in the precardiac arrest state should be initiated to prevent deterioration and should focus on support of oxygenation, ventilation, and hemodynamics, regardless of the presumed cause, as stated in 2
• High-quality compressions remain the foundation of cardiopulmonary resuscitation (CPR), optimizing coronary and cerebral perfusion pressure, as mentioned in 4
• Interruptions in compressions are detrimental to management, and mechanical compression devices are not associated with improved outcomes but can assist in several situations, as stated in 4

Key Considerations

• Pediatric cardiac arrest is a relatively rare but devastating presentation in infants and children, with poor outcomes, as mentioned in 2
• Physicians should be alert to the possibility of abrupt cardiopulmonary collapse in patients with preexisting conditions, such as pneumonia, as stated in 5