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Copyright (c) 2025 Mohammad Saad Saud Alrasheedi Alrasheedi, Abdulkarim Marzooq Awad Alhejaili, Abdullah Break Salim Alhazmi, Alaa Abdullah Mohammed Msmali, Saad Duhime Aldawsari, Seham Ibrahim Abdullah Alhuwaymil, Hana Saeed Faqih, Walaa Homad Mohammed Hakami
This work is licensed under a Creative Commons Attribution 4.0 International License.
Hospital-Based Management of High-Risk Patients with Cardiopulmonary Arrest in Children-An Updated Review for Nursing, Respiratory therapy, Health administration, Services management, and Medical secretarial services
Corresponding Author(s) : Mohammad Saad Saud Alrasheedi Alrasheedi
Saudi Journal of Medicine and Public Health,
Vol. 2 No. 2 (2025)
Abstract
Background: Pediatric cardiopulmonary arrest remains a major cause of morbidity and mortality, with over 20,000 cases annually in the United States. Respiratory failure, hypovolemia, sepsis, trauma, and congenital cardiac abnormalities are the leading etiologies in children. Early recognition, high quality CPR, and adherence to Pediatric Advanced Life Support (PALS) guidelines significantly improve outcomes.
Aim: This review aims to summarize updated hospital based management strategies for high risk pediatric patients experiencing cardiopulmonary arrest, highlighting etiology, pathophysiology, evaluation, and evidence based treatment.
Methods: A comprehensive narrative review approach was applied, integrating current AHA and PALS guidelines, epidemiologic data, and clinical management frameworks. Key topics include arrest physiology, rhythm classification, reversible causes, and advanced resuscitation techniques.
Results: Respiratory etiologies account for approximately 75% of pediatric arrests. Survival varies widely by location: in hospital survival approaches 24–40% compared with 5–8% for out of hospital events. Early CPR, rapid defibrillation for shockable rhythms, and correction of reversible causes significantly improve return of spontaneous circulation (ROSC). Defibrillation with biphasic shocks and timely epinephrine remain central to management. Post resuscitation care—including ventilation optimization, hemodynamic stabilization, and neuroprotection—is essential for improving neurological outcomes.
Conclusion: Pediatric cardiopulmonary arrest demands immediate recognition, high quality CPR, and structured evaluation using the ABCDE approach. Survival strongly depends on early interventions, rapid rhythm identification, and targeted management of reversible causes. Strengthening team coordination, improving caregiver and public CPR education, and enhancing hospital preparedness are vital for improving outcomes.
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- Hoyme DB, Patel SS, Samson RA, Raymond TT, Nadkarni VM, Gaies MG, Atkins DL., American Heart Association Get With the Guidelines–Resuscitation Investigators. Epinephrine dosing interval and survival outcomes during pediatric in-hospital cardiac arrest. Resuscitation. 2017 Aug;117:18-23.
- Reynolds JC, Grunau BE, Rittenberger JC, Sawyer KN, Kurz MC, Callaway CW. Association Between Duration of Resuscitation and Favorable Outcome After Out-of-Hospital Cardiac Arrest: Implications for Prolonging or Terminating Resuscitation. Circulation. 2016 Dec 20;134(25):2084-2094.
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- Andersen LW, Holmberg MJ, Granfeldt A, James LP, Caulley L. Cost-effectiveness of public automated external defibrillators. Resuscitation. 2019 May;138:250-258.
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- Huang CH, Tsai MS, Ong HN, Chen W, Wang CH, Chang WT, Wang TD, Chen SC, Ma MH, Chen WJ. Association of hemodynamic variables with in-hospital mortality and favorable neurological outcomes in post-cardiac arrest care with targeted temperature management. Resuscitation. 2017 Nov;120:146-152.
- Ujevich MM, Pozun A. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Mar 8, 2023. Pediatric and Neonatal Resuscitation.
- Morgan RW, Kirschen MP, Kilbaugh TJ, Sutton RM, Topjian AA. Pediatric In-Hospital Cardiac Arrest and Cardiopulmonary Resuscitation in the United States: A Review. JAMA Pediatr. 2021 Mar 01;175(3):293-302.
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References
Hoyme DB, Patel SS, Samson RA, Raymond TT, Nadkarni VM, Gaies MG, Atkins DL., American Heart Association Get With the Guidelines–Resuscitation Investigators. Epinephrine dosing interval and survival outcomes during pediatric in-hospital cardiac arrest. Resuscitation. 2017 Aug;117:18-23.
Reynolds JC, Grunau BE, Rittenberger JC, Sawyer KN, Kurz MC, Callaway CW. Association Between Duration of Resuscitation and Favorable Outcome After Out-of-Hospital Cardiac Arrest: Implications for Prolonging or Terminating Resuscitation. Circulation. 2016 Dec 20;134(25):2084-2094.
Duff JP, Topjian A, Berg MD, Chan M, Haskell SE, Joyner BL, Lasa JJ, Ley SJ, Raymond TT, Sutton RM, Hazinski MF, Atkins DL. 2018 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2018 Dec 04;138(23):e731-e739.
Dhillon GS, Lasa JJ, Aggarwal V, Checchia PA, Bavare AC. Cardiac Arrest in the Pediatric Cardiac ICU: Is Medical Congenital Heart Disease a Predictor of Survival? Pediatr Crit Care Med. 2019 Mar;20(3):233-242.
Hunt EA, Duval-Arnould JM, Bembea MM, Raymond T, Calhoun A, Atkins DL, Berg RA, Nadkarni VM, Donnino M, Andersen LW., American Heart Association’s Get With The Guidelines–Resuscitation Investigators. Association Between Time to Defibrillation and Survival in Pediatric In-Hospital Cardiac Arrest With a First Documented Shockable Rhythm. JAMA Netw Open. 2018 Sep 07;1(5):e182643.
Andersen LW, Holmberg MJ, Granfeldt A, James LP, Caulley L. Cost-effectiveness of public automated external defibrillators. Resuscitation. 2019 May;138:250-258.
Nakashima T, Noguchi T, Tahara Y, Nishimura K, Ogata S, Yasuda S, Onozuka D, Morimura N, Nagao K, Gaieski DF, Asai Y, Yokota H, Nara S, Hase M, Atsumi T, Sakamoto T., SAVE-J Group. Patients With Refractory Out-of-Cardiac Arrest and Sustained Ventricular Fibrillation as Candidates for Extracorporeal Cardiopulmonary Resuscitation - Prospective Multi-Center Observational Study. Circ J. 2019 Apr 25;83(5):1011-1018.
Soar J, Donnino MW, Maconochie I, Aickin R, Atkins DL, Andersen LW, Berg KM, Bingham R, Böttiger BW, Callaway CW, Couper K, Couto TB, de Caen AR, Deakin CD, Drennan IR, Guerguerian AM, Lavonas EJ, Meaney PA, Nadkarni VM, Neumar RW, Ng KC, Nicholson TC, Nuthall GA, Ohshimo S, O'Neil BJ, Ong GY, Paiva EF, Parr MJ, Reis AG, Reynolds JC, Ristagno G, Sandroni C, Schexnayder SM, Scholefield BR, Shimizu N, Tijssen JA, Van de Voorde P, Wang TL, Welsford M, Hazinski MF, Nolan JP, Morley PT., ILCOR Collaborators. 2018 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations Summary. Circulation. 2018 Dec 04;138(23):e714-e730.
Sahota RJ, Sayad E. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jul 7, 2025. Tension Pneumothorax.
Baram A, Othman YN, Muhammed RG, Majeed ZS, Rashid DF, Falah F, Sherzad H, Mahmood ZK, Hama RG. Metachronous recurrent pediatric primary spontaneous pneumothorax: A case presentation and literature review. Int J Surg Case Rep. 2020;76:139-143.
Berg RA, Reeder RW, Meert KL, Yates AR, Berger JT, Newth CJ, Carcillo JA, McQuillen PS, Harrison RE, Moler FW, Pollack MM, Carpenter TC, Notterman DA, Holubkov R, Dean JM, Nadkarni VM, Sutton RM., Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) Pediatric Intensive Care Quality of Cardio-Pulmonary Resuscitation (PICqCPR) investigators. End-tidal carbon dioxide during pediatric in-hospital cardiopulmonary resuscitation. Resuscitation. 2018 Dec;133:173-179.
Desai DS, Hajouli S. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Jun 5, 2023. Arrhythmias.
Huang CH, Tsai MS, Ong HN, Chen W, Wang CH, Chang WT, Wang TD, Chen SC, Ma MH, Chen WJ. Association of hemodynamic variables with in-hospital mortality and favorable neurological outcomes in post-cardiac arrest care with targeted temperature management. Resuscitation. 2017 Nov;120:146-152.
Ujevich MM, Pozun A. StatPearls [Internet]. StatPearls Publishing; Treasure Island (FL): Mar 8, 2023. Pediatric and Neonatal Resuscitation.
Morgan RW, Kirschen MP, Kilbaugh TJ, Sutton RM, Topjian AA. Pediatric In-Hospital Cardiac Arrest and Cardiopulmonary Resuscitation in the United States: A Review. JAMA Pediatr. 2021 Mar 01;175(3):293-302.
Wang AY, Huang CH, Chang WT, Tsai MS, Wang CH, Chen WJ. Initial end-tidal CO2 partial pressure predicts outcomes of in-hospital cardiac arrest. Am J Emerg Med. 2016 Dec;34(12):2367-2371.
Lankster MA, Brasfield MS. Update on pediatric advanced life support guidelines. Crit Care Nurs Clin North Am. 2005 Mar;17(1):59-64, xi.
Rycroft RJ, Smith NP, Stok ET, Middleton K. Investigation of suspected contact sensitivity to tobacco in cigarette and cigar factory employees. Contact Dermatitis. 1981 Jan;7(1):32-8.