Current and future therapies of pediatric cardiopulmonary arrest.
Current and future therapies of pediatric cardiopulmonary arrest.
复制标题
小儿心肺骤停的当前和未来治疗。
DOI：
10.1007/s12098-008-0117-3
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发表时间：
2008
影响因子：
4.3
通讯作者：
Kochanek,PatrickM
中科院分区：
文献类型：
--
作者：
Manole,MioaraD;Hickey,RobertW;Clark,RobertSB;Kochanek,PatrickM
目的回顾当代指南和治疗小儿心脏骤停，并讨论潜在的新therapeutis.MethodsKey文章和指南在该领域进行了审查沿着最近的出版物在神经重症监护和神经科学领域密切相关的脑复苏。大多数的逮捕在儿童人口是窒息的起源，这与成人人口有很大的不同。讨论了CPR指南的国际共识，包括高质量的CPR，不间断的胸部按压，100%氧气复苏和随后的氧气滴定至正常氧饱和度，肾上腺素的正确剂量，以及在最初12-24小时内使用低温。新的治疗方法，在动物研究中取得成功，如高血压再灌注，溶栓，血液稀释和体外CPR也discussed.ConclusionWith只有30%的自主循环，12%的生存出院和4%的完整的神经系统生存，小儿心脏骤停仍然是一个领域的激烈研究的治疗，以改善其结果。除了快速实施基本和高级生命支持干预外，可能具有价值的新疗法包括轻度低温、体外支持、促进脑血流和其他针对氧化应激、兴奋性毒性、神经元死亡和康复的更新颖的疗法。
ObjectiveTo review contemporary guidelines and therapies for pediatric cardiac arrest and discuss potential novel therapies.MethodsKey articles and guidelines in the field were reviewed along with recent publications in the fields of neurointensive care and neuroscience germane to cerebral resuscitation.ResultsA total of 45 articles were reviewed. The majority of arrests in the pediatric population are asphyxial in origin-which differs importantly from the adult population. The International Consensus on CPR guidelines are discussed, including good quality CPR, chest compressions without interruptions, resuscitation with 100% oxygen and subsequent titration of oxygen to normal oxygen saturations, correct dose of epinephrine, and use of hypothermia in the first 12–24 hours. Novel therapies that showed success in animal studies, such as hypertensive reperfusion, thrombolytics, hemodilution and extracorporeal CPR are also discussed.ConclusionWith only 30% return of spontaneous circulation, 12% survival to hospital discharge and 4% intact neurologic survival, pediatric cardiac arrest remains an area of intense research for therapies to improve its outcomes. In addition to the rapid implementation of basic and advanced life support interventions, new therapies that may have value include mild hypothermia, extracorporeal support, promotion of cerebral blood flow and other more novel therapies targeting oxidative stress, excitotoxicity, neuronal death, and rehabilitation.