RECENT ADVANCES IN PEDIATRIC - CARDIOPULMONARY-RESUSCITATION AND ADVANCED LIFE-SUPPORT

The end point of uncorrected shock is cardiac arrest. Once cardiac arr est occurs, the outcome in children is typically poor, reflecting the fact that cardiac arrest does not occur until the child's physiologic reserves are exhausted, Despite more than 35 years of research in card iac arrest, the optimal management sand treatment remain uncertain. Th e optimal method of basic and advanced life support to restore cardiac function and preserve brain function is unclear, as is the appropriat e application of pharmacologic agents to restart the heart and subsequ ently to manage postarrest shock. New techniques in basic life support merit evaluation in children, particularly interposed abdominal compr ession and active compression-decompression cardiopulmonary resuscitat ion, Epinephrine remains the pharmacologic agent of choice. The role o f bicarbonate in the management of acidosis and the role of calcium in restarting the heart remain controversial. If and when the heart is r estarted following: cardiac arrest, the work is just beginning for the intensivist to manage the postarrest shock state. Dobutamine is usefu l in the normotensive child while epinephrine infusions are used to st abilize hypotensive, postarrest shock in the child.