Thursday, June 9, 2011

Do Children Ever Survive a Sudden Cardiac Arrest ?

The vast majority of children and teens who experience a full cardiac arrest, do die. However, they do not ALL die, if they receive competent CPR and defibrillation from an AED (Automatic Emergency Defibrillator.) It therefore makes good sense to certify all parents, all coaches, all teachers in CPR. All health care providers in most US states and Canada are required to be anyway. It also makes sense to have an AED in every school, every government building, and present at every soccer, lacrosse, baseball, basketball, practice and game, as well as at track and field events. Even when an AED is present, at say perhaps a school, the ideal time for its use is a narrow window, and depending upon the size of the facility, it may be brought to the scene too late.
Daniel had the benefit of rapid discovery and rapid CPR, and we administered epinephrine, and later an additional dose, but there was no AED in our home. There was no reason to ever buy one, or request one, although now of course, I wish we had found a way. Still, the window in which an AED is helpful is short. By the time we heard his fall, unlicked the bathroom door, pushed the door gently to move his body which was obstructing the doors opening, time was passing. Then since he was on his face, he needed to be turned over, his head tilted back and assessed for breath sounds, vomitus cleared, and breaths given, and then pulselessness detected, All these things take time, although his body should have responded to the care he received.
When an adult comes across a child in cardiac arrest, we often do not know the cause. It could be a metabolic disorder, an influenza, a respiratory arrest which led to a cardiac arrest, an anaphylactic (severe allergic reaction), or a severe asthma attack. We can't know what happened simply by looking. When a child drops to the floor with a sudden cardiac arrhythmia, we know even less. A well child who has been active that day, has dropped and is unresponsive, breathless and pulseless. According to data tabulated by the Parent Heart Watch, 100-150 children from 3-35 die of a sudden cardiac death annually. This does not include those who were successfully resuscitated and treated thereafter. The Heart Rhythm Society reported in 2004, 14,000 infants and children deaths from a sudden cardiac death or unclear causation sudden death syndrome. This is not as rare as others might have us believe.
Yes, some children survive, but not as many as we would like. I will make an effort to profile some of the survivors of Sudden Cardiac Death as well as those who we remember for passing as a result of it. There is no one state, national or world group keeping complete and comprehensive records of causes of sudden cardiac arrests in adults or in children. In fact, whether an autopsy is even done in many municipalities is a question of money available, coroner's request, and even family preference. There are simply so many more causes of death in youth for this to be a significant focus yet for public heath. I wonder how many children will die before this receives broader attention ?

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