Cardiopulmonary resuscitation (CPR) in children with heart disease

Over the past two decades survival from pediatric cardiac arrest has improved dramatically, particularly in the in-hospital setting, from 15% to nearly 50%. The reasons for this are multifactorial and include but are likely not limited to the use of ECPR, personalizing the care delivered to the child’s age and also the child’s underlying cardiac anatomy and physiology, and applying a multitude of approaches to improving the quality of care we deliver. Teams are now systematically addressing the quality of cardiopulmonary resuscitation (CPR) delivered during the event with real-time feedback with bedside devices and quality CPR coaches, postevent debriefing, and meticulously managing the post-cardiac arrest care period. Unfortunately, there is evidence of great variability between hospitals, suggesting there are still lives to be saved. In the upcoming decades we need to continue to explore physiologic targets to optimize coronary and cerebral perfusion while minimizing harm from compressions, use human factors to improve team dynamics and room ergonomics, refine approaches to post-cardiac arrest care, and improve our ability to prognosticate on outcomes. Although avoiding a cardiac arrest is always best, we now know that many lives can be saved with exquisite CPR, and we must continue to focus on optimizing outcomes for these most vulnerable of patients.