The benefits of youth are lost on the young cardiac arrest patient [version 1; referees: 2 approved]

Abstract

Children and young adults tend to have reduced mortality and disability after acquired brain injuries such as trauma or stroke and across other disease processes seen in critical care medicine. However, after out-of-hospital cardiac arrest (OHCA), outcomes are remarkably similar across age groups. The consistent lack of witnessed arrests and a high incidence of asphyxial or respiratory etiology arrests among pediatric and young adult patients with OHCA account for a substantial portion of the difference in outcomes. Additionally, in younger children, differences in pre-hospital response and the activation of developmental apoptosis may explain more severe outcomes after OHCA. These require us to consider whether present practices are in line with the science. The present recommendations for compression-only cardiopulmonary resuscitation in young adults, normothermia as opposed to hypothermia (33°C) after asphyxial arrests, and paramedic training are considered within this review in light of existing evidence. Modifications in present standards of care may help restore the benefits of youth after brain injury to the young survivor of OHCA.

Keywords

• Acute Cardiovascular Problems
• Developmental & Pediatric Neurology
• Emergency Medicine
• Epidemiology
• Ethics & Organization in Critical Care & Emergency Medicine
• Geriatric Cardiology
• Health Systems & Services Research
• Neurobiology of Disease & Regeneration
• Neurodevelopment
• Neurological Problems in Critical Care
• Pediatric Problems in Critical Care
• Preventive Medicine
• Social & Behavioral Determinants of Health