There are distinct differences in the causes of cardiopulmonary arrest between pediatric and adult patients. In both patient populations, cardiopulmonary arrest can be preceded by multiple causes such as respiratory insufficiency of various etiologies–including airway obstruction, metabolic abnormalities, noncardiogenic shock, and arrhythmias. However, adults are more likely than a child to have a cardiopulmonary arrest secondary to a primary cardiac cause, most commonly myocardial infarction. Adults are approximately twice as likely to present in cardiopulmonary arrest with VF compared to the pediatric population. In out-of-hospital cardiac arrests, approximately 40% of adults will have VF as the first-monitored rhythm. Studies of in-hospital arrest demonstrate that approximately 25% of adults will have VT or fibrillation as their first documented rhythm in a pulseless arrest, compared to about half as many in children. Pulseless VT and VF are lethal arrhythmias, unless treated quickly. In both situations, the initial treatment is rapid defibrillation, followed by further treatment of the primary cause of the cardiac arrest. Although the approach to a patient in cardiopulmonary arrest differs when comparing pediatric to adult patients, a paramount tenet is that a patient who is in pulseless VT or VF should receive lifesaving cardiac defibrillation as soon as possible; studies in adults show the probability of survival declines for each minute without defibrillation and cardiopulmonary resuscitation (CPR). In the pediatric age group, primary cardiac arrest is rare, and more typically, cardiac arrest in children is a terminal event resulting from respiratory failure or shock. To that extent, Pediatric Advanced Life Support (PALS) recommendations focus heavily on the primary establishment of an airway with good ventilation techniques, along with chest compressions and fluid resuscitation, whereas Adult Advanced Cardiovascular Life Support (ACLS) focuses more on rapid along with ensuring adequate airway, ventilation, and circulation (CPR). It must be remembered, however, that in the event of a pulseless arrest in a child, the PALS algorithm calls for rapid determination of whether the patient has a “shockable rhythm,” pulseless VT or VF, at the same time that other basic
life-support measures are being performed. In the event that a pediatric patient is identified to have a shockable rhythm, then defibrillation at a dose of 2 Joule/kg should be immediately delivered. Health care providers must have efficient coordination of CPR and defibrillation with minimal interruptions for rhythm analysis and shock delivery.