Infant cardiac arrest occurs when an infant’s heart stops beating effectively or entirely, preventing blood circulation to the brain and other vital organs. This condition is a severe medical emergency that requires immediate action. Cardiac arrest in infants differs significantly from adults, largely due to underlying causes and physiological distinctions.
Understanding Infant Cardiac Arrest
Cardiac arrest in infants often results from respiratory issues rather than primary heart problems, which are more common in adults. Conditions that lead to a lack of oxygen, such as severe respiratory failure or shock, frequently precede cardiac arrest in infants. Common causes include sudden infant death syndrome (SIDS), choking on foreign objects, severe asthma, and pneumonia. Trauma and serious infections can also lead to cardiac arrest in this age group.
Congenital heart defects are another cause of infant cardiac arrest, with structural abnormalities affecting the heart’s ability to pump blood effectively. These defects can include conditions like aortic valve stenosis, atrial septal defect, and coarctation of the aorta. Infants also have physiological differences, such as immature respiratory control and less compliant heart muscles, making them more susceptible to rapid deterioration from respiratory or circulatory issues. Their smaller airways and higher oxygen metabolic needs contribute to their vulnerability when breathing is compromised.
Recognizing and Responding to Infant Cardiac Arrest
Recognizing infant cardiac arrest involves observing several key signs: unresponsiveness, absence of normal breathing (only gasping or no breathing), and no pulse if a trained individual is checking. If an infant appears unresponsive, a bystander should try to get their attention by shouting their name or gently tapping the bottom of their foot. If there is no response and no normal breathing, immediate action is necessary.
The first step is to call for emergency medical services (911 or your local equivalent). If alone and a phone is not immediately available, perform two minutes of CPR (five cycles of 30 compressions and two breaths) before calling for help. If another person is present, one person should call for help while the other begins CPR.
For infant CPR, place two fingers or one hand (depending on the infant’s size and your strength) on the center of the chest, just below the nipples. Compress the chest about 1.5 inches (one-third of the chest’s depth) at a rate of 100-120 compressions per minute. After 30 compressions, gently tilt the infant’s head to a neutral position, lift the chin, and give two rescue breaths by covering both the infant’s nose and mouth with your mouth, ensuring the chest rises. Continue these cycles of 30 compressions and two breaths until emergency services arrive or the infant shows signs of life.
Medical Management and Care
Once emergency medical services (EMS) arrive, they will provide advanced life support beyond bystander CPR. This includes advanced airway management, such as inserting a breathing tube, to ensure adequate oxygenation and ventilation. Medications, particularly epinephrine (adrenaline), are often administered intravenously to help restart the heart and improve blood flow. Other medications, such as amiodarone or lidocaine, may be used for specific heart rhythm abnormalities.
Defibrillation, the use of an electrical shock to reset the heart’s rhythm, is less common in infants compared to adults, as non-shockable rhythms are more prevalent in pediatric cardiac arrest cases. However, if a shockable rhythm like ventricular fibrillation is identified, an automated external defibrillator (AED) with pediatric pads should be used. If pediatric pads are unavailable, adult pads can be used, ensuring they do not touch each other.
After initial resuscitation, infants are transported to a neonatal or pediatric intensive care unit (NICU/PICU) for ongoing stabilization and care. Post-resuscitation care focuses on identifying the underlying cause and providing supportive treatments. These may include monitoring for hypoglycemia, managing fluid and electrolyte balance, and potentially therapeutic hypothermia to help protect the brain.
Outcomes Following Infant Cardiac Arrest
The outcomes for infants who experience cardiac arrest can vary widely, ranging from full recovery to significant long-term disabilities. Factors influencing prognosis include the initial cause, the duration of the arrest, and the quality of resuscitation efforts. Infants and newborns tend to have higher survival rates from in-hospital cardiac arrest compared to older children. However, out-of-hospital cardiac arrest generally has lower survival rates.
Many survivors may experience long-term cognitive impairments, affecting attention, language, memory, and executive functioning. Physical and sensory deficits, as well as difficulties with adaptive behaviors like motor skills and daily living activities, are also reported. Ongoing research and advancements in post-resuscitation care aim to improve these outcomes.