The etiology of cardiac arrest in children and young adults: Special considerations for ED management

Children and young adults rarely present to the emergency department (ED) in cardiac arrest. This review examines published series on nontraumatic, cardiac arrest for patients aged 1 to 45 years and discusses the differential diagnosis for cardiovascular collapse. Among the most common entities encountered are cardiac diseases (hypertrophic cardiomyopathy, myocarditis), airway diseases (pneumonia, epiglottitis, and asthma), epilepsy, hemorrhage (gastrointestinal bleeding, ectopic pregnancy), and drug toxicity (tricyclic antidepressants, cocaine). ED management of children and young adults in cardiac arrest requires an understanding of the heterogeneous pathophysiologic mechanisms and etiologies leading to cardiopulmonary dysfunction in these patients. The emergency physician should give particular focus to airway management for toddlers and preadolescents, because respiratory diseases predominate. When treating an adolescent or young adult, the resuscitation team should also consider toxic causes as well as occult hemorrhage. Management considerations unique to this patient population are discussed.