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Arrêt cardiaque du nourrisson et de l’enfant

Cardiac arrest in paediatrics

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Annales françaises de médecine d'urgence

Résumé

L’arrêt cardiaque en pédiatrie est rare et son pronostic gravissime. Il est le plus souvent l’ultime complication d’une hypoxie ou d’une insuffisance circulatoire. Il s’agit de rythmes non défibrillables (asystolie, activité électrique sans pouls), plus rarement le fait de troubles du rythme ventriculaire (15 %). Les recommandations de prise en charge actualisées en 2015 précisent la durée (1 sec) des insufflations, l’intensité des compressions thoraciques (le tiers du diamètre du thorax), renouvellent les algorithmes des rythmes choquables et non choquables d’arrêt, rappellent l’importance du monitorage post-arrêt (normothermie, normoxie / normocapnie, normoglycémie, dysfonction myocardique). L’effort doit porter sur sa prévention c’est-à-dire la reconnaissance des situations de détresse à risque de décompensation, l’évaluation hémodynamique des états septiques et/ou fébriles. La formation et l’entraînement par la simulation des équipes à des prises en charge coordonnées autour d’un leader sont des points d’amélioration potentielle très importants.

Abstract

Cardiac arrest in pediatrics has a very low prevalence and survival remains poor. In infants and children, asphyxia cardiac arrest is most common than cardiac arrest from a primary cardiac event. Most often cardiac arrest occurs with a non-shockable rhythm (asystole, pulseless electrical activity). Ventricular dysrhythmia is less frequent (15%). The 2015 guidelines update specify the duration (1 sec) of each breath, the intensity of chest compressions (one third of chest’ depth), renew the algorithms of shockable and not shockable rhythms, call back the importance of post-resuscitation care (normothermia, normoxaemia, normocapnia, normoglycaemia, myocardial dysfunction). Efforts have to concern cardiac arrest prevention that is the ability to detect cardiopulmonary deterioration, to assess the circulatory state of septic and/or feverish infants, the simulation training of the teams and the coordinated care around the team leader.

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Authors and Affiliations

  1. Service des urgences pédiatriques, université Paris Descartes, Assistance Publique Hôpitaux de Paris, hôpital Necker enfants malades, F-75743, Paris cedex 15, France

    A. L. Tarbé de Saint Hardouin, V. Nouyrigat, N. Bocquet, S. Timsit & G. Chéron

  2. Service de réanimation pédiatrique, Assistance Publique Hôpitaux de Paris, hôpital Necker enfants malades, F-75743, Paris cedex 15, France

    L. de Saint Blanquat

Authors
  1. A. L. Tarbé de Saint Hardouin
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  2. L. de Saint Blanquat
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  3. V. Nouyrigat
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  4. N. Bocquet
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  5. S. Timsit
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  6. G. Chéron
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Correspondence to G. Chéron.

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Tarbé de Saint Hardouin, A.L., de Saint Blanquat, L., Nouyrigat, V. et al. Arrêt cardiaque du nourrisson et de l’enfant. Ann. Fr. Med. Urgence 6, 403–409 (2016). https://doi.org/10.1007/s13341-016-0683-3

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  • DOI: https://doi.org/10.1007/s13341-016-0683-3

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