UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Assessment of perfusion in pediatric resuscitation

Author
Pamela Bailey, MD
Section Editor
Susan B Torrey, MD
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

The goal of cardiopulmonary resuscitation is the repair of deficits in ventilation, oxygenation, and perfusion. Rapid assessment of the adequacy of systemic perfusion is an essential part of pediatric resuscitation. It is accomplished by evaluation of mental status, capillary refill, pulses, and blood pressure.

The pathophysiology of the maintenance of cardiac output and assessment of perfusion during pediatric resuscitation are reviewed here. Epidemiology and outcome of pediatric resuscitation, cardiopulmonary resuscitation, and medications used in resuscitation are discussed separately. (See "Pediatric advanced life support (PALS)" and "Primary drugs in pediatric resuscitation".)

MAINTENANCE OF CARDIAC OUTPUT AND PERFUSION PRESSURE

Arterial blood pressure is the product of cardiac output and systemic vascular resistance (figure 1). Cardiac output is the volume of blood ejected by the heart each minute; it is the product of heart rate and stroke volume. The stroke volume is the volume of blood ejected by the ventricles with each contraction; it may be reduced by inadequate intravascular volume, myocardial dysfunction, or excessive systemic or pulmonary vascular resistance [1]. Cardiac output declines if either heart rate or stroke volume decrease without a commensurate increase in the other component.

During childhood, the heart rate is faster and the stroke volume is smaller than during adulthood. In children, particularly in infants, cardiac output is increased primarily by increasing the heart rate [1-3].

Heart rate and blood pressure are the only variables affecting cardiac output that can be directly and noninvasively measured. Stroke volume may be indirectly assessed by examining the volume and strength of the pulses. Systemic vascular resistance may be estimated by evaluating skin perfusion. Examination of the jugular veins to estimate venous pressure also may be useful in assessing the volume status in older children and adolescents. However, because low values may be normal, this technique is most useful in distinguishing among the causes of generalized edema. (See "Clinical manifestations and diagnosis of edema in adults", section on 'Distribution of edema and central venous pressure'.)

       

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Tue May 26 00:00:00 GMT 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Bell LM. Shock. In: Textbook of Pediatric Emergency Medicine, 6th edition, Fleisher GR, Ludwig S. (Eds), Wolters Kluwer Lippincott Williams & Wilkins, Philadelphia 2010. p.46.
  2. Pediatric Advanced Life Support Provider Manual, Chameides L, Samson RA, Schexnayder SM, Hazinski MF (Eds), American Heart Association, Dallas 2011. p.69.
  3. Friedman WF. The intrinsic physiologic properties of the developing heart. In: Neonatal Heart Disease, Friedman WF. (Ed), Grune and Stratton, New York 1973.
  4. Pediatric trauma. In: American College of Surgeons Committee on Trauma (Ed). Advanced Trauma Life Support for Doctors, American College of Surgeons, Chicago, IL, 2012, p.246.
  5. Ludwig S, Lavelle JM. Resuscitation-pediatric basic and advanced life support. In: Textbook of Pediatric Emergency Medicine, 5th, Fleisher GR, Ludwig S, Henretig FM. (Eds), Lippincott, Williams & Wilkins, Philadelphia 2006. p.3.
  6. Joly HR, Weil MH. Temperature of the great toe as an indication of the severity of shock. Circulation 1969; 39:131.
  7. Baraff LJ. Capillary refill: is it a useful clinical sign? Pediatrics 1993; 92:723.
  8. Gorelick MH, Shaw KN, Baker MD. Effect of ambient temperature on capillary refill in healthy children. Pediatrics 1993; 92:699.
  9. Cavallaro DL, Melker RJ. Comparison of two techniques for detecting cardiac activity in infants. Crit Care Med 1983; 11:189.
  10. Fleming S, Thompson M, Stevens R, et al. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet 2011; 377:1011.
  11. Gillette PC, Garson A Jr, Porter CJ, McNamara DG. Dysrhythmias. In: Moss's Heart Disease in Infants, Children, and Adolescents, 4th, Adams FH, Emmanouilides GC, Riemenschneider TA. (Eds), Williams & Wilkins, Baltimore 1989.
  12. Kisting, M, Goetting, MG. The misdiagnosis of pediatric cardiac arrest: Pseudo-electromechanical dissociation in children. Acad Emerg Med 1994; 1:A87.
  13. Versmold HT, Kitterman JA, Phibbs RH, et al. Aortic blood pressure during the first 12 hours of life in infants with birth weight 610 to 4,220 grams. Pediatrics 1981; 67:607.
  14. Report of the Second Task Force on Blood Pressure Control in Children--1987. Task Force on Blood Pressure Control in Children. National Heart, Lung, and Blood Institute, Bethesda, Maryland. Pediatrics 1987; 79:1.