Assessment of perfusion in pediatric resuscitation
- Susan B Torrey, MD
Susan B Torrey, MD
- Section Editor — Pediatric Resuscitation; Pediatric Trauma
- Director, Division of Pediatric Emergency Medicine
- Associate Professor of Emergency Medicine and Pediatrics (Clinical)
- NYU School of Medicine
- Section Editor
- Gary R Fleisher, MD
Gary R Fleisher, MD
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Pediatric Signs and Symptoms
- Egan Family Foundation Professor
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
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 . 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'.)
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