Protecting the Brain Immediately After Pediatric Cardiac Arrest

Can we stop the brain from getting hurt more?

During cardiac arrest, the body’s organs are damaged by lack of oxygen and nutrients, including the brain. When these organs stop receiving oxygen and nutrients, it leads to the death of cells. The brain and heart are very sensitive to this type of damage.

Can the brain’s damage from cardiac arrest be fixed?

No, unfortunately, there are no treatments available to reverse brain damage from the lack of oxygen and nutrients after a cardiac arrest. 

Can we try to save the brain from more injury?

Yes. The goal of treatment after a cardiac arrest is to protect the brain from more damage. If your child is not waking up after a cardiac arrest, there are treatments that healthcare providers may use to protect their brain from more injury. These treatments have two goals:  

1. Making sure that there is enough oxygen and nutrients delivered to your child’s brain
2. Put your child’s brain and body into “rest mode.” By lowering the brain’s activity, it will also need less energy. This helps to protect uninjured areas of the brain.

The healthcare team may do this by: 

1. Using medications to control your child’s blood pressure
2. Using a ventilator to take control of their breathing
3. Using medications to keep them asleep and comfortable
4. Monitoring for and treating seizures 
5. Providing fluids through their veins, to keep them hydrated 
6. Controlling their temperature, sometimes using devices that help to monitor temperature and provide cooling or warming as needed 

Why are the doctors controlling my child’s temperature?

You might hear the healthcare team say “targeted temperature management or hypothermia” to describe the treatment used to control their temperature. This treatment is used in some children who don’t wake up after a cardiac arrest. It involves purposefully controlling the body temperature to maintain a normal or cooler temperature to protect the brain from further damage and to allow further “rest” for the brain.   

It is crucial to avoid fevers or high temperatures, as they make the brain work harder after cardiac arrest.

How is my child monitored for seizures?

There may be times when the medical team thinks that your child may be having seizures. Seizures are changes in the brain’s electrical activity. Sometimes it may also be difficult to know if your child is having seizures, especially if your child is receiving medicines that make them calm and sleepy. Your child may be connected to an electroencephalogram (called EEG). This involves pasting metal discs (electrodes) with thin wires onto the scalp (think of it as an EKG, or electrocardiogram, but for the brain). The brain activity is recorded and shows up on a computer as wavy lines. It will alert doctors, including a neurologist (brain doctor), if your child is having seizures, even if the body does not show any abnormal movements. If your child is having seizures, doctors will start antiseizure medications. It is extremely important to treat and prevent more seizures as leaving them untreated can potentially cause further brain damage.

Will my child wake up after receiving these treatments?

These treatments do not guarantee that your child will wake up or go back to how they were before the cardiac arrest. These treatments cannot reverse the damage that occurred during the cardiac arrest. However, it provides your child with the best possible chance to heal and prevent more damage.

Sources

Johns Hopkins Medicine. (2024). Electroencephalogram (EEG). https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/electroencephalogram-eeg

Johns Hopkins Medicine. (2024). Therapeutic hypothermia after cardiac arrest. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/therapeutic-hypothermia-after-cardiac-arrest

Topjian, A. A., de Caen, A., Wainwright, M. S., Abella, B. S., Abend, N. S., Atkins, D. L., Bembea, M. M., Fink, E. L., Guerguerian, A. M., Haskell, S. E., Kilgannon, J. H., Lasa, J. J., & Hazinski, M. F. (2019). Pediatric post-cardiac arrest care: A scientific statement from the American Heart Association. Circulation, 140(6), e194–e233. https://doi.org/10.1161/CIR.0000000000000697 

Topjian, A., Fowler, J., Nadkarni, V., Berg, R., Dewitt, A., Blowey, B., Lourie, K., McGowan, N., Agarwal, K., Kirschen, M., Pinto, N., & Gardner, M. (2024, October). PICU and CICU clinical pathway for the care of the child after CPR. https://pathways.chop.edu/clinical-pathway/cardiac-arrest-post-cpr-clinical-pathway

Thank you to our contributors

Megan McSherry & Samantha Fernandez