Paeds Cases · acute-care-resuscitation-and-toxicology
Manage a child after cardiac arrest in PICU — OSCE
OSCE management station: stabilising a comatose school-age child after return of spontaneous circulation, delivering the post-arrest bundle, and planning delayed multimodal prognostication.
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Target exams
MRCPCH ClinicalRACP DCERCPSC Pediatrics
Prompt
A 6-year-old girl, weight 20 kg, is admitted to PICU one hour after return of spontaneous circulation following an out-of-hospital arrest from severe asthma. She is intubated and ventilated, sedated, and unresponsive to pain. Her temperature is 38.0 degrees C, heart rate 140, blood pressure 78/45 (MAP 56), SpO2 100 percent on FiO2 1.0, and PaCO2 28 mmHg on the blood gas. Continuous EEG has just been applied. You are the PICU registrar asked to optimise her post-arrest care.
Candidate brief
This child has achieved ROSC but is now in post-cardiac arrest syndrome with four active harms that will worsen her secondary brain injury if not corrected: fever, hyperoxia, hypocarbia and relative hypotension. Your task in this station is to recognise each harm and deliver the post-arrest bundle.[1][3]
References4ShowHide
- [1]Topjian AA, de Caen A, Wainwright MS, et al. Pediatric Post-Cardiac Arrest Care: A Scientific Statement From the American Heart Association. Circulation, 2019.PMID 31242751
- [3]Lasa JJ, Dhillon GS, Duff JP, et al. Part 8: Pediatric Advanced Life Support: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation, 2025.PMID 41122885
- [9]Gardner MM, Hehir DA, Reeder RW, et al. Identification of post-cardiac arrest blood pressure thresholds associated with outcomes in children: an ICU-Resuscitation study. Crit Care, 2023.PMID 37805481
- [10]Barreto JA, Weiss NS, Nielsen KR, et al. Hyperoxia after pediatric cardiac arrest: Association with survival and neurological outcomes. Resuscitation, 2022.PMID 34906621