Article, Pediatrics

Continuous chest compression pediatric cardiopulmonary resuscitation after witnessed electrocution

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American Journal of Emergency Medicine

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Continuous chest compression Pediatric cardiopulmonary resuscitation after witnessed electrocution?,??


Electrical injury is a relatively infrequent but potentially devas- tating multisystem injury with high morbidity and mortality. We describe the case of an 11-year-old boy who suffered loss of his consciousness after touching an electrical cable.

Electrical injury is characterized by high morbidity and mortality, causing 0.54 deaths per 100000 people each year [1]. Most electrical injuries in children occur primarily at home and are associated generally with low voltage [2].

We describe the case of an 11-year-old boy who suffered loss of his consciousness after touching an electrical cable supplying the amplifier of the home TV antenna. The duration of electrocution was approximately 2 minutes. After switching off the power, the cable was removed from the child’s hand and the victim was transferred immediately from the bed to the floor. Some family members called for help, while some others started to check the victim. The local emergency number for an ambulance was called.

The child was neither breathing nor responding to stimuli and was pale with Central cyanosis. As none of the attendees were trained in basic life support, the father tried several times to open the mouth in order to give rescue breaths but all efforts were ineffective due to severe generalized muscle spasm. Within 3 to 4 minutes from loss of consciousness, a woman passing by responded to the call for help. The responder was uncertified but stated that she had some basic life support knowledge. After confirming the absence of breath sounds, she started chest compressions of adequate depth at a rate of 100 min-1. After about 8 minutes of continuous chest compressions with frequent role exchange and occasional ineffective attempts for Rescue breathing, the muscle spasm was diminished. The father managed to open the mouth and started asynchronous rescue breaths at a rate of 10 min-1. Five minutes later, the child started to move and breathe normally. The ambulance arrived 2 minutes after the victim regained consciousness and transported him to the closest rural primary health care facility.

In the emergency department, the patient was breathing sponta- neously at a rate of 17 min-1, maintaining SpO2 98% in room air. He was hemodynamically stable with blood pressure of 120/80 mm Hg and in sinus rhythm. The remaining clinical examination was unremarkable and chest x-ray and biochemistry were also normal.

? Sources of support: None.

?? Conflict of interest: None.

The patient was admitted in for monitoring and observation and was discharged home 2 days later in an excellent clinical condition.

Electrical injuries remain a worldwide problem with household electrical cords being the major electrocution hazard for children younger than 12 years [3,4]. In a retrospective Indian study, domestic accidents were responsible in 61.86% of the cases [5], while in another study, household accidents (78.06%) prevailed over occupational accidents (13.39%) [6]. Childhood deaths due to electrocution are rare and are more likely to occur in the home environment in children playing around electrical wires or equipment [7].

In the case presented hereby, although the direct effects of electrical current cannot be determined, the absence of respiratory efforts indicates that the child suffered at least respiratory arrest due to generalized muscle spasm. Given that the bystanders were untrained as well as they were unable initially to give rescue breaths, the child practically received continuous chest compres- sion cardiopulmonary resuscitation (CCC-CPR) during the first

8 minutes. However, the total time of CCC-CPR may have been longer due to the uncertainty about the quality of the rescue breaths that were given after the reduction of the increased muscle spasm and the difficulty in ventilating effectively the victim asynchronously to chest compressions; the increased intrathoracic pressure during the compression phase impedes entry of air into the lungs.

In adults, the cardiocerebral Resuscitation protocol mandates that bystander CCC-CPR should be provided by lay rescuers who witness unexpected collapse in nonresponsive person with abnormal breathing [8]. Although CCC-CPR is not recommended for individuals with respiratory arrest [9], it promotes passive oxygen insufflation due to the creation of negative intrathoracic pressure during chest decompression. Considering that neither oxygenation nor ventilation status seems to be associated with outcome early after Pediatric cardiac arrest [10], as well as that both severe hypoxia and, to a lesser extent, hyperoxia are associated with an increased risk of death during the post-resuscitation period [11], we may conclude that passive oxygen insufflation was sufficient for preventing Anoxic brain injury in our case. Furthermore, even if respiratory arrest was not the only manifestation of electrocution, we believe that CCC-CPR was beneficial regardless of the total effects of the electrical current (Table).

Of note, the American Heart Association Emergency Cardiovas- cular Care Committee recommends “hand-only CPR” for lay bystanders of witnessed cardiac arrest but only “if the bystander is not trained in CPR” [12]. However, rescue breathing may be necessary in victims with arrest of non-Cardiac origin, while in either case, there is an interval after cardiac arrest when ventilations

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Benefits of continuous chest compression lay rescuer cardiopulmonary resuscitation

Type of arrest Critical resuscitation benefit

Respiratory arrest Passive insufflation

Hellenic Society of Cardiopulmonary Resuscitation

Athens, Greece E-mail address: [email protected]

Ventricular fibrillation/pulseless ventricular tachycardia (<=4 min)

Ventricular fibrillation/pulseless ventricular tachycardia (N4 min)

Cardiocerebral perfusion

Passive insufflation– cardiocerebral perfusion

Asystole/pulseless electrical activity Passive insufflation– cardiocerebral perfusion

become absolutely critical for survival [13,14]. We present evidence for the first time that CCC-CPR may be of benefit in witnessed post- electrocution pediatric cardiac or respiratory arrest regardless of the pathophysiological mechanism or the phase of arrest in case of ventricular fibrillation.


Published with the written consent of the patient’s parents.

Athanasios Chalkias, PhD

National and Kapodistrian University of Athens Medical School, MSc Cardiopulmonary Resuscitation”, Athens, Greece Hellenic Society of Cardiopulmonary Resuscitation

Athens, Greece

Nicoletta Iacovidou, PhD

Hellenic Society of Cardiopulmonary Resuscitation

Athens, Greece 2nd Department of Obstetrics and Gynecology

Neonatal Division, National and Kapodistrian University of Athens

Medical School, Athens, Greece

Theodoros Xanthos, PhD

National and Kapodistrian University of Athens Medical School, MSc Cardiopulmonary Resuscitation”, Athens, Greece


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