How can congenital heart disease alter resuscitation strategy in pediatric arrest?

• A. May require advanced hemodynamic management and consideration for ECPR; shunt physiology must be considered.
• B. CHD does not affect resuscitation.
• C. You should only use standard adult protocols.
• D. Shunt physiology can be ignored.

Answer: (A)

Congenital heart disease changes how blood moves and how oxygen is delivered during arrest, so resuscitation must be guided by the child’s specific heart anatomy and any shunt physiology. In these kids, you may need more than chest compressions alone—advanced hemodynamic management with targeted vasopressors or inotropes to support coronary and cerebral perfusion, and, in some cases, extracorporeal CPR to sustain circulation while definitive repair or palliation is pursued. Shunt physiology matters because many CHD lesions rely on balanced systemic and pulmonary flows or on the ductus arteriosus; failing to account for these pathways can misroute blood and impair oxygen delivery. This can also influence ventilation strategies, since excessive intrathoracic pressure can decrease venous return and worsen perfusion in a patient who already has unusual circulatory dynamics. So, a resuscitation plan that acknowledges CHD—and considers options like ECPR and the need to maintain or manage shunts—is often required rather than applying standard protocols alone.