CardioSomaticsCardioSomaticsCardioСоматика2221-71852658-5707Eco-Vector69125010.17816/CS691250CYVYLVReviewsОбзорыReview ArticleCurrent challenges in the organization of pediatric resuscitation: a reviewПроблемы организации деятельности детской реанимации на современном этапе: обзорhttps://orcid.org/0000-0002-2062-8060MegeryanManuel M.МегерянМануэл Максимович
Russian Federation
pdgb-work@mail.ruhttps://orcid.org/0000-0001-7178-12601235-6273AbramovAleksey Yu.АбрамовАлексей Юрьевич
Russian Federation

MD, Dr. Sci. (Medicine), Professor

д-р мед. наук, профессор

abramov-au@rudn.ruhttps://orcid.org/0000-0003-4865-732X3606-5570DegtyarevaElena A.ДегтяреваЕлена Александровна
Russian Federation

MD, Dr. Sci. (Medicine), Professor

д-р мед. наук, профессор

dgp48@yandex.ruPodolsk Children's HospitalПодольская детская больницаPeoples' Friendship University of RussiaРоссийский университет дружбы народов имени Патриса Лумумбы190820260609202617141502409202520042026Copyright ©; 2026, Eco-VectorCopyright ©; 2026, ООО "Эко-Вектор"2026Eco-VectorООО "Эко-Вектор"https://eco-vector.com/for_authors.php#07https://cardiosomatics.ru/2221-7185/article/view/691250

This paper presents a narrative review of Russian and international studies on the current problems in the organization of pediatric resuscitation and potential solutions. We characterize the causes of acute and chronic critical illnesses in children that require admission to the intensive care unit. Significant progress has been made in pediatric critical care: whereas the previous goal was to reduce mortality in pediatric patients, the current priority is improving the quality of life of surviving children and their families.

However, several key issues remain debated: optimal indications for extracorporeal cardiopulmonary resuscitation, choice of infusion solutions and pharmacotherapy in neonatal resuscitation, and standardization of nutritional support and sedation protocols. The number of children with chronic critical illnesses has increased; their prolonged ICU stays are associated with higher healthcare costs and worse outcomes. A systematic, multidisciplinary approach, supported by international and national clinical guidelines and diagnostic algorithms, is essential. Synthesis of the available data helps identify priority areas for further research on the organization of pediatric critical care. This review may be of interest to critical care physicians, pediatricians, and healthcare administrators.

В работе представлен нарративный обзор отечественной и зарубежной научной литературы, посвящённый анализу существующих проблем организации деятельности детской реанимации и возможных путей их решения. Охарактеризованы причины острых и хронических критических состояний у детей, требующих госпитализации в отделения интенсивной терапии. К настоящему времени достигнуты значительные успехи в детской реаниматологии: если ранее основной целью являлось снижение смертности педиатрических пациентов, то сегодня приоритетом становится улучшение качества жизни выживших детей и их семей.

Вместе с тем ряд ключевых вопросов остаётся дискуссионным: оптимальные показания к экстракорпоральной сердечно-лёгочной реанимации, выбор инфузионных растворов и фармакотерапии при неонатальной реанимации, стандартизация нутритивной поддержки и протоколов седации. Отмечен рост числа детей с хроническими критическими заболеваниями, длительное пребывание которых в отделениях интенсивной терапии ассоциировано с увеличением затрат системы здравоохранения и ухудшением исходов. Констатируется важность системного мультидисциплинарного подхода, подкреплённого международными и национальными клиническими рекомендациями и диагностическими алгоритмами. Проведённая систематизация данных позволяет определить приоритетные направления дальнейших исследований в области организации педиатрической реанимационной помощи. Обзор может представлять интерес для врачей-реаниматологов, педиатров и организаторов здравоохранения.

reviewpediatric intensive careresuscitationcritical illnesschronic diseasechild mortalityextracorporeal membrane oxygenationобзордетская интенсивная терапияреанимациякритические состоянияхроническая болезньдетская смертностьэкстракорпоральная мембранная оксигенацияFoglia DC, Milonovich LM. The evolution of pediatric critical care nursing: past, present, and future. Crit Care Nurs Clin North Am. 2011;23(2):239–253. doi: 10.1016/j.ccell.2011.02.003Chan JL, Nallamothu BK, Tang Y, et al. Resuscitation practices in hospitals caring for children: Insights from get with the guidelines-resuscitation. Resuscitation Plus. 2022;9:100199. doi: 10.1016/j.resplu.2021.100199 EDN: GVZCDLDean JM. Evolution of the Collaborative Pediatric Critical Care Research Network. Pediatr Crit Care Med. 2022;23(12):1049–1055. doi: 10.1097/PCC.0000000000003098 EDN: YFQMOURecher M, Leteurtre S, Canon V, et al. Severity of illness and organ dysfunction scoring systems in pediatric critical care: the impacts on clinician's practices and the future. Front Pediatr. 2022;10:1054452. doi: 10.3389/fped.2022.1054452 EDN: AAPIWBBerg KM, Bray JE, Ng KC, et al. 2023 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation. 2023;195:109992. doi: 10.1016/j.resuscitation.2023.109992 EDN: USQBTEBembea MM, Ng DK, Rizkalla N, et al. Outcomes after extracorporeal cardiopulmonary resuscitation of pediatric in-hospital cardiac arrest: a report from the Get With The Guidelines-Resuscitation and the Extracorporeal Life Support Organization registries. Crit Care Med. 2019;47(4):e278–e285. doi: 10.1097/CCM.0000000000003622De Mul A, Nguyen DA, Doell C, et al. Prognostic evaluation of mortality after pediatric resuscitation assisted by extracorporeal life support. J Pediatr Intensive Care. 2019;8(3):145–150. doi: 10.1055/s-0038-1667012Esangbedo ID, Brunetti MA, Campbell FM, Lasa JJ. Pediatric extracorporeal cardiopulmonary resuscitation: a systematic review. Pediatr Crit Care Med. 2020;21(10):e934–e943. doi: 10.1097/PCC.0000000000002373 EDN: SARVXLRamsie M, Cheung PY, O'Reilly M, et al. Cardiac agents during neonatal cardiopulmonary resuscitation. Neonatology. 2024;121(2):157–166. doi: 10.1159/000535502 EDN: SMBHWZConrad P, Meyer S, Whiting J, Connor JA. Iatrogenic withdrawal syndrome in specialty pediatric critical care. Appl Nurs Res. 2020;55:151284. doi: 10.1016/j.apnr.2020.151284 EDN: SHMEISEmrath ET, Fortenberry JD, Travers C, et al. Resuscitation with balanced fluids is associated with improved survival in pediatric severe sepsis. Crit Care Med. 2017;45(7):1177–1183. doi: 10.1097/CCM.0000000000002365Elkbuli A, Zajd S, Ehrhardt JD Jr, et al. Aggressive crystalloid resuscitation outcomes in low-severity pediatric trauma. J Surg Res. 2020;247:350–355. doi: 10.1016/j.jss.2019.10.009 EDN: OAGRCHFoglia EE, Jensen EA, Wyckoff MH, et al. Survival after delivery room cardiopulmonary resuscitation: a national registry study. Resuscitation. 2020;152:177–183. doi: 10.1016/j.resuscitation.2020.01.010 EDN: LCERHWShapiro MC, Henderson CM, Hutton N, Boss RD. Defining pediatric chronic critical illness for clinical care, research, and policy. Hosp Pediatr. 2017;7(4):236–244. doi: 10.1542/hpeds.2016-0170Shapiro MC, Boss RD, Donohue PK, et al. A snapshot of chronic critical illness in pediatric intensive care units. J Pediatr Intensive Care. 2021;13(1):55–62. doi: 10.1055/s-0041-1736334 EDN: CVZSFLZorko DJ, McNally JD, Rochwerg B, et al. Defining pediatric chronic critical illness: a scoping review. Pediatr Crit Care Med. 2023;24(2):e91–e103. doi: 10.1097/PCC.0000000000003125 EDN: IFFAUASeifu A, Eshetu O, Tafesse D, Hailu S. Admission pattern, treatment outcomes, and associated factors for children admitted to pediatric intensive care unit of Tikur Anbessa specialized hospital, 2021: a retrospective cross-sectional study. BMC Anesthesiol. 2022;22:2. doi: 10.1186/s12871-021-01556-7 EDN: BCKPPFZorko D, McNally JD, Rochwerg B, et al. Pediatric chronic critical illness: protocol for a scoping review. JMIR Res Protoc. 2021;10(10):e30582. doi: 10.2196/30582 EDN: GLUIVZO'Brien S, Nadel S, Almossawi O, Inwald DP. The impact of chronic health conditions on length of stay and mortality in a general PICU. Pediatr Crit Care Med. 2017;18(1):1–7. doi: 10.1097/PCC.0000000000000976Namachivayam P, Taylor A, Montague T, et al. Long-stay children in intensive care: long-term functional outcome and quality of life from a 20-yr institutional study. Pediatr Crit Care Med. 2012;13(5):520–528. doi: 10.1097/PCC.0b013e31824fb989Kanthimathinathan HK, Plunkett A, Scholefield BR, et al. Trends in long-stay admissions to a UK paediatric intensive care unit. Arch Dis Child. 2020;105(6):558–562. doi: 10.1136/archdischild-2019-317797Wieczorek B, Ascenzi J, Kim Y, et al. PICU Up!: impact of a quality improvement intervention to promote early mobilization in critically ill children. Pediatr Crit Care Med. 2016;17(12):e559–e566. doi: 10.1097/PCC.0000000000000983Smith HAB, Besunder JB, Betters KA, et al. 2022 Society of Critical Care Medicine clinical practice guidelines on prevention and management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients. Pediatr Crit Care Med. 2022;23(2):e74–e110. doi: 10.1097/PCC.0000000000002873 EDN: WTINVPOrdinarceva EA, Semyanskaya AG, Khabarov AE, Mumladze KV. Review of existing scales for assessing the severity of newborns with critical congenital heart defects. Anesteziologiya i Reanimatologiya. 2015;60(5):89–92. EDN: UNNDUZÇaylan N, Yalçin SS, Tezel B, et al. Investigation of infant deaths associated with critical congenital heart diseases; 2018-2021, Turkiye. BMC Public Health. 2024;24:441. doi: 10.1186/s12889-024-17966-4 EDN: YUWZHCBokeriya EL. Perinatal cardiology: the present and the future. Part I: congenital heart disease. Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics). 2019;64(3):5–10. doi: 10.21508/1027-4065-2019-64-3-5-10 EDN: OHQHLJTaksande A, Jameel PZ. Critical congenital heart disease in neonates: a review article. Curr Pediatr Rev. 2021;17(2):120–126. doi: 10.2174/1573396317666210219162515 EDN: XJRTSVAlkushi N. The management of newborns with critical congenital heart diseases prior to transport to a cardiac center. Cardiothorac Surg. 2023;31(1):1–7. doi: 10.1186/s43057-022-00090-7 EDN: VACEVWJullien S. Newborn pulse oximetry screening for critical congenital heart defects. BMC Pediatr. 2021;21(1):305. doi: 10.1186/s12887-021-02520-7 EDN: VWIIJOKemper AR, Mahle WT, Martin GR, et al. Strategies for implementing screening for critical congenital heart disease. Pediatrics. 2019;128(5):e1–e8. doi: 10.1542/peds.2011-1317Lisitsa IA, Aleksandrovich YuS, Zavyalova AN, et al. Dysphagia in pediatric intensive care unit patients (review). Messenger of anesthesiology and resuscitation. 2023;20(6):97–105. doi: 10.24884/2078-5658-2023-20-6-97-105 EDN: GZILZSLekmanov AU, Erpuleva YuV, Suvorov SG. Clinical nutrition practice in pediatric intensive care units: results of the NutriPed-2015 study. Anesteziologiya i Reanimatologiya. 2016;61(5):376–380. doi: 10.18821/0201-7563-2016-61-5-376-380 EDN: XDMMLXChubarova AI, Biryukova SR. Insulin-like growth factor-i in the assessment of the current nutritional status in infants with congenital heart disease. Rossiyskiy Vestnik Perinatologii i Pediatrii. 2014;59(2):83–88. EDN: SGGZAJGlebova ES, Amcheslavsky VG. Nutritional support for patients with pancreatic trauma in a pediatric intensive care unit. Detskaya Khirurgiya. 2023;27(1):34–40. doi: 10.55308/1560-9510-2023-27-1-34-40 EDN: ERCBJDSergevnin VI, Kudryavtseva LG, Lazarkov PV. Mechanical ventilation as a risk factor for nosocomial pneumonia in patients of the anesthesiology and intensive care department of a cardiac surgery hospital. Analiz Riska Zdorovyu. 2022;(1):106–113. doi: 10.21668/health.risk/2022.1.11 EDN: PJZPFTDriver BE, Prekker ME, Levitan RM, et al. Engagement of the median glossoepiglottic fold and laryngeal view during emergency department intubation. Ann Emerg Med. 2021;78(6):699–707. doi: 10.1016/j.annemergmed.2021.04.024 EDN: CGHGGWAchten NB, Klingenberg C, Benber WB, et al. Association of use of the neonatal early-onset sepsis calculator with reduction in antibiotic therapy and safety: a systematic review and meta-analysis. JAMA Pediatr. 2019;173(11):1032–1040. doi: 10.1001/jamapediatrics.2019.2825Florin TA, Plint AC, Zorc JJ. Viral bronchiolitis. Lancet. 2017;389(10065):211–224. doi: 10.1016/S0140-6736(16)30951-5 EDN: YXGUZLEaster JS, Rose E. Advances in pediatric emergency from 2023. Am J Emerg Med. 2024;80:77–86. doi: 10.1016/j.ajem.2024.03.010 EDN: VXLUMASankar J, Kissoon N. Insights and advances in pediatric critical care. Front Pediatr. 2022;10:1057991. doi: 10.3389/fped.2022.1057991 EDN: OJSQJCNas J, Kleinnibbelink G, Hannink G, et al. Diagnostic performance of the basic and advanced life support termination of resuscitation rules: a systematic review and diagnostic meta-analysis. Resuscitation. 2020;148:3–13. doi: 10.1016/j.resuscitation.2019.12.016 EDN: HIHUCINguyen DA, De Mul A, Hoskote AU, et al. Factors associated with initiation of extracorporeal cardiopulmonary resuscitation in the pediatric population: an international survey. ASAIO J. 2022;68(3):413–418. doi: 10.1097/MAT.0000000000001495 EDN: IISGDHHolmberg MJ, Ross CE, Fitzmaurice GM, et al. Annual incidence of adult and pediatric in-hospital cardiac arrest in the United States. Circ Cardiovasc Qual Outcomes. 2019;12(7):e005580. doi: 10.1161/CIRCOUTCOMES.119.005580Garcia-Hidalgo C, Schmölzer GM. Chest compressions in the delivery room. Children (Basel). 2019;6(1):4. doi: 10.3390/children6010004Schmölzer GM. Chest compressions during sustained inflation during cardiopulmonary resuscitation in newborn infants translating evidence from animal studies to the bedside. JACC Basic Transl Sci. 2019;4(1):116–121. doi: 10.1016/j.jacbts.2018.12.004Plotonenko ZA, Senkevich OA, Vasilieva ZhB, Dorofeev AL. Formation of professional competencies in the medical team for emergency care of newborns - strategy and tactics for reducing infant mortality in the region. Neonatologiya: Novosti. Mneniya. Obuchenie. 2019;7(3):12–19. doi: 10.24411/2308-2402-2019-13002 EDN: GZQHUHMavropulo TK, Ivanov DO, Surkov DN, Fot AYu. Features of emergency and resuscitation care for newborns born at 22-27 weeks of gestation. Detskaya Meditsina Severo-Zapada. 2012;3(2):4–13. EDN: OZNKSJMoskowitz EE, Burlew CC, Kulungowski AM, et al. Survival after emergency department thoracotomy in the pediatric trauma population: a review of published data. Pediatr Surg Int. 2018;34(8):857–860. doi: 10.1007/s00383-018-4290-9 EDN: BPGMYVRivera EAT, Patel AK, Chamberlain JM, et al. Criticality: a new concept of severity of illness for hospitalized children. Pediatr Crit Care Med. 2021;22(1):e33–e43. doi: 10.1097/PCC.0000000000002560 EDN: LHTPOOTrujillo Rivera EA, Chamberlain JM, Patel AK, et al. Dynamic mortality risk predictions for children in ICUs: development and validation of machine learning models. Pediatr Crit Care Med. 2022;23(5):344–352. doi: 10.1097/PCC.0000000000002910 EDN: WIMSJTRivera EAT, Patel AK, Zeng-Treitler Q, et al. Severity trajectories of pediatric inpatients using the criticality index. Pediatr Crit Care Med. 2021;22(1):e19–e32. doi: 10.1097/PCC.0000000000002561 EDN: EHJHCN