Paediatric cardiac collapse in the operating theatre is rare, but when it occurs it often evolves from a rapidly progressing state of shock. Children have remarkable physiological reserves and can compensate for significant circulatory compromise for a surprising amount of time. The challenge is that deterioration can then occur very quickly once those compensatory mechanisms begin to fail.
Shock develops when the circulatory system can no longer deliver adequate oxygen and nutrients to the body’s organs. This system relies on three essential components: a functioning heart, adequate circulating blood volume, and an intact vascular system. When one of these fails, tissue perfusion drops and organ injury can rapidly follow.
In paediatric patients, several pathways can lead to collapse in theatre.
🔴 Hypovolaemic shock – loss of circulating volume from bleeding, dehydration, or fluid shifts can reduce cardiac output.
🔴 Distributive shock – conditions such as sepsis or anaphylaxis cause widespread vasodilation, meaning blood volume is present but poorly distributed.
🔴 Cardiogenic shock – the heart fails to pump effectively, often related to myocarditis, cardiomyopathy, arrhythmias, or congenital heart disease.
🔴 Obstructive shock – physical obstruction to cardiac output, such as tension pneumothorax, cardiac tamponade, or major vascular obstruction.
Children often maintain blood pressure during early shock through tachycardia and redistribution of blood to vital organs. Hypotension is therefore a late and concerning sign that decompensation has already occurred.
For perianaesthesia nurses, recognising these early physiological clues is essential. Subtle signs such as tachycardia, delayed capillary refill, altered behaviour, or reduced urine output may be the first indication that a child is deteriorating.
Understanding the possible causes allows the theatre team to anticipate deterioration and escalate early. In paediatric collapse, timing and vigilance can make all the difference.
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References
Green, M. & Patel, T. (n.d.). Paediatric Shock. TeachMePaediatrics.
Wheeler, D. & Basu, R. (2013). Pediatric Shock: An Overview. The Open Pediatric Medicine Journal.
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