Pediatric Basic Life Support(BLS) Changes made in the new AHA guidelines 2010,2015,2017,2019
Jump to navigation
Jump to search
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Neepa Shah, M.B.B.S.[2]
Overview
Pediatric Basic Life Support is a life-saving skill comprising of high quality CPR (Cardiopulmonary Resuscitation) and Rescue Breadths with Artificial External Defibrillator (AED).
- Bystander CPR - Bystander resuscitation plays a key role in out of hospital CPR. A study by Maryam Y Naim et all found out communities, where bystander CPR is practiced, have better survival outcomes in children less than 18 years from out of hospital cardiac arrest(CA)
- Two studies (Total children 781) concluded that about half of the Cardio-Respiratory arrests in children under 12 months occur outside the hospital.
- Good Prognostic Factor upon arrival at the emergency department-
- The short interval between arrest and arrival at the hospital.
- Less than 20 minutes of resuscitation in the emergency department.
- Less than 2 doses of epinephrine.
References
Changes made in the new AHA guidelines 2010,2015,2017,2019
According to the 2010,2015,2017,2019 Pediatric BLS Guidelines, the following changes were made and are followed:
Pediatric BLS algorithm for single and 2 or more rescuers
- For single rescuers start with 30 compressions followed by 2 rescue breaths.
- For 2 or more rescuers start with 15 compressions followed by 2 rescue breaths and then both rescuers should change the positions alternating between compressions and breathing every 2 minutes.
Change of order of A-B-C TO C-A-B
- A-B-C is airway, breathing, and compressions in that order. C-A-B is compression, airway, and breathing.
- This change was advised by the 2010 guidelines but in 2015 there is more evidence supporting this sequence of CPR.
- Evidence
- Manikin studies in both adult and children shows a decrease in time to achieve the first chest compressions by following C-A-B compared to A-B-C.
- The delay in getting to ventilation was of 6 seconds compared with the new C-A-B compared to A-B-C
Chest compression rate and depth
- Adult model for compression rate and depth is to be followed for pediatrics cases due to lack of evidence.
- More studies need to be found for the pediatric rate of compressions.
- A study by Sutton RM et al reported among 87 pediatric CPR of more than 8 years of age, found that compression depth greater than 51 mm for more than 60% of the compressions during 30-second epochs within the first 5 minutes was associated with improved 24-hour survival.[1]
Compression-only (Hands-Only) CPR [1]
- Adult BLS protocols advise for CPR-Only resuscitation to achieve more compressions.
- Pediatric cardiac arrest are majority due to asphyxia.[2] Hence for children, it is advised to continue with CPR with rescue breaths.
- If the rescuer is not trained or is not able to give rescue breaths then CPR-Only resuscitation is advised.
References
- ↑ 1.0 1.1 Atkins DL, Berger S, Duff JP, Gonzales JC, Hunt EA, Joyner BL; et al. (2015). "Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care". Circulation. 132 (18 Suppl 2): S519–25. doi:10.1161/CIR.0000000000000265. PMID 26472999.
- ↑ de Caen AR, Maconochie IK, Aickin R, Atkins DL, Biarent D, Guerguerian AM; et al. (2015). "Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations". Circulation. 132 (16 Suppl 1): S177–203. doi:10.1161/CIR.0000000000000275. PMID 26472853.