Pediatric Basic Life Support(BLS) Changes made in the new AHA guidelines 2010,2015,2017,2019
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 [1] 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.[2]
References
- ↑ Naim MY, Burke RV, McNally BF, Song L, Griffis HM, Berg RA; et al. (2017). "Association of Bystander Cardiopulmonary Resuscitation With Overall and Neurologically Favorable Survival After Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Report From the Cardiac Arrest Registry to Enhance Survival Surveillance Registry". JAMA Pediatr. 171 (2): 133–141. doi:10.1001/jamapediatrics.2016.3643. PMID 27837587.
- ↑ Sahu S, Kishore K, Lata I (2010). "Better outcome after pediatric resuscitation is still a dilemma". J Emerg Trauma Shock. 3 (3): 243–50. doi:10.4103/0974-2700.66524. PMC 2938489. PMID 20930968.
Changes made in the new AHA guidelines 2010,2015,2017,2019
According to the 2015 Pediatric BLS Guidelines, the following changes were made
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.[1]
- Evidence [2]
- 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[3].
- More studies need to be found for the pediatric rate of compressions.
- A study by Sutton RM et al[4] 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.[3]
Compression-only (Hands-Only) CPR [3]
- Adult BLS protocols advise for CPR-Only resuscitation to achieve more compressions.
- Pediatric cardiac arrest are majority due to asphyxia.[1] 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 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.
- ↑ Lubrano R, Cecchetti C, Bellelli E, Gentile I, Loayza Levano H, Orsini F; et al. (2012). "Comparison of times of intervention during pediatric CPR maneuvers using ABC and CAB sequences: a randomized trial". Resuscitation. 83 (12): 1473–7. doi:10.1016/j.resuscitation.2012.04.011. PMID 22579678.
- ↑ 3.0 3.1 3.2 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.
- ↑ Sutton RM, French B, Niles DE, Donoghue A, Topjian AA, Nishisaki A; et al. (2014). "2010 American Heart Association recommended compression depths during pediatric in-hospital resuscitations are associated with survival". Resuscitation. 85 (9): 1179–84. doi:10.1016/j.resuscitation.2014.05.007. PMC 4138295. PMID 24842846.