Pediatric BLS

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Neepa Shah, M.D.

Synonyms and keywords:

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.

Classification

• Pediatric Basic Life Support is classified according to age
  • Age - Less than 1 year - Infant Basic Life Support
  • Age - 1 year to Puberty - Child Basic Life Support
  • Age - After Puberty - Adult Basic Life Support

• BLS can be classified as
  • BLS in Out of hospital cardiac arrest (OHCA)
  • BLS inpatient cardiac arrest (IHCA)

Causes of Cardiac arrest(CA) in children

• Ventricular Fibrillation
• Pulseless Ventricular tachycardia
• Children with preexisting cardiac disorders
  • Hypertrophic cardiomyopathy
  • Anomalous coronary artery (from the pulmonary artery)
  • Long QT syndrome
  • Myocarditis
• Drug intoxication (eg, tricyclic antidepressants, digoxin, cocaine)
• Commotio cordis

High - quality CPR Cardiopulmonary resuscitation comprises of effective chest compression and ventilation by rescue breath.

• According to the AHA guidelines 2015,2017,2010, the following are the steps for high-quality CPR.
  • Rate - Rate of CPR is the frequency of the chest compressions in a minute the AHA guidelines recommend 100 compressions per minute.
  • Depth- For high-quality CPR, the depth of the compressions should be 4 cm for infants and 5 cm for children more than 1 year of age.
  • Chest recoil- Allow the chest to recoil during chest compression which allows blood to flow back to the heart and hence the to the other vital organs.
  • CPR with rescue breaths- The above guidelines suggest better neurological complications in children more than 1 year of age who were given CPR with the rescue breaths as compared to children who received Compression- only CPR for cardiac arrest,

Algorithm

• According to the AHA guidelines
• Look out for the safety of yourself as a bystander and the child/infant.
• Call for help if alone and if 2 rescuers are present send one person to call the EMS (Emergency medical service) and get the AED(Automated external defibrillator).
• Check for response ask "What is your name?" Can you hear me"
• Check if the child is breathing,
  • If the child is breathing normally, don't do CPR.
  • If the child is not breathing or is gasping for air start CPR
• Check for a pulse in an infant it is the Brachial pulse. For children above 1 year of age check the Femoral artery pulse or the Brachial pulse, not more than 10 seconds.
• The new AHA guidelines in 2010,2015 have changed the order from "ABC" Airway, Breathing/ventilation, and Chest compressions (or Circulation) to "CAB" Compression (Circulation) Airway and Breathing/Ventilation.
• High-quality chest compressions:
  • For infants - Place 2 fingers below the intermammary line not compressing any rib or xiphoid process and start compressions 100/minute and up to 4 cm or 1.5-inch depth in infants and 5 cm or 2-inch depth in children above 1 year.
  • Use two hands wrapped around the thorax for better grip depending on the size of the child to avoid exhaustion especially if its a lone rescuer.
  • If 2 people are there give 15 chest compressions followed by 2 rescue breaths. Interchange the position every 2 minutes if 2 people are present to avoid exhaustion and ensure high-quality CPR.
  • If there is a single person for CPR give 30 chest compressions followed by 2 rescue breaths.
  • CPR with rescue breaths has more survival benefit in children vs CPR- Only Compressions.
  • In children the majority of the cause for cardiac arrest is Asphyxia .
  • If the lone rescuer is not trained in ventilation then Compression only CPR can be done.
• Ventilation
  • If you are a lone rescuer, follow 30 x 2 cycle which is 30 compressions with 2 breaths. Observe for a chest rise as you are giving ventilation.
  • Use the head tilt and chin lift method to open the airway for injured and non-injured children.
  • If there is no chest rise after mouth to mouth ventilation adjust the neck.
  • Infants- Follow mouth to mouth ventilation, pinch the nose to prevent air movement out of the nose.
    • Mouth to nose ventilation can also be administered, close the mouth to prevent air being lost in the mouth.
  • Children- Follow Mouth to Mouth ventilation with pinching the nose.
  • In each of the rescue breaths make sure the chest rises and quickly resume immediately compressions in 30 x 2 cycle if you are a lone rescuer for improving the survival.