Pediatric Basic Life Support(BLS) Changes made in the new AHA guidelines 2010,2015,2017,2019: Difference between revisions
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=='''Overview'''== | =='''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)]]. | 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 | * 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. | * Two studies (Total children 781) concluded that about half of the Cardio-Respiratory arrests in children under 12 months occur outside the hospital. | ||
| Line 9: | Line 9: | ||
**The short interval between arrest and arrival at the hospital. | **The short interval between arrest and arrival at the hospital. | ||
**Less than 20 minutes of resuscitation in the emergency department. | **Less than 20 minutes of resuscitation in the emergency department. | ||
**Less than 2 doses of epinephrine. | **Less than 2 doses of epinephrine. | ||
=='''References'''== | =='''References'''== | ||
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=='''Changes made in the new AHA guidelines 2010,2015,2017,2019'''== | =='''Changes made in the new AHA guidelines 2010,2015,2017,2019'''== | ||
According to the 2015 Pediatric BLS Guidelines, the following changes were made | 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 === | ===[[Pediatric BLS|Pediatric BLS algorithm]] for single and 2 or more rescuers === | ||
*For single rescuers start with 30 compressions followed by 2 rescue breaths. | *For single rescuers start with 30 compressions followed by 2 [[Rescue breathing|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. | *For 2 or more rescuers start with 15 compressions followed by 2 [[Rescue breathing|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 === | === 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. | *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. | *This change was advised by the 2010 guidelines but in 2015 there is more evidence supporting this sequence of CPR. | ||
*Evidence | *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. | **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 | **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 === | === Chest compression rate and depth === | ||
*Adult model for compression rate and depth is to be followed for pediatrics cases due to lack of evidence | *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. | *More studies need to be found for the pediatric rate of compressions. | ||
*A study by Sutton RM et al | *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.<ref name="pmid26472999">{{cite journal| author=Atkins DL, Berger S, Duff JP, Gonzales JC, Hunt EA, Joyner BL | display-authors=etal| title=Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. | journal=Circulation | year= 2015 | volume= 132 | issue= 18 Suppl 2 | pages= S519-25 | pmid=26472999 | doi=10.1161/CIR.0000000000000265 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26472999 }} </ref> | ||
=== Compression-only (Hands-Only) CPR <ref name="pmid26472999">{{cite journal| author=Atkins DL, Berger S, Duff JP, Gonzales JC, Hunt EA, Joyner BL | display-authors=etal| title=Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. | journal=Circulation | year= 2015 | volume= 132 | issue= 18 Suppl 2 | pages= S519-25 | pmid=26472999 | doi=10.1161/CIR.0000000000000265 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26472999 }} </ref> === | === Compression-only (Hands-Only) CPR <ref name="pmid26472999">{{cite journal| author=Atkins DL, Berger S, Duff JP, Gonzales JC, Hunt EA, Joyner BL | display-authors=etal| title=Part 11: Pediatric Basic Life Support and Cardiopulmonary Resuscitation Quality: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. | journal=Circulation | year= 2015 | volume= 132 | issue= 18 Suppl 2 | pages= S519-25 | pmid=26472999 | doi=10.1161/CIR.0000000000000265 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26472999 }} </ref> === | ||
*Adult BLS protocols advise for CPR-Only resuscitation to achieve more compressions. | *[[Bls|Adult BLS]] protocols advise for [[CPR]]-Only resuscitation to achieve more compressions. | ||
*Pediatric cardiac arrest are majority due to asphyxia.<ref name="pmid26472853">{{cite journal| author=de Caen AR, Maconochie IK, Aickin R, Atkins DL, Biarent D, Guerguerian AM | display-authors=etal| title=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. | journal=Circulation | year= 2015 | volume= 132 | issue= 16 Suppl 1 | pages= S177-203 | pmid=26472853 | doi=10.1161/CIR.0000000000000275 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26472853 }} </ref> Hence for children, it is advised to continue with CPR with rescue breaths. | *[[Sudden cardiac death|Pediatric cardiac arrest]] are majority due to [[asphyxia]].<ref name="pmid26472853">{{cite journal| author=de Caen AR, Maconochie IK, Aickin R, Atkins DL, Biarent D, Guerguerian AM | display-authors=etal| title=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. | journal=Circulation | year= 2015 | volume= 132 | issue= 16 Suppl 1 | pages= S177-203 | pmid=26472853 | doi=10.1161/CIR.0000000000000275 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26472853 }} </ref> Hence for children, it is advised to continue with CPR with [[Rescue breathing|rescue breaths]]. | ||
*If the rescuer is not trained or is not able to give rescue breaths then CPR-Only resuscitation is advised. | *If the rescuer is not trained or is not able to give [[Rescue breathing|rescue breaths]] then [[CPR]]-Only resuscitation is advised. | ||
=='''References'''== | =='''References'''== | ||
Latest revision as of 10:15, 11 July 2020
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.