This chapter reviews CPR in children and pertinent differences
from adults. One major difference between adult and pediatric cardiopulmonary
arrest is the cause of the arrest. The most common cause of primary cardiac
arrest in adults is coronary artery disease. Respiratory failure
and shock are more common causes among children and infants. After
resuscitation, survival to discharge may be greater among children
and adolescents than in infants or adults.1–3 After a cardiac arrest, the survival rate without devastating neurologic
sequelae in children is only 2%.4 The best
chance for a good outcome is to recognize impending respiratory failure
or shock and intervene to prevent the development of cardiopulmonary
Age-related differences are important considerations when treating
children. An appropriate drug dose for a 6-month-old infant may
be excessive for a 1-month-old newborn but inadequate for a 5-year-old
child. Other aspects of resuscitation, such as endotracheal tube
size, tidal volumes, cardiac compression rates, and respiratory
rates, vary with a child’s age. Equipment selection and
medication dosing are based upon age and body weight. Valuable time
can be lost in weight estimation, dosage calculations, and equipment
selection. Emergency personnel must be able to find the proper equipment
rapidly. Equipment can be stored on shelves or in drawers labeled
by age and weight, or a system of color codes can be used in which
color-coded shelves, carts, or equipment organizers correspond to
specific length categories as illustrated in Figures 15-1, 15-2, and 15-3.
The Broselow resuscitation tape. (Courtesy of Rita K. Cydulka,
MD, MS, MetroHealth Medical Center.)
Equipment side of the Broselow resuscitation tape. One of
seven color equipment zones. (Courtesy of Rita K. Cydulka, MD, MS, MetroHealth
Drug side of the Broselow resuscitation tape. One of
25 precalculated weight zones for resuscitation drugs. (Courtesy
of Rita K. Cydulka, MD, MS, MetroHealth Medical Center.)
The American Heart Association (AHA) Guidelines4,5 use
the following age group delineations: newborn,
1 month or less in age; infant, 1 month to 1 year
of age; child, 1 year of age to the onset of puberty.
As in adults, the priorities of resuscitation are airway, oxygenation,
ventilation, and shock management. Cardiopulmonary arrest may be
prevented with prompt recognition of and intervention for compromised
physiology.5 International consensus guidelines
for BLS procedures are listed in Table 15-1.6
Table 15-1 Guidelines for Pediatric BLS |Favorite Table|Download (.pdf)
Table 15-1 Guidelines for Pediatric BLS
|Maneuver||Newborn||Infant <1 Y||Child 1 Y to Puberty||Adult Onset of Puberty|
|Airway||Head tilt/chin lift||Head tilt/chin lift||Head tilt/chin ...|
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