Basic life support

The need for CPR in the pediatric age group is rare after the neonatal period. Pediatric cardiac arrests usually result from hypoxemia linked to respiratory failure or airway obstruction. Initial efforts should be directed toward the establishment of a secure airway and adequate ventilation. The pediatric guidelines apply to infants between the ages of about 1 month and 1 year and to children more than 1 year of age. For newborns, see the next section. The definition of “children” for healthcare providers is patients between the ages of 1 year and the start of puberty; for the lay public, a child is defined as aged 1 to 8 years. In contrast to the guideline of “phone first” for adult CPR, one should “phone fast” for infants and children. That is, the lone rescuer should perform five cycles (about 2 minutes) of CPR before phoning 911. The “phone fast” rule also applies to resuscitation from drowning, traumatic arrest, or drug overdose. Exceptions include witnessed and sudden arrests (eg, an athlete who collapses on the playing field) or situations in which a child is known to be at high risk for a sudden arrhythmia. Modifications to the rate and magnitude of compressions and ventilations, as well as to the hand positions for compressions are necessary because of anatomic and physiologic differences (Table 39.2). Differences between pediatric and adult resuscitation techniques are detailed below. Airway and breathing Maneuvers to establish an airway are the same as in the adult, with a few caveats. For children less than 1 year of age, abdominal thrusts are not used in the setting of airway foreign body obstruction since the gastrointestinal tract can be damaged easily. Hyperextension of an infant’s neck for the head tilt-chin lift may lead to airway obstruction because of the small diameter and ease of compression of the immature airway. Submental compression while performing the chin lift can also lead to airway obstruction by pushing the tongue into the pharynx. Ventilations should be given slowly and with low airway pressures to avoid gastric distention and should be of sufficient volume to cause visible chest rise and fall.