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Basic life support in infants and children

INTRODUCTION

Early recognition and treatment of sudden cardiac arrest improve survival for children and adults [1-3]. Basic life support (BLS) involves a systematic approach to initial patient assessment, activation of emergency medical services, and the initiation of cardiopulmonary resuscitation (CPR), including defibrillation. Key components of effective CPR include adequate ventilation and chest compressions.

BLS can be performed by trained lay persons, as well as by healthcare providers. This topic will review BLS principles for healthcare providers. Basic airway management for children, neonatal resuscitation, and basic life support for adults is discussed separately. (See "Basic airway management in children" and "Neonatal resuscitation in the delivery room" and "Basic life support (BLS) in adults".)

EPIDEMIOLOGY AND SURVIVAL

Cardiopulmonary arrest among infants and children is typically caused by progressive tissue hypoxia and acidosis as the result of respiratory failure and/or shock [4]. Causes of respiratory failure and shock leading to cardiopulmonary arrest in these age groups include accidents, sudden infant death syndrome, respiratory distress, and sepsis [1,5-7]. This is in contrast to adults, for whom the most common cause of cardiac arrest is ischemic cardiovascular disease. (See "Basic life support (BLS) in adults", section on 'Epidemiology and survival'.)

Overall survival rates vary between 4 and 40 percent for infants and children who have had out-of-hospital cardiopulmonary arrest [1,6-10]. Increased survival rates occur in pediatric patients who receive early CPR and those with an initial cardiac arrest rhythm of ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) [1,9,10]. For example, in one multicenter observation study of 78 children with out-of hospital cardiopulmonary arrest, 50 percent of children who received CPR within four minutes of arrest and 22 percent of children with an initial rhythm of VF or pVT survived compared with an overall survival rate of 14 percent [1]. In another observational study of 361 patients with cardiopulmonary arrests including 90 children younger than 14 years of age cared for by a regional emergency medical service agency, overall survival rate was 27 percent [9]. Survival was significantly improved in patients who had a witnessed arrest (OR 13.4), received bystander CPR (OR 3.2), and had an initial rhythm of VF or pVT (OR 9.4). Thus early recognition of cardiopulmonary arrest and prompt initiation of CPR are essential to successful resuscitation of children with cardiopulmonary arrest.  

Among children with in-hospital cardiopulmonary arrest, acute resuscitation survival approaches 78 percent and survival to discharge occurs in 39 to 65 percent of patients who receive cardiopulmonary resuscitation (CPR) [11-13]. In one multicenter observational study of 1031 children with in-hospital cardiopulmonary arrests occurring in academic pediatric hospitals over a 10 year period (2000 to 2009), adjusted survival to discharge increased from 14 to 43 percent while the rates of significant neurologic disability remained stable [12]. This improvement in survival occurred despite a high prevalence of asystole and pulseless electrical activity (PEA) found as the initial arrest rhythm (up to 85 percent of patients) and was similar regardless of the initial cardiac arrest rhythm (ventricular fibrillation, pulseless ventricular tachycardia, asystole or PEA). The use of extracorporeal membrane oxygenation during resuscitation and postresuscitation care (ECPR) significantly increased from 8 to 14 percent of patients during the study but was not associated with overall survival to discharge.

               

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Literature review current through: Sep 2014. | This topic last updated: May 20, 2014.
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