Pediatric basic life support for healthcare providers
- Pamela Bailey, MD
Pamela Bailey, MD
- Assistant Professor
- Baylor College of Medicine
- Susan B Torrey, MD
Susan B Torrey, MD
- Section Editor — Pediatric Resuscitation; Pediatric Trauma
- Director, Division of Pediatric Emergency Medicine
- Associate Professor of Emergency Medicine and Pediatrics (Clinical)
- NYU School of Medicine
- Section Editor
- Gary R Fleisher, MD
Gary R Fleisher, MD
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Pediatric Signs and Symptoms
- Egan Family Foundation Professor
- Harvard Medical School
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
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 laypersons, as well as by healthcare providers. This topic will review BLS principles for healthcare providers. Basic airway management for children, neonatal resuscitation, and BLS 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 . Causes of respiratory failure and shock leading to cardiopulmonary arrest in these age groups include trauma, sudden infant death syndrome, respiratory distress, and sepsis [1,5-8]. 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'.)
Survival following pediatric cardiac arrest varies according to the site of arrest:
●Out-of-hospital arrest – Out-of-hospital pediatric arrests often occur at or near home and are frequently unwitnessed [8,9]. Based upon observational studies, survival to discharge is approximately 3 to 4 percent for infants younger than one year of age [6,7], 9 to 11 percent for children 1 to 11 years of age [8,10] and 9 to 16 percent for adolescents [8,10].
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- Part 2: Adult Basic Life Support. Circulation 2005; II2:III5.
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- Kleinman ME, de Caen AR, Chameides L, et al. Pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Pediatrics 2010; 126:e1261.
- Abella BS, Alvarado JP, Myklebust H, et al. Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. JAMA 2005; 293:305.
- Wik L, Kramer-Johansen J, Myklebust H, et al. Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest. JAMA 2005; 293:299.
- Berg RA, Sanders AB, Milander M, et al. Efficacy of audio-prompted rate guidance in improving resuscitator performance of cardiopulmonary resuscitation on children. Acad Emerg Med 1994; 1:35.
- Kitamura T, Iwami T, Kawamura T, et al. Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study. Lancet 2010; 375:1347.
- Ogawa T, Akahane M, Koike S, et al. Outcomes of chest compression only CPR versus conventional CPR conducted by lay people in patients with out of hospital cardiopulmonary arrest witnessed by bystanders: nationwide population based observational study. BMJ 2011; 342:c7106.
- Kleinman ME, Chameides L, Schexnayder SM, et al. Part 14: pediatric advanced life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122:S876.
- Mogayzel C, Quan L, Graves JR, et al. Out-of-hospital ventricular fibrillation in children and adolescents: causes and outcomes. Ann Emerg Med 1995; 25:484.
- Cecchin F, Jorgenson DB, Berul CI, et al. Is arrhythmia detection by automatic external defibrillator accurate for children?: sensitivity and specificity of an automatic external defibrillator algorithm in 696 pediatric arrhythmias. Circulation 2001; 103:2483.
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- Divekar A, Soni R. Successful parental use of an automated external defibrillator for an infant with long-QT syndrome. Pediatrics 2006; 118:e526.
- Bar-Cohen Y, Walsh EP, Love BA, Cecchin F. First appropriate use of automated external defibrillator in an infant. Resuscitation 2005; 67:135.
- Markenson D, Pyles L, Neish S, et al. Ventricular fibrillation and the use of automated external defibrillators on children. Pediatrics 2007; 120:e1368.
- EPIDEMIOLOGY AND SURVIVAL
- INTERNATIONAL RESUSCITATION GUIDELINES
- BASIC LIFE SUPPORT ALGORITHMS
- CHEST COMPRESSIONS
- - Two fingers
- - Two thumb-encircling hands
- COMPRESSION TO VENTILATION RATIO
- Conventional versus compression-only CPR
- AUTOMATED EXTERNAL DEFIBRILLATOR
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS