Pediatric cardiopulmonary

resuscitation
By B.Malekianzadeh
Pediatric anesthesiologist
Assistant professor of TUMS
 Basic life support (BLS)
BLS is a level of medical care which is used for victims
until they can be given full medical care at a hospital. It
can be provided by trained medical personnel, such as
emergency medical technicians, and by qualified
bystanders.
• Mortality of out of hospital cardiorespiratory arrest in
children is high.

• Survival requires prompt recognition and treatment.

• BLS involves a systematic approach to

Initial patient assessment

Activation of emergency medical services

Initiating of CPR including defibrillation

Key actions:
Verify scene safety

Determine unresponsiveness, get help, activate

EMS

Assess breathing and pulse together

No breathing or only gasping and no
definite pulse after 10 seconds

Single rescuer
unwitnessed: Start CPR (CAB)
witnessed: activate EMS, AED,

Two or more rescuer: Start CPR (CAB)

 CAB
• C: chest compression
• A: Airway
• B: breathing

Compression first, followed by clearing of the airway

and rescue breaths
Chest compression

Infants (younger than one year):

Two finger (one rescuer)

Two thumb-encircling hands (two rescuer)

Chest compression should be performed over the
lower half of the sternum.
The chest should be depressed at least one-third of
its antroposterior diameter with each compression.
Optimum rate of compression: 100-120/min
Each compression and decompression phase should
be of equal duration.
Allowing the chest to recoil fully.
Minimal interruption
Compression to ventilation ratio
One rescuer: 30/2
Two rescuer: 15/2

Once the trachea is intubated, ventilation and

compression can be performed independently.

Ventilation 8-10/min
Compression 100-120/min without pauses
Ventilation
Mouth to mouth
Mouth to nose
Bag and mask

Avoid excessive ventilation

Hyperventilation: increased intrathoracic
pressure and decreased coronary and cerebral
perfusion
The E-C clamp is recommended for bag-mask ventilation
No normal breathing but pulse is present(same actions
for single or multiple rescuer)
Start rescuer breathing by providing 1 breath every 2-3
seconds(20-30 breaths/min)
Add compressions if pulse remains ≤ 60/min with poor
perfusion
Activate EMS if not already done
Continue rescue breathing, check pulse every 2
minutes.
If no pulse: start CPR(CAB)
Initiate CPR in an infant or child who is
unresponsive, has no normal breathing and no
definite pulse after 10 seconds.
Start compression BEFORE performing airway or
breathing maneuvers.
After 30 or 15 compressions open the airway and give 2
breaths.
Pulse>60/min after about 2 minutes of CPR, continue
ventilation.
Apply AED or defibrillator, If rhythm is shockable, give 1
shock and rescue CPR immediately for about 2 minutes or
until prompted by AED.
Effective(a clear and patent) airway support is
an essential component of CPR

Anatomy differences
Airway opening maneuvers
suction
Jaw thrust without neck
extension maneuver

Head tilt–chin lift

Oral airways are available in Sizing an oropharyngeal airway.
many sizes.

The large occiput of an infant or

young toddler
Sizing a nasopharyngeal airway.
AED: automated external defibrillator
• AED is a portable electronic device that
automatically diagnoses the life threatening
cardiac arrhythmias of ventricular fibrillation and
pulseless ventricular tachycardia and able to
treat them through defibrillation.
• It is a component of basic life support.
PALS
PALS: pediatric advanced life spport
• PALS is a set of lifesaving skills and protocols that
extend basic life support to further support the
circulation and provide an open airway and adequate
ventilation.
These include:
Tracheal intubation, rapid sequence induction,
cardiac monitoring, cardiac defibrillation not
using an AED, transcutaneous pacing, intravenous
cannulation(IV), intraosseous (IO) access and
intraosseous infusion, Surgical cricothyrotomy,
needle cricothyrotomy, pleural decompression of
tension pneumothorax, advanced medical
administration
Assessment of an ill or injured child requires
a systematic approach, knowledge of the
anatomic and physiologic differences between
children and adults.
Team work is important when providing
patient care and is essential to patient safety.
The PALS content includes:
Overview of assessment
Recognition and management of respiratory
distress and failure, shock, cardiac arrhythmia,
cardiac arrest.

The clinician should primarily focus on prevention

of cardiopulmonary failure.
Airway management
• Endotracheal intubation as an advanced airway is
recommended in advanced pediatric life support.
• Traditionally, in children uncuffed endotracheal tubes
are used but during the recent years it has been
shown that cuffed tubes have some advantages than
uncuffed tubes.
Reversible causes
5H 5T
• Hypovolemia • Tension pneumothorax
• Hypoxia • Tamponade, cardiac
• Hydrogen ions(acidisis) • Toxins
• Hypoglycaemia • Thrombosis,pulmonary
• Hypo/Hyperkalemia • Thrombosis,coronary
• Hypothermia
Termination of resuscitation
No single factor is reliable enough to accurately
guide whether termination efforts should cease
or continue.
Duration of cardiac arrest
Presenting rhythm (shockable versus asystole or
PEA)
Underlying disease or cause
Setting and available resource
Do not resuscitate status (DNR in some
countries)
‫مالحظات احیا کودکان درپاندمی کووید‬
 ‫‪ CPR‬و انتوباسیون تراشه‪،‬پروسیجرهای تولید کننده آئروسل هستند‪.‬‬

‫لزوم استفاده از حفاظت فردی(‪ )PPE‬شامل عینک محافظ چشم‪،‬ماسک ‪،N95‬دستکش‪،‬گان‬ ‫•‬
‫فقط افراد الزم در اتاق حضور داشته باشند‪.‬‬ ‫•‬
‫بهتر است ‪CPR‬در اتاقهای با فشار منفی انجام شود‪.‬‬ ‫•‬
‫اگر ونتیالسیون با بگ و ماسک بطور موقت الزم است‪،‬حداقل لیک را طی ونتیالسیون‬ ‫•‬
‫فراهم کنید و بین ماسک و بگ از فیلتر ‪ HME‬یا ‪ HEPA‬استفاده کنید‪.‬‬
‫اگر تک نفره قادر به ‪seal‬کردن ماسک نیستید‪،‬دو نفره ماسک بگیرید‪.‬‬ ‫•‬
 ‫• برای انتوباسیون تراشه از لوله کافدار استفاده شود و کاف حتما باد شود‪.‬‬
‫• استفاده از ویدئو الرنگوسکوپ ارجح است‪.‬‬
‫• توقف ‪ chest compression‬طی انتوباسیون‬
‫• کم کردن انتشاز آئروسل با استفاده از وسایل سوپراگلوتیک مثل ماسک حنجره ای قابل‬
‫اعتماد نیست ولی از ‪ face mask‬بهتر است‪.‬‬
‫• در نظر گرفتن پروتکل برای انتوباسیون اورژانس و الکتیو‬
‫• تجویز شل کننده برای پیشگیری از تحریک راه هوایی و سرفه‬
‫• فیلتر ‪HME‬یا ‪ HEPA‬بین لوله تراشه و سیستم ونتیالسیون و در مسیر بازوی بازدمی‬
‫• استفاده ازسیستم ساکشن بسته‬