Cardiopulmonary Resuscitation

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Cardiopulmonary Resuscitation

• Shamiel Salie
• Paediatric Intensive Care Unit
• Red Cross Childrens Hospital,
• University of Cape Town

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BasicLifeSupport
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Age Definitions

• Newborn
• Infant - under 1 year
• Child - from 1 year to puberty

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2005 BLS Changes

• Lay rescuers should start compressions for an
  unresponsive child who is not breathing/moving
• Universal compression-ventilation ratio of 302
  for the lone rescuer of infants, children and
  adults
• Increased evidence on the importance of
  uninterrupted chest compressions

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Compression Techniques

• Position
• for all ages compress the lower third
  of the sternum
• number of hands
• In infants two thumbs or two fingers
• in children use one or two hands depressing the
  sternum by approximately one third of the depth
  of the chest

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Chest Compressions

• Push hard
• Push Fast
• Complete chest recoil
• Minimize interruptions

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Calling for help!!

• Perform 5 cycles or about 2 minutes of CPR before
  calling for help
• Indications for activating EMS before BLS by a
  lone rescuer are
• witnessed sudden collapse with no apparent
  preceding morbidity
• witnessed sudden collapse in a child with a known
  cardiac abnormality

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Choking
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Universal Algorithm
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Asystole and PEA
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VF/VT
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Neonatal Resuscitation
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Drugs in Cardiac Arrest

• 10mcg/kg of adrenalin as the first and subsequent
  iv doses.
• high dose iv adrenalin is not recommended and may
  be harmful
• Insufficient evidence to recommend for or against
  the routine use of vasopressin in children

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Route of drug delivery in ALS

• where possible give drugs intra-vascularly rather
  than via the tracheal route
• lower adrenaline concentrations may produce
  transient beta adrenergic effects resulting in
  hypotension.
• Intra-osseous access is safe for fluid
  resuscitation and drug delivery.

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Airway Management

• guedel airways
• laryngeal airways
• Cuffed or uncuffed endotracheal tubes

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Do children have Ventricular fibrillation?
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Number of Defibrillating Shocks

• one shock rather than three stacked shocks
• Modern biphasic defibrillators have a high first
  shock efficacy
• Most patients have a non perfusing rhythm after
  successful defibrillation

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AED IN CHILDREN

• Age gt 8 years
• use adult AED
• Age 1-8 years
• use paediatric pads / settings if available
  (otherwise use adult mode)
• Age lt 1 year
• use only if manufacturer instructions indicate it
  is safe

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Fluid Resuscitation

• Boluses of fluid may be required to maintain
  systemic perfusion
• Crystalloids - ringers or normal saline
• Septic children may require in excess of 100ml/kg
  fluid resuscitation

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Family Presence during Resuscitation

• Evidence suggests that the majority of parents
  would like to be present during resuscitation,
  that they gain a realistic understanding of the
  efforts made to save the child, and they
  subsequently show less anxiety and depression.

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When do you start?
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When do you stop?

• In the absence of reversible causes eg drowning
  with severe hypothermia, poisoning, prolonged CPR
  in children is unlikely to result in intact
  neurological survival.
• One should consider stopping resuscitation after
  20 minutes.

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Post Resuscitation Care

• Ventilate to normo-capnoea
• Hypothermia for 12-24 hours post arrest may be
  helpful, whilst hyperthermia should be treated
  aggressively
• Vaso-active drugs should be considered to
  improve haemodynamic status.
• Maintain normoglycaemia

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Conclusions

• The 2005 guidelines minimizes the differences in
  the steps and techniques of CPR used for infants,
  children and adults.
• Push hard, push fast, minimizing interruptions
• Respiratory failure and hypoxia is the commonest
  reason for paediatric arrests.
• There are usually warning signs of impending
  doom, and early and effective therapy will
  prevent cardiac arrest

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Questions