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Although resuscitation is a widely taught routine, a formalized approach to resuscitating an infant or child is a relatively recent development. The first published report of successful closed-chest resuscitation in 1960 contained details about the resuscitation of a 9-year-old with respiratory arrest and a 12-year-old with anesthesia-induced cardiac arrest. The first guidelines for pediatric basic life support (PBLS) and neonatal resuscitation were in 1980.1 Initial guidelines for pediatric advanced life support (PALS) were published in 1986.2 Recent research, prehospital series, and inhospital registry data have provided additional information about the epidemiology, presentation, and outcome of pediatric cardiopulmonary arrest (CPA) at different ages. As a result, the 2005 AHA guidelines recommended applying pediatric basic life support guidelines to children up to approximately age 12 (or whenever the physical signs of puberty begin) and emphasized differing priorities based on type and circumstances of arrest. For all victims of CPA, the guidelines now emphasize the importance of providing effective chest compressions with minimal interruptions.

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From 1980 to 2005, American Heart Association (AHA) pediatric basic life support (PBLS) guidelines were written for children up to approximately 8 years of age. They emphasized establishing effective oxygenation and ventilation, with less emphasis on immediate identification and treatment of arrhythmias. These priorities were based on consensus of experts and the limited published data documenting infrequency of “shockable” rhythms in pediatric arrest. The guidelines did recommend defibrillation for sudden, witnessed arrest in all ages. Recent research, prehospital series, and in-hospital registry data have provided additional information about the epidemiology, presentation, and outcome of pediatric cardiopulmonary arrest (CPA) at different ages. As a result, the 2005 AHA guidelines recommended applying pediatric basic life support guidelines to children up to approximately age 12 (or whenever the physical signs of puberty begin) and emphasized differing priorities based on type and circumstances of arrest. For all victims of CPA, the guidelines now emphasize the importance of providing effective chest compressions with minimal interruptions.

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It is now clear that resuscitation must be tailored to the type of cardiopulmonary arrest. Evidence in adults suggests that effective protocol-driven postresuscitation care can improve intact neurological survival from cardiopulmonary arrest. Every step in resuscitation is important, including recognizing prearrest conditions, identifying the arrest itself, supporting appropriate oxygenation and ventilation, delivering effective chest compressions with minimal interruptions, and, if defibrillation is needed, seamlessly integrating shock delivery with CPR. Thus, pediatric health care providers must prevent cardiac arrest when possible and must be prepared to perform skilled resuscitation and postresuscitation care when needed.

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Estimating the incidence of cardiopulmonary arrest in children has been complicated by inconsistent definitions of arrest and limited data. International resuscitation experts have developed two templates for reporting outcomes of pediatric resuscitation. In 1995, an international consensus group published the pediatric Utstein criteria to facilitate uniform reporting of pediatric resuscitation data.3 This pediatric template included criteria for documenting both prehospital and in-hospital arrests. It also suggested optional reporting of data regarding ...

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