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Successful closed-chest cardiopulmonary resuscitation (CPR), the fundamental life-saving skill, was first reported in 1960, and the American Heart Association (AHA) has published pediatric and neonatal resuscitation guidelines since 1980. Although CPR has been widely taught to healthcare providers (HCPs) and the public, it is only recently that survival from cardiac arrest has improved. This improvement has occurred in association with an emphasis on teaching, monitoring, and improving CPR quality; widespread implementation of lay-rescuer CPR and automated external defibrillation (AED) programs; increased frequency of dispatcher-guided lay-rescuer CPR; and improvements in postcardiac arrest care, including targeted temperature management. Published studies from both out-of-hospital and in-hospital registries have provided additional information about the epidemiology, presentation, and outcome of pediatric cardiopulmonary arrest (CPA) at different ages and in different settings. The AHA Guidelines for Pediatric Basic Life Support (PBLS) and Pediatric Advanced Life Support (PALS) are now based on a continuous, structured international evidence-based review process. The reviews, sponsored by the AHA and the International Liaison Committee on Resuscitation (ILCOR), are posted on ILCOR’s Web site (http://www.ilcor.org./home/), in the Systematic Evidence Evaluation and Review System.
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Neonatal resuscitation guidelines are jointly created by the AHA and the American Academy of Pediatrics. These guidelines target resuscitation in the delivery room, emphasizing establishment of effective ventilation, because inadequate airway and ventilation are the most common problems requiring newborn resuscitation. Neonatal resuscitation guidelines are typically applied during the initial hospitalization of the newborn. The AHA infant Basic Life Support (BLS) and CPR guidelines typically apply to the infant after the initial hospitalization until 1 year of age. If a newborn remains hospitalized for treatment of heart disease, it is appropriate to apply infant CPR guidelines to provide a higher compression-to-ventilation ratio consistent with focus on establishment of adequate blood flow as well as oxygenation and ventilation. The AHA PBLS and CPR guidelines apply to children from 1 year of age to puberty. Adult BLS guidelines apply to adolescents. For ease of teaching and practice, providers in a unit such as a pediatric cardiovascular intensive care unit (ICU) may elect to apply the infant and child CPR guidelines to all patients in the unit.
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In 2010, the AHA recommended a change in the initial sequence of CPR from ABC (airway, breathing, circulation/compressions) to CAB (circulation/compressions, airway, breathing). This change was made because the initial steps of opening the airway and delivering breaths are relatively complicated and often created long delays to initiating chest compressions. Although support of airway, oxygenation, and ventilation is especially important during pediatric cardiac arrest, this change in sequence should delay ventilation only by a few seconds, and is designed to shorten the overall time to initiation of CPR for all victims of cardiac arrest.
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Every step in resuscitation is important, including treating prearrest conditions when possible; immediately identifying the arrest itself and providing high-quality CPR; and seamlessly integrating shock delivery with CPR when needed. Skilled, ...