++
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.
++
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.
++
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.
++
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 ...