ABC or CAB sequence in paediatric cardiopulmonary resuscitation?

Abstract

Quality cardiopulmonary resuscitation is essential for a per­son in cardiac arrest. Survival chances and subsequent qua­lity of life depend on timely quality resuscitation. For over 40 years, in all types of patients, ABC sequence was in­ter­na­tio­nally accepted. Although in-hospital cardiac ar­­rest prognosis has significantly improved in recent years, the survival was lower in out-of-hospital cardiac arrest, especially in infants and children. In an attempt to improve post-cardiac arrest survival, since 2010, based on studies published after 2000, a CAB sequence has been recommended in adults, in order to reduce the time to chest compressions. This is partly sustained by the fact that, in adults, the main cause of cardiac ar­rest is a cardiovascular disease. For resuscitation at birth, the ABC sequence is maintained, but controversy per­sists with respect to approach of cardiac arrest in in­fants and children. The American Heart Association and the American Academy of Pediatrics recommend the use of CAB sequence, for similar reasons as those for adults. The European Resuscitation Council recommends main­tai­ning the traditional ABC sequence, arguing that most of the cases of cardiac arrest in children are caused by a res­pi­ra­tory disease. Pro and counter arguments for the two options are discussed in the paper. For the time being, a practical and logical conclusion would be the use of the ABC sequence in cardiac arrest of respiratory origin and CAB in those of cardiac origin – as long as the cause can be rapidly identified, based on the patient’s status and the context in which cardiac arrest has occurred.