Pediatric cardiopulmonary resuscitation

Abstract

Our aim is to summarize the new European Resuscitation Council (ERC) 2021 guidelines on paediatric life support. In children, exhaustion of compensatory mechanisms in respiratory or circulatory failure leads to cardiac arrest. Recognition and treatment of children in critical condition are the most important element of its prevention. With the ABCDE approach, life-threatening problems can be identified and treated using simple interventions (bag-mask ventilation, intraosseous access, fluid bolus, etc.). Important new recommendations: 4-hand ventilation during bag-mask ventilation, target saturation of 94-98% during oxygen therapy, and fluid bolus of 10 ml/kg. In pediatric basic life support, if there is no normal breathing after 5 initial rescue breaths in absence of signs of life, chest compression should be initiated immediately using primarily two-thumb encircling method for infants. Recommended rate is 100-120/min, ratio of compression to ventilation is 15:2. Pediatric advanced life support is a teamwork. The structure of the algorithm is unchanged, high-quality chest compression is still a paramount. Recognition and treatment of potential reversible causes (4H-4T) and the decisive role of focused ultrasound are emphasized. New features: recommendation of 4-hand technique bag-mask ventilation, role of capnography, and age-dependent ventilatory rate in the case of continuous chest compression after endotracheal intubation. Drug therapy is unchanged, the fastest way to administer adrenaline during resuscitation is via intraosseous access. Treatment after return of spontaneous circulation decisively influences neurological outcome. Patient care is further based on the ABCDE scheme. Important goals are maintaining normoxia, normocapnia, avoiding hypotension, hypoglycemia, fever and use of targeted temperature management. Orv Hetil. 2023; 164(12): 463-473.