Recommendations on Paediatric Basic Life Support

Abstract

Unlike adult patients, infants and children usually suffer cardiac arrest as the terminal event in conditions resulting in progressive respiratory and circulatory failure. The cessation of respiratory efforts almost always precedes bradycardia and cessation of spontaneous circulation. The haemodynamic deterioration occurs in a context of arterial hypoxemia, myocardial ischaemia and profound acidosis (Fig. 1). On the contrary, the most frequent adult CPR recipient is an otherwise healthy individual with a primary ventricular dysrhythmia and there is normal oxygenation and circulation immediately prior to cardiac arrest. In paediatrics, respiratory and circulatory failure, resulting from a variety of medical diseases or injuries, leads to inadequate gas exchange with progressive hypoxemia, hypercarbia and acidosis and culminates in asystolic cardiac arrest. The commonest underlying cause of cardiac arrest in children is respiratory failure. The cessation of circulation is preceded by respiratory distress and may result from lung or airway diseases, such as pneumonia, pneumothorax, asthma, bronchiolitis, croup, epiglottis and thoracic trauma. Cardiac arrest preceded by respiratory depression is caused by prolonged convulsions, central nervous system trauma, raised intracranial pressure, neuromuscular pathology and poisoning. The second main pathway to cardiac arrest in children is through circulatory shock, caused most frequently by sepsis, haemorrhages, traumatic blood loss and fluid loss brought about by vomiting and/or diarrhoea (Fig. 1) [1, 2]. Cardiac arrest does not occur in paediatrics until the child’s physiologic reserves are exhausted. Primary sudden cardiac arrest is very rare. Ventricular fibrillation has always been reported in less than 10% of children with pulseless arrest [1–3]. A recent study confirms that asystole was the most common presenting rhythm (83%), pulseless electric activity occurred in 12% and ventricular fibrillation in 4% [4]. Ventricular fibrillation and pump failure are more likely in children with complex congenital heart diseases and seen most frequently in the paediatric intensive care ward of a cardiothoracic unit. Neonates are less likely to develop ventricular tachyarrhythmias than older children, probably because of insufficient cardiac mass and different balance between α and β adrenergic receptors [5].