Chapter 37. Paediatric cardiac arrest
Introduction
Cardiorespiratory arrest in children is a much rarer event than in adults. Unfortunately, the outcome for children is much worse. In children the underlying event is usually hypoxia followed by a respiratory arrest and it is easier to prevent paediatric respiratory arrest than to treat it. For the youngest children (i.e. infants) the most common clinical cause is sudden infant death syndrome. For older children, the underlying cause is hypoxia which is secondary to severe sepsis, drowning, poisoning, aspiration and trauma.
Basic life support
Infants (aged under 1 year)
• For infants, basic life support (BLS) starts with checking for responsiveness by shaking while shouting for help
• The next step is to open the airway by tilting the head and lifting the chin
• When this is achieved, the presence of breathing is assessed by looking, listening and feeling for any signs of respiration
• If breathing is found to be absent deliver five rescue breaths. When this has been performed, the next step is to check for a brachial pulse.
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| Figure 37.1. |
| Paediatric basic life support (Resuscitation Council UK). The authors are aware of impending changes in resuscitation guidelines (late 2010). Refer to: www.resus.org.uk for further up-to-date information. |
In infants check the brachial pulse
• If the pulse is absent or the infant is found to be significantly bradycardic (i.e. the pulse rate is less than 60/min) then chest compressions should begin
• To achieve this, two fingers are placed on the lower sternum, a finger’s breadth beneath the nipple line. The chest is compressed by approximately one-third of its depth and five rapid compressions are administered
• Alternatively, use the encircling technique. Place both thumbs, side by side, on the lower third of the sternum with the tips pointing towards the infant’s head, encircle the lower part of the rib cage with the fingers and depress the rib cage with the thumbs by at least one-third of the depth of the chest.
• If the pulse is below 60/min, commence basic life support
• Ratio of: 15 chest compressions : 2 rescue breaths
• Rate 100–120 compressions per minute.
The paramedic crew attending such a call should continue basic life support measures while more advanced life support techniques are considered.
Children (aged over 1 year)
• For children over 1 year old, the same algorithm is followed with some slight differences
• Cardiac output can be established by feeling the carotid pulse
• Chest compressions can be given with the heel of one hand or with a two-handed technique, whichever is the most effective for the size of the patient
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