Cardiopulmonary resuscitation in children

Initial assessment and preparation for CPR

First, you must assess the safety of the scene. If there is a threat to the rescuer, approaching the patient is prohibited, and emergency services must be activated. If the threat is only to the victim, immediate evacuation to a safe zone is required.

Next, the patient's condition is assessed, which includes checking consciousness, breathing, and circulation:

• Checking consciousness. In older children, gentle shoulder shaking and a loud question are permissible. Infants and young children should only be called out to and gently pressed on the extremities. It is strictly forbidden to shake infants due to the risk of severe trauma.
• Calling for help. When activating emergency services, the dispatcher must be provided with the exact coordinates, time of the incident, number of victims, their condition, and the scope of care already being provided.
• Checking breathing. The "look, listen, feel" method is used: you need to tilt the patient's head back, lean over their face, and try to hear exhalation sounds, feel the airflow against your cheek, and see chest movements. Establishing the absence of normal breathing (apnea) is a direct indication to immediately start CPR.

The "ABC" algorithm in children

Unlike adults, for whom early compressions have been prioritized since 2010 (the "CAB" algorithm), cardiac arrest in children most commonly has an asphyxial genesis. Therefore, modern guidelines for pediatric practice retain the classic "ABC" sequence (Peter Safar's ABCs). Each subsequent step is performed only after the successful completion of the previous one.

A (Airways) — Airway patency

The most common cause of obstruction in an unconscious patient is posterior displacement of the tongue due to muscular atonia. Other causes may include foreign bodies, trauma, or tissue edema (e.g., in anaphylaxis or croup syndrome). Actions:

1. Place the patient strictly flat on their back on a hard surface.
2. Perform manual clearance of the oral cavity if foreign masses are present.
3. Tilt the head back (if neck trauma is not suspected) to relieve the base of the tongue.

An oropharyngeal airway may be used to maintain patency, sized by the distance from the corner of the mouth to the earlobe.

B (Breathing) — Artificial ventilation

Mechanical ventilation is performed either by a non-apparatus method (blowing exhaled air through barrier devices) or an apparatus method (using a bag-valve-mask of appropriate volume). For children over 1 year of age, the mouth-to-mouth or mouth-to-nose method is used; for infants, the mouth-to-mouth and nose method. The main criterion for breath effectiveness is chest rise. After a breath, a pause for passive exhalation is mandatory.

C (Circulation) — Artificial circulation

Chest compressions are performed on a hard surface. The rescuer's arms must be straightened at the elbows and positioned perpendicular to the sternum. Pressure is applied using body weight. It is important to fully allow the chest to recoil after each compression without removing the palms from the patient's skin.

Monitoring and termination of resuscitation

One cycle of CPR consists of alternating rescue breaths and compressions (e.g., 2 breaths per 15 or 30 compressions). Every 5 cycles, pulse and breathing must be checked. The pulse check site depends on age: in older children, it is the carotid artery (a. carotis); in infants, the brachial artery (a. brachialis).

Signs of effective CPR:

• Restoration of pink skin and mucous membranes.
• Pupillary constriction (miosis) and the appearance of a light reflex.
• Presence of a pulse in major and then peripheral vessels.
• Appearance of spontaneous breathing.

If spontaneous circulation and breathing are restored, but the patient remains unconscious, they are placed in the post-resuscitation (recovery) position. Older children are placed on their side, and infants are placed on their stomach (prone position) with their head turned to the side.

CPR is stopped upon successful restoration of vital functions, transition to advanced life support (defibrillation), ineffectiveness of measures for 30 minutes, declaration of brain death, or if the rescuer's life is in danger.

Class and exam questions

What else to study on this topic

• Age-related features of compression technique: compression depth, hand placement
• Organizational errors and biomechanical violations during chest compressions
• Advanced life support: early defibrillation, instrumental airway management
• Technique for inserting an oropharyngeal airway
• Reliable signs of biological death

Other topics in "Chapter 13. Main syndromes requiring emergency care"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.