cpr in childhood 2013

CPR IN CHILDHOOD

Ötvös Tamás m.d.

2013

Summary of changes since 2005

Lay rescuers have to start the CPR if the patient doesn’t breath well for 10sec

Healthcare providers can add looking for pulse (carotid, brachial, femoral)

CV-ratio:Lay rescuers 30:2Professionals 15:2 (30:2)

Summary of changes since 2005

Compression technique:For infants:

○ 2 finger for single rescuer○ 2 thumb encircling for at least 2 rescuers

For older children:○ 1 or 2 hand technique

Depth: 1/3 of the AP chest diameterCompression rate: 100-120/min

Summary of changes since 2005

DefibrillationModified or unmodified AED can be used

over the age 1 yearManual defibrillators: 4Joule/kgAntero-lateral or antero-posterior position

Airway:Cuffed tubes are safe (except newborns)Cricoid pressure (safe?)Capnometry is recommended

Paediatric Basic Life Support

Ensure the safety Check the responsiveness

Gently stimulate and ask:”are you all right?”Answering&moving: leave in position, check

his condition and get help, re-assess Shout for help Open the airways

Head tilt chin liftJaw thrust

Paediatric Basic Life Support

Keep the airway open, check the breathing for 10 secIf breathing, recovery position, get help&re-

assessAbsent of breathing

○ Remove any obvious airway obstruction○ Give 5 initial rescue breaths

Paediatric Basic Life Support

Asses circulation(no more than 10 sec)Look for signs of life (movement, coughing,

breathing)Check the pulse (professionals)

○ >1 year-carotid or femoral○ <1 year-brachial or femoral

Paediatric Basic Life Support

If there are no signs of life:Start chest compressionsCombine with rescue breathing

Chest compressions:100-120/minThe lower half of the sternum1/3 deep of the AP chest diameter>1 year: 1 or 2 hands technique<1 year: 2fingers(alone) or encircling way

Paediatric Basic Life Support

Continue CPR until:The child shows sign of lifeFurther qualified help arrivesYou become exhausted

Paediatric Basic Life Support

When to call Help?If there are 2 rescuers, one call helpIf there is 1 rescuer, after 1 min CPRIn the case of a child with a witnessed,

sudden collapse & the rescuer is alone (arrhytmia!!!)

Paediatric Advanced Life Support

During CPR Ensure high quality CPR: rate, depth, recoil Plan actions before interrupting CPR Give oxygen Vascular access (intravenous, intraosseous) Give adrenalin 3-5min Consider advanced airway&capnography Continuous chest compressions when

intubated Correct reversible causes

Paediatric Advanced Life Support

Reversible causes(4H/4T) Hypoxia Hypovolaemia Hypo-/hyperkalaemia/metabolic Hypothermia Tension PTX Toxins Tamponade-cardiac Thromboembolism

Drugs during CPR

Fluids

Isotonic crystalloids 20ml/kg

Drugs during CPR

Adrenalin

0.01mg/kg Every 3-5 min

Drugs during CPR

Amiodarone

VF or pulseless VT After 3. shock give 5mg/kg After 5. shock give 5mg/kg Infusion pump (dose?)

Drugs during CPR

Calcium

Hypocalcaemia Calcium channel blockers overdose Hypermagnesaemia Hyperkalaemia

Drugs during CPR

Glucose

Only in hypoglycaemia

Drugs during CPR

Magnesium

Hypomagnesaemia Torsade de Pointes

Drugs during CPR

Sodium bicarnonate

Do not give it routinely Hyperkalaemia Tricyclic antidepressant drug overdose

Special circumstances

Channelopathy (?) Blunt or penetrating trauma

(thoracotomy) Single ventricle

Post arrest management

Myocardial dysfunction (vasoactive drugs)

Temperature control (therapeutic hypothermia 32-34 Celsius)

Glucose control

Resuscitation of babies at birth

Relatively few babies need any resuscitation

Majority require only assisted lung aeration

Minority need chest compressions

Classification to initial assessment

Vigorous breathing or crying/good tone/HR>100/min (no intervention)

Breathing inadequately/normal or reduced tone/HR<100/min (dry, mask ventilation, chest compressions possible)

Breathing inadequately/floppy/low heart rate(dry,mask ventilation, chest compressions,drugs)

Apgar score

Airway

Neutral head position Suction not recommended (only if

there’s meconium in the airways)

Breathing

Circulatory support

After the lungs are inflated HR<60/min-start chest compressions Compression/Ventilation=3:1

Drugs

Adrenaline

Adequate ventilation and chest compression but HR<60/min

10-30ug/kg i.v. Tracheal route (not reccomended): 50-

100ug/kg

Bicarbonate

??? 1-2mmol/kg Not recommended

Fluids

10ml/kg bolus

When to stop CPR?

If there’s no detectable heart rate, after 10-15 min

Specific questions

Normal temperature Meconium (use suction) Air or 100% O2 (in term infants start

ventilation with air) Time of cord clamping (1min, if CPR is

not necessary) LMA can be used