Cardiorespiratory arrest is an emergency situation caused by the interruption of breathing and circulation, potentially recoverable.
In children, the most common causes are those that produce respiratory failure. Once it occurs, it can lead to serious consequences unless appropriate cardiopulmonary resuscitation maneuvers are quickly initiated, which allow emergency oxygenation without technical means.
Basic cardiopulmonary resuscitation is what we can perform in first aid.
It is important that we remain calm, make sure that the child is not breathing or has a pulse, in any case, we must notify the emergency number (112 in Spain) or ask someone to make this call if the baby is not breathing and/or He has no pulse.
And, although we hope to never have to use them, it is always good to know first aid and how to perform cardiopulmonary resuscitation on a child, since their life may depend on our actions. In the next section we share the basic knowledge of how perform resuscitation maneuvers on a child.
Pediatric cardiopulmonary resuscitation
The first step is to evaluate the situation, motivating a response through verbal and tactile stimulation, without shaking him.
- If the child does not respond, open the airway by extending the head and raising the jaw (forehead-chin maneuver), and assess breathing for no more than 10 seconds.
- Look for respiratory effort, listening and feeling the movement of air from the nose and/or mouth. If there is effort, but no air movement, the airway is not open.
- In cases where there is more than one rescuer, the second rescuer should call the Emergency Services (EMS) immediately after recognizing unconsciousness, preferably using the speakerphone function of a mobile phone.
In the unconscious child, if breathing is abnormal:
- Give five initial rescue breaths/ventilations. For infants, ensure a neutral head position. In older children, more head extension (head tilt with the forehead-chin maneuver) will be needed.
- Breathe steadily into the child's mouth (or the infant's mouth and nose) for about 1 second, long enough for the chest to visibly rise.
- If you have difficulty breathing effectively, your airways may be obstructed (choking is the most common cause of cardiorespiratory arrest in children): remove any visible obstruction. Do not blindly sweep your finger. Reposition the head or adjust the method of opening the airway. Make up to five attempts to achieve effective ventilations, if still unsuccessful, continue with chest compressions only.
Proceed immediately with 15 chest compressions unless there are clear signs of circulation (such as movement, coughing), as indicated:
- When possible, perform compressions on a firm surface.
- Frequency: 100-120/min for both infants and children.
- Depth: compress in the lower half of the sternum (just below the imaginary line that separates both nipples) at least one third of the anteroposterior diameter of the thorax. Compressions should never be deeper than the 6 cm limit for adults.
- Reexpansion: Avoid leaning. Release all pressure between compressions and allow complete recoil of the chest.
- NOTE: Depending on the age of the child, use the two-thumb or two-finger technique for chest compression in infants; and in children older than 1 year, depending on hand size and reach, use a one- or two-handed technique. If only one hand is used, the other can be positioned to maintain an open airway at all times
After 15 compressions, perform 2 effective inflations and continue with a 15:2 ratio. Do not stop CPR unless there are obvious signs of recovery.
Special situation due to the Covid-19 pandemic
The European Resuscitation Council guidelines promote the continuation of resuscitation attempts in cardiac arrests, while seeking to minimize the risk to the person or persons acting as rescuers and providing treatment. If there is uncertainty about the presence of COVID-19, people performing CPR should perform a dynamic risk assessment considering:
- the current prevalence of COVID-19,
- the clinic and presentation of the victim (for example, history of risk contact, symptoms compatible with COVID-19...),
- the probability that the treatment will be effective or futile,
- the availability of personal protective equipment and the personal and occupational risks for the people providing the treatment.
Resuscitation of low-risk people or those with confirmed negative results for COVID-19 has been addressed in this post.
Do not stop CPR until…
- You may be told not to continue by a healthcare professional, or the victim is definitely waking up, moving, opening their eyes, and breathing normally, or you are becoming exhausted.
- CPR alone is unlikely to restart spontaneous heartbeat; so unless you are sure the victim has recovered, continue CPR.
- Signs that the victim has recovered: waking up, movements, eye opening, normal breathing.
General cardiologist and hemodynamic specialist