The 2010 International Liaison Committee on Resuscitation Pediatric Task Force has updated the 2005 treatment recommendations for pediatric resuscitation. Highlights include the following:
- Initiate cardiopulmonary resuscitation (CPR) if there are no signs of life and a pulse is not palpated within 10 seconds.
- Provide conventional CPR (chest compressions with rescue breathing).
- Compress at least one third of the anterior-posterior dimension of the chest.
- Consider using cuffed tracheal tubes in infants and young children; cuff pressure should not exceed 25 cm H2O. Appropriate sized tubes by age are as follows:
# 3 mm for age ≤1 year
# 3.5 mm for age 1–2 years
# Age in years/4 + 3.5 mm for age >2 years
- Modify or discontinue cricoid pressure if it impedes preintubation ventilation or intubation.
- Monitor capnography to confirm endotracheal tube position, recognizing that end-tidal CO2 in infants and children might be below detectable limits for colorimetric devices (85% sensitivity and 100% specificity).
- Consider use of an esophageal detector device in children weighing >20 kg.
- Use capnography monitoring to assess effectiveness of chest compressions.
- Avoid excessive ventilation, which can decrease cerebral perfusion pressure, rates of return of spontaneous circulation (ROSC), and survival rates.
- After ROSC, titrate oxygen concentration to limit the risk for toxic oxygen byproducts.
- For pediatric septic shock, include therapy directed at normalizing central venous oxygen saturation to ≥70%.
- Do not routinely use bicarbonate or calcium for pediatric cardiac arrest: Both agents are associated with decreased survival.
These consensus recommendations are based on a thorough evaluation of the literature, and emergency physicians should know them.
Katherine Bakes, MD
Published in Journal Watch Emergency Medicine January 21, 2011
Citation(s): Kleinman ME et al. Pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Pediatrics 2010 Nov; 126:e1261.