Define Pediatric Cardiopulmonary Resuscitation. Describe its causes, clinical features and prevention.

Introduction

• Cardiopulmonary resuscitation (CPR) restores circulation and oxygenation in cardiorespiratory arrest.
• In children, arrest is usually the end-result of progressive hypoxia (respiratory) rather than a primary cardiac event, so airway/breathing are especially important.

Basic Life Support (BLS) — Sequence

• Ensure scene safety; assess responsiveness and call for help/activate emergency response.
• C-A-B — check the pulse (≤ 10 s: brachial in infants, carotid/femoral in children); if absent/< 60 with poor perfusion, start chest compressions.
• High-quality compressions — rate 100–120/min, depth about one-third of the chest AP diameter (~4 cm infant, ~5 cm child), full recoil, minimal interruptions.
• Compression:ventilation ratio — 30:2 (single rescuer), 15:2 (two rescuers) for infants/children.
• Technique — infant: two-finger or two-thumb encircling; child: one or two hands.

Advanced Life Support (pals)

• Attach a monitor/defibrillator and classify the rhythm.
• Non-shockable (asystole/pea) — CPR + adrenaline, and treat reversible causes.
• Shockable (VF/pulseless VT) — defibrillate 2–4 J/kg, resume CPR, adrenaline, and consider amiodarone.
• Secure the airway and vascular/intraosseous access; give drugs; reassess every 2 minutes.

Reversible Causes (4 HS & 4 TS)

• 4 Hs — Hypoxia, Hypovolaemia, Hypo/hyperkalaemia (metabolic), Hypothermia.
• 4 Ts — Tension pneumothorax, Tamponade, Toxins, Thromboembolism.

Choking / Foreign-body Obstruction

• Infant — alternating 5 back blows and 5 chest thrusts (no abdominal thrusts).
• Child — abdominal thrusts (Heimlich); if unconscious, start CPR.

High-quality CPR Metrics

• Correct rate (100–120/min) and depth (⅓ AP), full recoil, minimal interruptions, avoid over-ventilation.
• Rotate compressors every 2 minutes to prevent fatigue; use waveform capnography if available.

Team & Airway

• Assign clear roles; establish a definitive airway and IO/IV access early.
• Reassess rhythm and pulse every 2 minutes.

Signs of Good CPR / Rosc

• Return of a palpable pulse, spontaneous breathing, rising end-tidal CO2, and improving colour/consciousness.
• On ROSC, move immediately to structured post-resuscitation care.

Defibrillation Practice

• Minimise interruptions — charge during compressions, deliver the shock, and immediately resume CPR.
• Use paediatric pads/attenuator where available; 2 J/kg first, then 4 J/kg.

Drugs & Access in Pals

• Intraosseous access is a rapid, reliable route when IV access fails.
• Give adrenaline every 3–5 minutes; amiodarone for refractory shockable rhythms; treat reversible causes.

Prevention of Arrest

Since paediatric arrest is usually the end-stage of respiratory or circulatory failure, early recognition and treatment of the sick child (the 'chain of survival' begins with prevention) is the most effective way to improve outcomes.

The Chain of Survival

• Prevention/early recognition → early CPR → early defibrillation (shockable) → advanced care → post-arrest care.
• Each link improves the chance of intact survival; bystander CPR is crucial.

Post-resuscitation Care

• Optimise oxygenation/ventilation (avoid hyperoxia/hypocapnia), support circulation, control temperature, and manage the underlying cause.
• Transfer to intensive care.