Cardiopulmonary resuscitation in infants and children: new guidelines

Fortunately, cardiopulmonary arrest (CPA) in the paediatric population and the need for advanced life support are relatively rare. However, because the outcome from CPA in children is dismal, this makes the gaining of expertise knowledge about the nature of CPA and the effectiveness of advanced life support (ALS) intervention mandatory.

In the USA, an estimated 16 000 children die each year of unexpected CPA. 1–3 Approximately 50% of them are younger than 1 year old.

CPA due to primary cardiac arrest in infancy and childhood is rare. This is different from the situation in adults, where the primary cause of arrest is often cardiac. Moreover, in children, cardiorespiratory function may remain near normal until the moment of arrest.

In childhood and in infants most cardiac arrests are secondary to hypoxia, epiglottitis, inhalation of foreign body, bronchiolitis, asthma or pneumo-thorax. 4,5 Respiratory arrest also occurs secondary to neurological dysfunction due to convulsions or certain poisons. The worst outcome is observed in children who have a prehospital arrest and who arrive apnoeic and pulseless. 6–8 These children have a poor chance of complete neurological recovery even after adequate cardiopulmonary resuscitation. This is often related to a prolonged period of asphyxia and ischaemia before the start of adequate cardiopulmonary resuscitation. Earlier recognition of serious illness in children and paediatric cardiopulmonary resuscitation training for the public could improve the outcome for these children. 4,9,10

Children are not little adults. The spectrum of diseases that they suffer from is different, and their responses to diseases and injury may differ at the anatomical, physiological and psychological level.

After an overview of the anatomical, physiological and psychological differences, the changes reported in the new guidelines 11–13 for cardiopulmonary resuscitation in children and in infants will be discussed.