Cardiopulmonary Resuscitation

Pediatric CPR - Tiny Lives, Big Actions

• Primary cause: Often respiratory failure/hypoxia (unlike adults).
• Initial: Scene safety, check responsiveness, shout for help/activate EMS.
• Compressions: Rate 100-120/min.
  • Infants (<1 yr): Depth ~4 cm (1/3 AP diameter); 2-finger or thumb-encircling.
  • Children (1 yr-puberty): Depth ~5 cm (1/3 AP diameter); 1 or 2 hands.
• Ventilation: Crucial. Ratios: Single rescuer 30:2; Two rescuers 15:2.

⭐ Most common cause of pediatric cardiac arrest is respiratory failure/hypoxia, making oxygenation and ventilation paramount.

Pediatric CPR - The C-A-B Dance

📌 C-A-B: Compressions, Airway, Breathing. High-quality CPR is key.

• Compressions (C)
  • Rate: 100-120/min.
  • Depth: Infant ~4cm (1.5in); Child ~5cm (2in).
  • Technique:
    • Infant (1 rescuer): 2 fingers.
    • Infant (2 rescuers): 2 thumb-encircling hands.
    • Child: 1 or 2 hands.
  • Full chest recoil.
  • Ratios: Single rescuer 30:2; Two rescuers 15:2 (child/infant).
• Airway (A)
  • Open: Head-tilt/chin-lift (jaw thrust if trauma).
• Breathing (B)
  • 1 breath/1 sec.
  • Rescue breathing (pulse >60/min, no/poor breathing): 1 breath/2-3s (20-30/min).
• AED: Use ASAP. Pediatric pads <8 yrs.

⭐ For infants, two-rescuer CPR uses the two-thumb-encircling hands technique for chest compressions.

Pediatric CPR - PALS Power-Up

• Prioritize C-A-B: Compressions, Airway, Breathing.
• High-quality CPR: Rate 100-120/min; depth ⅓ AP diameter (Infants: ~4cm, Children: ~5cm). Full recoil, minimal interruptions.
• Advanced Airway: Consider ETT/LMA. Confirm placement & monitor CPR quality with waveform capnography.
• Vascular Access: IV/IO. Epinephrine 0.01 mg/kg IV/IO (max 1mg). Amiodarone 5 mg/kg for shock-refractory VF/pVT.
• Team Dynamics: Clear roles, closed-loop communication.

⭐ IO access is preferred if IV access is not rapidly achievable (<90s) in critically ill children during resuscitation attempts for rapid drug delivery and fluid administration効果

Pediatric CPR - Rhythms & Shocks

• Rhythm ID: Shockable (VF/pVT) vs. Non-shockable (Asystole/PEA).
• Shockable Rhythms (VF/pVT):
  • Defibrillate: 2 J/kg (initial) → 4 J/kg → max 10 J/kg / adult dose.
  • Epinephrine: 0.01 mg/kg (0.1mL/kg of 1:10,000) IV/IO, q3-5min.
  • Refractory: Amiodarone 5 mg/kg or Lidocaine 1 mg/kg IV/IO.
• Non-Shockable Rhythms (Asystole/PEA):
  • High-quality CPR.
  • Epinephrine: 0.01 mg/kg (0.1mL/kg of 1:10,000) IV/IO, q3-5min.
  • NO defibrillation. Treat reversible causes (H's & T's).

vs Non-Shockable (Asystole/PEA) Rhythms)

⭐ Amiodarone 5 mg/kg IV/IO bolus (max single dose 300 mg) for shock-refractory VF/pVT; may repeat twice.

Pediatric CPR - Potion Commotion

Drug Therapy:

• Hypovolemia, Hypoxia, H⁺ (acidosis), Hypo/Hyperkalemia, Hypoglycemia, Hypothermia.
• T's: Tension pneumo, Tamponade, Toxins, Thrombosis (PE/MI).

⭐ For suspected opioid overdose, Naloxone 0.1 mg/kg (max 2mg) is indicated.

High‑Yield Points - ⚡ Biggest Takeaways

• C-A-B sequence (Compressions, Airway, Breathing) is critical in pediatric CPR.
• Compression depth: 1/3 AP diameter (approx. 4 cm infants, 5 cm children).
• Compression rate: 100-120/min.
• Compression-to-ventilation ratio: 30:2 (single rescuer), 15:2 (two rescuers).
• Epinephrine (IV/IO 0.01 mg/kg) every 3-5 mins for all rhythms.
• Amiodarone for refractory VF/pVT.
• Prioritize high-quality CPR: push hard, fast; allow full chest recoil; minimize interruptions.