European Resuscitation Council
Summary
Causes of cardiorespiratory arrest
BLS sequence in paediatrics
AED in children
Foreign body airway obstruction relieve
BLS
Recognition of a person in cardiac or
respiratory arrest
Delivery of oxygen to vital organs by CPR
Without the use of adjuncts
Paediatric cardiorespiratory arrest
Secondary to hypoxia, acidosis,
inappropriate perfusion
Terminal Rhythm: Bradycardia, Pulseless
Electrical Activity → Asystole
Out-of-hospital arrest is « hypoxic and
hypercapnic with respiratory arrest
preceding asystolic cardiac arrest»
Comparison with adult arrest
Ventricular Fibrillation in children is more
rare than in adult

6-9% to 15-24% (SIDS excl) of cardiac arrest
Secondary to metabolic anomaly : 4H/4T
 Hypothermia
 Hypoxia
 Hyper/hypokalaemia
 Hypovolaemia
Tamponade
Toxics - drugs
Thrombo-embolism
Tension-pneumothorax
Activation of the EMS system
In child less than 8 years
All: Drowning, Trauma, Poisonning
Single rescuer summons help (EMS)
after one minute of BLS
“call fast”
Activation of the EMS system
In child older than 8 years
All: Witnessed sudden collapse,
Known cardiopathy
Single rescuer summons help (EMS)
immediately to provide rapid access
to AED
“call first”
Safety
Ensure rescuer’s safety first
Then ensure victim’s safety (even
trauma)
Use barrier devices (infectious diseases)
Look for clues of what has caused the
emergency
Stimulate
Establish responsiveness
Never shake a child

Tactile stimulation
• Maintaining C-spine (stabilise forehead)
• Shake arm or tug hair

Verbal stimulation
• Child’s name
• “Wake up”
• “Are you alright”
Shout for assistance
Single rescuer: shouts for help while
remaining with the child and starts CPR
Multiple rescuers: one rescuer provides
BLS while one rescuer activates EMS
system
Airway
To open the airway, lift the tongue that occludes
the AW by
Head tilt-chin lift
Neutral position
More head extension
Airway
To open the airway, lift the tongue that occludes
the AW by
Jaw thrust
Checking the airway
Look into the mouth
Ensure no foreign body is present
Remove with ONE gentle finger sweep
Avoid blind finger sweep
(further impaction, soft tissue damage)
Breathing
Check breathing: Look, Listen, Feel
For up to10 seconds
If the child
Is breathing spontaneously and effectively
 Maintain AW
 Summon help
 Place in recovery
position
Has no detectable,
spontaneous, effective
breathing
 Deliver rescue breaths
Rescue Breaths
Deliver up to 5 breaths to ensure 2
effective
 Slow breath : 1 to 1.5 second each


Minimise gastric distension
Optimise oxygen delivered
 Deep rescuer’s breath between each rescue breath


Optimise amount of oxygen
Minimise amount of expired CO2
Rescue Breaths
Mouth-to-mouth and nose technique
Rescue Breaths
Mouth-to-mouth technique
Circulation
Assess for signs of circulation
For up to 10 seconds
 Pulse

Brachial or femoral pulse in infant

Carotid pulse in child
 Signs of life



Cough
Movement
Normal breathing (no gasp)
If signs of circulation are
Found
 Reassess breathing
 Give rescue breaths
(20 cpm)
 Reassess
Absent or pulse is very
slow + poor perfusion
 Deliver external chest
compression
Depress 1/3 to ½ of A/P Ø
thorax

Rate : 100/min (actual 60-80
min)

Ratio : 5 compressions for
1 rescue breath

Circulation
ECC in Infant
Two-fingers technique
Two-thumbs technique
Circulation
ECC in Child < 8 years
Circulation
ECC in Child > 8 years
Ratio 15:2
Reassess
ECC produces a palpable central pulse
Reassess briefly after one minute and
summon help
Continue CPR non-stop
Activate EMS System
Take the child with you to continue CPR
Informations




Detailed location, phone number
Type of accident, number and age of
victims
Severity and urgency (ALS)
Confirm reception of message
Duration of CPR
ROSC and spontaneous respiration
Qualified team arrives
Rescuer exhausted
Automated External Defibrillator
(AED)
 Evaluates the victim’s ECG
 Determines if a “shockable”
rhythm is present
 Charges the “appropriate” dose
 When activated by operator,
delivers a shock
 Provides synthesised voice
prompts to assist the operator
AED in children?
Class Indeterminate recommendation in children < 8 years
 Recommended (Class IIb) for children older than
8 years in the pre-hospital setting (ILCOR 2000)


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Most arrests in young children are of respiratory origin
In this class of age arrests rhythms are mainly
asystole and PEA
VF may occur in up to 25% of cardiac arrest when
SIDS are excluded
Prompt defibrillation is the definitive treatment for VF
and pulseless VT
CPR remains the most important step of Paeds-BLS
Recommendation (Circulation 2003; July)
ILCOR consensus statement for AED in children
 May be used for children 1-8 years of age with no
signs of circulation
 Should deliver a child dose
 Arrhythmia detection algorithm with high specificity
for paediatric shockable rhythms (i.e not recommend shock
delivery for non-shockable rhythms)
 Insufficient evidence to support recommendation for
or against the use of AEDs in children < 1 year of age
 For single rescuer, 1 minute of CPR before any other
action (i.e. activating EMS or AED attachment)
 Defibrillation is recommended for documented
VF/pulseless VT. (Class I)
FBAO in conscious victim
Assess Airway
5 Chest
Thrusts
INFANT
5 Back
Blows
Assess Airway
Assess
breathing
adequacy
If conscious
level
deteriorated
Unconscious
FBAO
Algorithm
CHILD
5 Back
Blows
5 Abdominal
Thrusts
FBAO in unresponsive child
Unconscious Victim
Attempt
5 Rescue
Breaths
Open
Airway
5 Back
Blows
Check
mouth
5 Chest
Thrusts
Unable to
achieve chest
movements on 5
attempts of
breaths
Attempt
5 Rescue
Breaths
Open
Airway
5 Back
Blows
Check
mouth
5 Chest
thrusts
5
Abdominal
Thrusts
Recovery position
To avoid the back-fall of the tongue in the
pharynx and hence obstruction of AW
To avoid risk of aspiration of vomit,
secretions…
Recovery position
Principles




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As near a true lateral position as possible
Patent airway maintained
Child easily observed and monitored
Child stable cannot roll over
Free drainage of vomit/secretion
No pressure on chest (impeding breathing)
Can be turn easily on their back for BLS
Conclusions
We discuss about…
• Results of BLS
• Sequence of Paeds-BLS
• Use of AED in children
• FBAO