In the United States, approximately 16,000 children have out-of-hospital cardiac arrests each year. The majority of these arrests are due to asphyxiations, including choking, drowning and sudden infant death syndrome. Cardiopulmonary resuscitation (CPR) is a quick and safe means of preventing deaths by cardiac arrest. The goal of CPR is to provide perfusion to the brain and oxygen to the lungs.
History
The earliest evidence of CPR was first recorded in an official statement by the Paris Academy of Sciences in 1740. At that time, mouth-to-mouth resuscitation was recognized as an effective treatment for drowning victims. In 1903, a physician and founder of the Cleveland Clinic, Dr. George Crile, came to be known as the first to preform chest compressions with success.
In the early 1990s, the International Liaison Committee on Resuscitation (ILCOR) formed to establish clear CPR protocols worldwide. Around this time, a set of separate CPR guidelines specifically geared toward children and neonates began to develop. In 2000, pediatric-specific CPR guidelines were published by the American Heart Association (AHA) in conjunction with the American Academy of Pediatrics (AAP). The AHA and AAP publish a pediatric 22-minute, at-home training kit, which instructs parents on infant CPR.
Significance
Early CPR accompanied with early defibrillation and activation of the emergency medical system can increase survival rates by at least 40 percent, states the AHA. In children, the outcome of cardiac arrests is worse than that of adults. This is due to the differences in the cause of the attack. For instance, cardiac arrests in adults arise from age and heart disease, while asphyxiation and trauma are the major causes in children. The factors that determine survival in children are early recognition of the arrest and the immediate application of CPR. The earlier the response, the greater the chance of survival.
Function
Child and infant CPR specifically addresses the differences in anatomy between children and adults. For the most part, the procedures for CPR are similar, but with distinct differences. Take into consideration the anatomy of a child's airway and neck when performing rescue breathing. In infants, not only must the rescue breathing must be adapted, but also the rate and manner at which the chest compressions are preformed.
According to the American Academy of Orthopaedic Surgeons, children have much larger tongues relative to the small size of their mouths, making it easier for their tongues to fall back and block their airways. The back of a child's head is larger and rounder, thus requiring more accurate and careful placement. The cartilage rings on the front of a child's trachea are less developed than in an adult. If a child's head is overextended or flexed during CPR, the cartilage rings collapse, closing off the airway.
Process
The steps to CPR can be remembered as easily as the ABCs-- Airway, Breathing, Circulation and Defibrillation. Airway refers to the manner in which mouth-to-mouth is given in a child. It is similar to that of an adult, but in the case of infants aged one year old and younger, the rescuer's mouth must cover both the baby's mouth and nose in a tight seal. Breathing refers to the method of keeping oxygen flowing to a child's lungs. Instead of the one-second breaths as administered in adults and children older than one, the breaths given in infant CPR are "puffs" of air as if blowing the air from your cheeks. In both infants and children, breaths are given every three to five seconds or at a rate of 12 to 20 breaths per minute. Circulation refers to keeping the blood flowing. Compressions are different for both children and infants. In a child, the heel of one hand is used during compressions instead of the two-handed method applied in adult CPR. The compressions are administered only one-third the depth of the child's chest. In an infant, only two fingers are used to perform compressions just below the nipple line. These too are applied only one-third the depth of the infant's chest.
In both children and infants, the compression to breath ratio is the same as preformed in adult CPR, which is 30 compressions to every two breaths.
Warning
Automated external defibrillators (AED) are essential to the management of cardiac arrest, but they should never be used on infants. According to the American Heart Association, AEDs have been recommended for children older than one year of age since 2003. Some AED models starting at that time began to recognize the shockable heart rhythms in pediatric patients.
References
- "Circulation"; Epidemiology and Outcomes from Out-of-Hospital Cardiac Arrest in Children: The ROC Epistry-Cardiac Arrest; Dianne Atkins, MD, & et al.; May 8, 2009
- "British Medical Journal"; Guidelines for Paediatric Life Support; Paediatric Life Support Working Party of the European Resuscitation Council; May 21, 1994
- "Emergency Care and Transport of the Sick and Injured" 8th ed.; American Academy of Orthopaedic Surgeons.; 2006
- "Current Opinion in Critical Care"; Cardiopulmonary Resuscitation in Children; Alexis Topijan, MD & et al.; June 2009
- "Currents in Emergency Cardiovascular Care"; Highlights of the 2005 Amwericain Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascualr Care; American Heart Association;Winter 2005-2006
