PCPC 1 Normal 2 Mild cerebral disability 3 Moderate cerebral disability 4 Severe cerebral disability 5 Coma or vegetative state 6 Brain death
Welcome to an introduction of the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.
Advancements in medical science are continuously evolving and improving survival outcomes. 2010 marks the 50th anniversary of the first medical publication to document cardiac arrest patient survival following closed chest compression. The American Heart Association is more dedicated than ever before to reducing death and disability from cardiovascular diseases and stroke.
The 2010 Guidelines are based on an international evidence evaluation process: hundreds of resuscitation scientists and experts evaluated, discussed, and debated thousands of peer-reviewed publications to identify the most current evidence-based information.
By implementing the recommendations in the new guidelines, you will be up-to-date with the latest scientific studies and current best practices in resuscitation science.
Bystanders, first responders, and healthcare providers all play crucial roles in the Chain of Survival. Together, we continue to improve survival for victims of cardiac arrest by emphasizing high-quality chest compressions, increasing frequency of bystander CPR, and providing excellent post-cardiac arrest care.
To deliver acute and critical care to the youngest of patients, you must be up-to-date with the latest science and treatment recommendations for pediatric advanced life support (PALS).
In the 2010 AHA Guidelines for CPR and ECC, you will find evidence-based best-practices about pediatric resuscitation and training.
This introductory course will familiarize you with important changes affecting PALS and the scientific rationale behind the new recommendations.
By completing this course, you will be able to describe relevant science updates to Pediatric Basic Life Support, Pediatric Advanced Life Support, and Neonatal Resuscitation.
You will gain new information about best practices related to team approaches and systems of care. And you will be able to find in-depth information about the Guidelines from AHA's Highlights and Circulation publications.
You also will be prepared to take next steps in your education, certification, and implementation of the AHA recommendations.
This new section of the 2010 AHA Guidelines for CPR and ECC has been added to address the growing body of evidence guiding best practices for teaching and learning resuscitation skills.
Recommendations here are meant to improve implementation of the Chain of Survival and best practices related to teams and systems of care.
This section of the course highlights the recommendations specific to advanced life saving courses.
Many key issues in pediatric basic life support are the same as those in adult basic life support: emphasizing high-quality chest compressions of adequate rate and depth, allowing chest recoil after each compression, minimizing interruptions in chest compressions, and avoiding excessive ventilation.
For basic life support in children, there are new recommendations on compression depth and the use of AED for infants, and a de-emphasis of the pulse check for healthcare providers.
As for adults, initiate CPR for infants and children with chest compressions rather than rescue breaths. The pediatric BLS sequence is now C-A-B.
For a single rescuer, begin CPR with 30 compressions. For resuscitation of infants and children by two or more rescuers, begin with 15 compressions.
This major change in CPR sequencing to compressions before ventilations (C-A-B) led to vigorous debate among experts in pediatric resuscitation.
Because most pediatric cardiac arrests are due to progressive respiratory failure or shock, rather than sudden primary cardiac arrest, both intuition and clinical data support the need for ventilations and compressions for pediatric CPR.
For resuscitation of the newly born, see the Neonatal Resuscitation section of this course.
Evidence from radiologic studies of the chest in children suggests that compression to one-half the anterior-posterior diameter may not be achievable.
However, effective chest compressions require pushing hard. The new data suggests an achievable depth of about 1½ inches (4 cm) for most infants and about 2 inches (5 cm) for most children.
To achieve effective chest compressions, rescuers should compress at least one-third the anterior-posterior dimension of the chest.
This corresponds to approximately 1½ inches (about 4 cm) in most infants and about 2 inches (5 cm) in most children.
The review of the pediatric advanced life support literature resulted primarily in the refinement of existing recommendations, rather than the creation of new recommendations.
New sections have been added on resuscitation of infants and children with congenital heart disease, including those with single ventricle, those with single ventricle after palliative procedures, and those with pulmonary hypertension.
Also, several recommendations for medications have been revised.
The recommendation regarding calcium administration is stronger than in past AHA Guidelines: routine calcium administration is not recommended for pediatric cardiopulmonary arrest in the absence of documented hypocalcemia, calcium channel blocker overdose, hypermagnesemia, or hyperkalemia.
Routine calcium administration in cardiac arrest provides no benefit and may be harmful.
Etomidate has been shown to facilitate endotracheal intubation in infants and children with minimal hemodynamic effect. Etomidate is not routinely recommended if evidence of septic shock.
While there have been no published results of prospective randomized pediatric trials of therapeutic hypothermia, based on adult evidence, therapeutic hypothermia (to 32oC – 34oC) may be beneficial for adolescents who remain comatose following resuscitation from sudden witnessed out-of-hospital VF cardiac arrest.
Therapeutic hypothermia (to 32°C to 34°C) may also be considered for infants and children who remain comatose following resuscitation from cardiac arrest.
Pediatric Cardiac Arrest: state of
Survival to discharge from out-of-hospital
pediatric cardiac arrest (PCA) has not
changed in 20 years remains at 6%
3% for infants
9% for children and adolescents
Poor outcomes of pediatric
Examined cohort of 118 children <13 years of
age found pulseless and apneic after an
6 (5%) survived
Median ISS was 25
All survivors were neurologically impaired with
pediatric cerebral performance category of 5
Brindis, SL et al PEC 2011
Pediatric out of hospital cardiac arrest
EMS systems and healthcare providers should identify
and strengthen “weak links” in the chain of survival
Topjian and Berg Circulation 2012
Field et al Circulation 2010
In-hospital PCA: state of the art
Survival from in-house cardiac arrest in
infants and children has improved
What changed in the hospital
Earlier recognition of clinical deterioration
More aggressive implementation of
Implementation of formal rapid response
teams (RRT) or medical emergency teams
Decreased number of cardiac arrests and
respiratory arrests by as much as 72%
Decreased hospital mortality by 35%
Assess baby’s response to birth
Establish effective ventilation
•Bag and mask
Always needed by
Rarely needed by