CPR in special situations discusses CPR for pediatric patients, infants, children, pregnancy, and perimortem caesarean delivery. For pediatric patients, the basic principles are the same as for adults but differences exist due to anatomy, physiology, and causes of cardiac arrest which are usually respiratory. For infants and children, after ensuring scene safety and checking responsiveness, call for help and provide breaths every 2-3 seconds at a rate of 30 compressions to 2 breaths for single rescuer or 15:2 for two rescuers. Chest compressions should be at a depth of 4cm for infants and 5cm for children at a rate of 120/min. For pregnancy, the basic principles are the same as

1. CPR in SPECIAL SITUATIONS

2. CPR in Paediatric Patients
Infants & Children
•Basic principles are same as adults - Scene safety - Checking
Responsiveness - Call for the help - High performance CPR
•Differences are due to Anatomy, Physiology & Causes of cardiac arrest
•Cardiac arrest is usually due to respiratory causes

3. CPR in Paediatric Patients
Infants & Children
• After checking whether scene is safe:
• Check for responsiveness –
• by tapping the shoulders in Children,
• by tapping the feet in Infants
• • Activate Emergency medical services

4. CPR in INFANTS & CHILDREN
• Assess for breathing & pulse for 5 to 10 seconds
• - Child: carotid or femoral pulse,
• - Infant: brachial pulse
• •Breathing & Pulse present – monitor
• •No breathing, Pulse present – Provide 1 breath every 2 to 3 seconds [20
– 30/ min]
• •Both absent – Start CPR
• - 30:2 with single rescuer, 15:2 with 2 rescuers

5. CPR in Paediatric Patients
• Chest compressions in Children
• •Rate – 120/ min
• •Depth – around 4 cm in infants, 5
cm in children
• - 1/3 of the antero-posterior width
of the chest
• •Allow complete recoil in between
compressions
• •Minimal interruptions
• •Technique – child: same as adults,
in small child can use only 1 hand

6. CPR in Paediatric
Patients
• Chest compressions in
Infants
• •Compress with 2 fingers
below the nipple line at the
centre of chest: 1-rescuer
• • With both hands
supporting the back –
compress with both thumbs:
2-rescuer

7. CPR in Paediatric Patients
• Key Points
• •Breaths are important as arrest is usually due to respiratory causes, -
deliver effective breaths
• • Keep infant’s head in neutral position, as hyperextension can also
obstruct the airway
• • If it is a witnessed arrest – get AED or Defibrillator as soon as possible
• • Un-witnessed cardiac arrest – Start CPR first & then call for help
• • If single rescuer – 30:2 Ratio
• • If two rescuers – 15:2 Ratio

8. CPR in Pregnancy
• Basic principles are same as adults - Scene safety -
Checking Responsiveness - Call for the help - High
performance CPR
•Differences are due to - Physiology

9. CPR in Pregnancy
•Call for the Help:
••Emergency response team
••Obstetrician
••Paediatrician

10. CPR in Pregnancy
• Important to start CPR quickly
• - 2 lives, mother and baby are at
risk
• • Keep mother in left lateral
position or perform – 15-30 degree
left lateral tilt
• - Uterine displacement at all times
– to relieve the pressure on major
vessels to help with blood flow

11. Perimortem caesarean delivery
If no Restoration of Spontaneous Circulation
in 5 minutes of Cardiac Arrest

12. CPR in Pregnancy Key Points
• Basic Principle are same as ordinary adult
• Lateral displacement of uterus or 15 to 30 degree lateral tilt is a
must
•If no ROSC in 5 minutes of Cardiac arrest, - Perform Caesarean
delivery

13. THANKYOU
COURTSEY INDIAN RESUSCITATION COUNCIL FEDERATION &
INDIAN SOCIETY OF ANAESTHESIOLOGISTS 2017 RESUSCITATION
GUIDELINES