Paediatric basic life support

Aetiology of arrests

Cardiac arrest in infants and children is not usually the result of a primary cardiac cause, but instead is often the end result of progressive respiratory or cardiovascular deterioration. In the paediatric population, cardiac arrest is usually preceded by a period of deterioration, which progresses to cardiorespiratory failure, bradycardia, and eventually cardiac arrest. The initial focus of BLS in children and infants is establishing effective ventilation. Most children with hypoxia undergo a period of deterioration with worsening bradycardia preceding cardiac arrest. It is important that paediatric BLS is commenced as soon as bradycardic deterioration is noted and is not withheld until the patient becomes pulseless and asystolic. Chest compressions should be provided in children who are unresponsive with no spontaneous breathing and a heart rate below 60 beats per minute (bpm).

Anatomy and physiology

The anatomy and physiology of the human body changes with age, as the infant progressively develops from the immature neonatal form into the more adult form of the older child. The differences listed below influence provision of BLS in children (see later) in a number of ways:

• Airway : Infants and young children have a relatively large head (particularly the occiput) and short neck, resulting in neck flexion when lying on a flat surface in the supine position. Infants have large tongue and more easily compressible oropharyngeal soft tissues. The infant larynx lies more anteriorly and higher (C2–C3) and the cricoid ring is the narrowest part of the airway. Children have a softer and shorter trachea.

• Breathing : Younger children have an increased respiratory rate; a more compliant chest wall; a greater dependence on diaphragmatic breathing; and reduced end-expiratory lung volume.

• Circulation: Infants and young children have an increased heart rate; a greater dependence on heart rate for delivery of adequate circulation; and a small absolute volume of circulating blood (70–80 mL/kg).

• Metabolism : Children have both a relatively higher metabolic rate and body surface area compared to adults.

Preparation and equipment

PBLS requires no equipment other than a trained rescuer/s. It is advantageous, however, to have certain basic equipment available to assist in the resuscitation process:

• Portable suction and suction catheters (for clearing secretions) may improve the ability to achieve and maintain a patent airway.

• An oropharyngeal airway may assist in improving airway patency.

• A self-inflating bag and appropriately sized mask may assist provision of ventilation and reduces the risk of cross-infection.

• The addition of high-concentration oxygen to ventilation may further reduce the risk of hypoxic injury.

Basic life support sequence

The ‘DRSABC’ approach

When first approaching the collapsed child, it is important to optimise rescuer and patient safety. DRSABC is a mnemonic used to remind the rescuer of the appropriate sequence of events that should be followed when encountering any collapsed patient:

• D anger: check for dangers or hazards that may affect you or the patient.

• R esponsiveness: check if the patient is responsive.

• S end: send for help.

• A irway: open the airway.

• B reathing: check for breathing; if patient is not breathing normally, give two rescue breaths.

• C irculation: assess circulation by checking for a pulse and/or for signs of life; if absent or inadequate pulse or no signs of life, commence CPR.