The resuscitation of children differs from that of adults in a number of important ways. For example, the most common cause of primary cardiac arrest in adults is coronary artery disease, whereas respiratory failure and shock are more common causes among children and infants; hypoxemia, hypercapnia, and acidosis subsequently lead to bradycardia, hypotension, and secondary cardiac arrest in children. After resuscitation, survival to discharge may be greater among children and adolescents than in infants or adults.1-4 The survival rate without devastating neurologic sequelae in children varies by age, ranging from 1% to 2% in infants and young children to 11% for adolescents in whom a shockable rhythm is more common; survival rates as high as 30% have been seen after sudden out-of-hospital witnessed ventricular fibrillation.5-7 The best chance for a good outcome is to recognize impending respiratory failure or shock and intervene to prevent the development of cardiopulmonary arrest.
Age-related differences are important considerations when treating children. An appropriate drug dose for a 6-month-old infant may be excessive for a 1-month-old newborn but inadequate for a 5-year-old child. Other aspects of resuscitation, such as endotracheal tube size, tidal volumes, cardiac compression rates, and respiratory rates, vary with a child's age. Equipment selection and medication dosing are based on age and body weight. Valuable time can be lost in weight estimation, dosage calculations, and equipment selection. Emergency personnel must be able to find the proper equipment rapidly. Equipment can be stored on shelves or in drawers labeled by age and weight, or a system of color codes can be used in which color-coded shelves, carts, or equipment organizers correspond to specific length categories as illustrated in Figure 1.
The Broselow resuscitation tape. [Courtesy of Rita K. Cydulka, MD, MS, MetroHealth Medical Center.]
The American Heart Association Guidelines8 use the following age group delineations: newborn, 1 month or less in age; infant, 1 month to 1 year of age; and child, 1 year of age to the onset of puberty. As in adults, the priorities of resuscitation are airway, oxygenation, ventilation, and shock management. An important change in the 2010 American Heart Association Guidelines is the order of basic life support assessment. Instead of using ABC (airway, breathing, circulation) as a mnemonic, the American Heart Association recommends CAB, emphasizing the importance of chest compressions beginning as rapidly as possible (Figure 2). Reasons for this change in approach include the following: (1) starting with chest compressions reduces the delay to the start of the first compression; (2) all rescuers can start chest compressions immediately, because airway management requires manipulation and positioning of the patient; and (3) simplifying the basic life support resuscitation approach is consistent for all patients regardless of the arrest cause.8,9 Cardiopulmonary arrest should be prevented whenever possible with ...