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This chapter reviews CPR in children and pertinent differences from adults. One major difference between adult and pediatric cardiopulmonary arrest is the cause of the arrest. The most common cause of primary cardiac arrest in adults is coronary artery disease. Respiratory failure and shock are more common causes among children and infants. After resuscitation, survival to discharge may be greater among children and adolescents than in infants or adults.1–3 After a cardiac arrest, the survival rate without devastating neurologic sequelae in children is only 2%.4 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 upon 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 Figures 15-1, 15-2, and 15-3.

Figure 15-1.

The Broselow resuscitation tape. (Courtesy of Rita K. Cydulka, MD, MS, MetroHealth Medical Center.)

Figure 15-2.

Equipment side of the Broselow resuscitation tape. One of seven color equipment zones. (Courtesy of Rita K. Cydulka, MD, MS, MetroHealth Medical Center.)

Figure 15-3.

Drug side of the Broselow resuscitation tape. One of 25 precalculated weight zones for resuscitation drugs. (Courtesy of Rita K. Cydulka, MD, MS, MetroHealth Medical Center.)

The American Heart Association (AHA) Guidelines4,5 use the following age group delineations: newborn, 1 month or less in age; infant, 1 month to 1 year of age; child, 1 year of age to the onset of puberty. As in adults, the priorities of resuscitation are airway, oxygenation, ventilation, and shock management. Cardiopulmonary arrest may be prevented with prompt recognition of and intervention for compromised physiology.5 International consensus guidelines for BLS procedures are listed in Table 15-1.6

Table 15-1 Guidelines for Pediatric BLS

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