Abstract

The year 2010 marked the 50th anniversary of modern resuscitation. In October 2010, the American Heart Association released updated guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care. This chapter will outline current CPR recommendations and review the evidence for major changes in pediatric basic and advanced life support with a special emphasis on children with cardiac disease.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 1,299.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 1,799.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free ship** worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Kouwenhoven WB, Jude JR, Knickerbocker GG (1960) Closed-chest cardiac massage. JAMA 173:1064–1067

    Article  CAS  PubMed  Google Scholar 

  2. Berg MD et al (2010) Part 13: pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 122(18 Suppl 3):S862–S875

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kleinman ME et al (2010) Part 14: pediatric advanced life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 122(18 Suppl 3):S876–S908

    Article  PubMed  Google Scholar 

  4. Young KD et al (2004) A prospective, population-based study of the epidemiology and outcome of out-of-hospital pediatric cardiopulmonary arrest. Pediatrics 114(1):157–164

    Article  PubMed  Google Scholar 

  5. Nadkarni VM et al (2006) First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA 295(1):50–57

    Article  CAS  PubMed  Google Scholar 

  6. Samson RA et al (2006) Outcomes of in-hospital ventricular fibrillation in children. N Engl J Med 354(22):2328–2339

    Article  CAS  PubMed  Google Scholar 

  7. Donoghue AJ et al (2005) Out-of-hospital pediatric cardiac arrest: an epidemiologic review and assessment of current knowledge. Ann Emerg Med 46(6):512–522

    Article  PubMed  Google Scholar 

  8. Dick WF et al (2000) The carotid pulse check revisited: what if there is no pulse? Crit Care Med 28(11 Suppl):N183–N185

    Article  CAS  PubMed  Google Scholar 

  9. Eberle B et al (1996) Checking the carotid pulse check: diagnostic accuracy of first responders in patients with and without a pulse. Resuscitation 33(2):107–116

    Article  CAS  PubMed  Google Scholar 

  10. Donoghue A et al (2009) Cardiopulmonary resuscitation for bradycardia with poor perfusion versus pulseless cardiac arrest. Pediatrics 124(6):1541–1548

    Article  PubMed  Google Scholar 

  11. Inagawa G et al (2003) A comparison of five techniques for detecting cardiac activity in infants. Paediatr Anaesth 13(2):141–146

    Article  PubMed  Google Scholar 

  12. Sarti A et al (2006) Comparison of three sites to check the pulse and count heart rate in hypotensive infants. Paediatr Anaesth 16(4):394–398

    Article  PubMed  Google Scholar 

  13. Tibballs J, Russell P (2009) Reliability of pulse palpation by healthcare personnel to diagnose paediatric cardiac arrest. Resuscitation 80(1):61–64

    Article  PubMed  Google Scholar 

  14. Parra DA et al (2000) Outcome of cardiopulmonary resuscitation in a pediatric cardiac intensive care unit. Crit Care Med 28(9):3296–3300

    Article  CAS  PubMed  Google Scholar 

  15. Bobrow BJ et al (2010) Chest compression-only CPR by lay rescuers and survival from out-of-hospital cardiac arrest. JAMA 304(13):1447–1454

    Article  CAS  PubMed  Google Scholar 

  16. Sharek PJ et al (2007) Effect of a rapid response team on hospital-wide mortality and code rates outside the ICU in a Children’s Hospital. JAMA 298(19):2267–2274

    Article  CAS  PubMed  Google Scholar 

  17. Tibballs J, Kinney S (2009) Reduction of hospital mortality and of preventable cardiac arrest and death on introduction of a pediatric medical emergency team. Pediatr Crit Care Med 10(3):306–312

    Article  PubMed  Google Scholar 

  18. Brilli RJ et al (2007) Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit. Pediatr Crit Care Med 8(3):236–246, quiz 247

    Article  PubMed  Google Scholar 

  19. Peddy SB et al (2007) Cardiopulmonary resuscitation: special considerations for infants and children with cardiac disease. Cardiol Young 17(Suppl 2):116–126

    PubMed  Google Scholar 

  20. Tabbutt S et al (2001) Impact of inspired gas mixtures on preoperative infants with hypoplastic left heart syndrome during controlled ventilation. Circulation 104(12 Suppl 1):I159–I164

    Article  CAS  PubMed  Google Scholar 

  21. Bradley SM, Simsic JM, Mulvihill DM (2003) Hypoventilation improves oxygenation after bidirectional superior cavopulmonary connection. J Thorac Cardiovasc Surg 126(4):1033–1039

    Article  PubMed  Google Scholar 

  22. Shekerdemian LS et al (1997) Cardiopulmonary interactions after Fontan operations: augmentation of cardiac output using negative pressure ventilation. Circulation 96(11):3934–3942

    Article  CAS  PubMed  Google Scholar 

  23. Hoffman GM et al (2004) Alteration of the critical arteriovenous oxygen saturation relationship by sustained afterload reduction after the Norwood procedure. J Thorac Cardiovasc Surg 127(3):738–745

    Article  PubMed  Google Scholar 

  24. Motta P et al (2005) Comparison of phenoxybenzamine to sodium nitroprusside in infants undergoing surgery. J Cardiothorac Vasc Anesth 19(1):54–59

    Article  CAS  PubMed  Google Scholar 

  25. Hoffman TM et al (2003) Efficacy and safety of milrinone in preventing low cardiac output syndrome in infants and children after corrective surgery for congenital heart disease. Circulation 107(7):996–1002

    Article  CAS  PubMed  Google Scholar 

  26. Johnson BA et al (2009) Near-infrared spectroscopy in neonates before palliation of hypoplastic left heart syndrome. Ann Thorac Surg 87(2):571–577, discussion 577–9

    Article  PubMed  Google Scholar 

  27. Hoffman GM et al (2005) Systemic venous oxygen saturation after the Norwood procedure and childhood neurodevelopmental outcome. J Thorac Cardiovasc Surg 130(4):1094–1100

    Article  PubMed  Google Scholar 

  28. Ravishankar C et al (2006) Extracorporeal membrane oxygenation after stage I reconstruction for hypoplastic left heart syndrome. Pediatr Crit Care Med 7(4):319–323

    Article  PubMed  Google Scholar 

  29. Booth KL et al (2004) Extracorporeal membrane oxygenation support of the Fontan and bidirectional Glenn circulations. Ann Thorac Surg 77(4):1341–1348

    Article  PubMed  Google Scholar 

  30. Berg RA et al (2001) Adverse hemodynamic effects of interrupting chest compressions for rescue breathing during cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest. Circulation 104(20):2465–2470

    Article  CAS  PubMed  Google Scholar 

  31. Paradis NA et al (1990) Coronary perfusion pressure and the return of spontaneous circulation in human cardiopulmonary resuscitation. JAMA 263(8):1106–1113

    Article  CAS  PubMed  Google Scholar 

  32. Michael JR et al (1984) Mechanisms by which epinephrine augments cerebral and myocardial perfusion during cardiopulmonary resuscitation in dogs. Circulation 69(4):822–835

    Article  CAS  PubMed  Google Scholar 

  33. Halperin HR et al (1986) Determinants of blood flow to vital organs during cardiopulmonary resuscitation in dogs. Circulation 73(3):539–550

    Article  CAS  PubMed  Google Scholar 

  34. Schleien CL et al (1986) Effect of epinephrine on cerebral and myocardial perfusion in an infant animal preparation of cardiopulmonary resuscitation. Circulation 73(4):809–817

    Article  CAS  PubMed  Google Scholar 

  35. Idris AH et al (1994) Effect of ventilation on acid–base balance and oxygenation in low blood-flow states. Crit Care Med 22(11):1827–1834

    Article  CAS  PubMed  Google Scholar 

  36. McInnes AD et al (2011) The first quantitative report of ventilation rate during in-hospital resuscitation of older children and adolescents. Resuscitation 82(8):1025–1029

    Article  PubMed  PubMed Central  Google Scholar 

  37. Aufderheide TP, Lurie KG (2004) Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation. Crit Care Med 32(9 Suppl):S345–S351

    Article  PubMed  Google Scholar 

  38. Aufderheide TP et al (2004) Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation 109(16):1960–1965

    Article  PubMed  Google Scholar 

  39. Sutton RM et al (2009) Quantitative analysis of CPR quality during in-hospital resuscitation of older children and adolescents. Pediatrics 124(2):494–499

    Article  PubMed  Google Scholar 

  40. Abella BS et al (2005) Quality of cardiopulmonary resuscitation during in-hospital cardiac arrest. JAMA 293(3):305–310

    Article  CAS  PubMed  Google Scholar 

  41. Braga MS et al (2009) Estimation of optimal CPR chest compression depth in children by using computer tomography. Pediatrics 124(1):e69–e74

    Article  PubMed  Google Scholar 

  42. Kattwinkel J et al (2010) Part 15: neonatal resuscitation: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 122(18 Suppl 3):S909–S919

    Article  PubMed  Google Scholar 

  43. Kleinman ME et al (2010) Part 10: pediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 122(16 Suppl 2):S466–S515

    Article  PubMed  PubMed Central  Google Scholar 

  44. Menegazzi JJ et al (1993) Two-thumb versus two-finger chest compression during CRP in a swine infant model of cardiac arrest. Ann Emerg Med 22(2):240–243

    Article  CAS  PubMed  Google Scholar 

  45. Berg RA et al (1997) Assisted ventilation does not improve outcome in a porcine model of single-rescuer bystander cardiopulmonary resuscitation. Circulation 95(6):1635–1641

    Article  CAS  PubMed  Google Scholar 

  46. Voelckel WG et al (2000) Effects of vasopressin and epinephrine on splanchnic blood flow and renal function during and after cardiopulmonary resuscitation in pigs. Crit Care Med 28(4):1083–1088

    Article  CAS  PubMed  Google Scholar 

  47. Fleisher G et al (1985) Open- versus closed-chest cardiac compressions in a canine model of pediatric cardiopulmonary resuscitation. Am J Emerg Med 3(4):305–310

    Article  CAS  PubMed  Google Scholar 

  48. Boczar ME et al (1995) A technique revisited: hemodynamic comparison of closed- and open-chest cardiac massage during human cardiopulmonary resuscitation. Crit Care Med 23(3):498–503

    Article  CAS  PubMed  Google Scholar 

  49. Sanders AB et al (1984) Improved resuscitation from cardiac arrest with open-chest massage. Ann Emerg Med 13(9 Pt 1):672–675

    Article  CAS  PubMed  Google Scholar 

  50. Berg RA et al (2010) Part 5: adult basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 122(18 Suppl 3):S685–S705

    Article  PubMed  Google Scholar 

  51. Kitamura T et al (2010) Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study. Lancet 375(9723):1347–1354

    Article  PubMed  Google Scholar 

  52. Pokorna M et al (2010) A sudden increase in partial pressure end-tidal carbon dioxide (P(ET)CO(2)) at the moment of return of spontaneous circulation. J Emerg Med 38(5):614–621

    Article  PubMed  Google Scholar 

  53. Wik L et al (1996) Effects of various degrees of compression and active decompression on haemodynamics, end-tidal CO2, and ventilation during cardiopulmonary resuscitation of pigs. Resuscitation 31(1):45–57

    Article  CAS  PubMed  Google Scholar 

  54. Dhillon R et al (1995) Extracorporeal membrane oxygenation and the treatment of critical pulmonary hypertension in congenital heart disease. Eur J Cardiothorac Surg 9(10):553–556

    Article  CAS  PubMed  Google Scholar 

  55. Perondi MBM et al (2004) A comparison of high-dose and standard-dose epinephrine in children with cardiac arrest. N Engl J Med 350(17):1722–1730

    Article  CAS  PubMed  Google Scholar 

  56. Srinivasan V et al (2008) Calcium use during in-hospital pediatric cardiopulmonary resuscitation: a report from the National Registry of Cardiopulmonary Resuscitation. Pediatrics 121(5):e1144–e1151

    Article  PubMed  Google Scholar 

  57. Larsen MP et al (1993) Predicting survival from out-of-hospital cardiac arrest: a graphic model. Ann Emerg Med 22(11):1652–1658

    Article  CAS  PubMed  Google Scholar 

  58. Gutgesell HP et al (1976) Energy dose for ventricular defibrillation of children. Pediatrics 58(6):898–901

    CAS  PubMed  Google Scholar 

  59. Berg RA et al (2005) Better outcome after pediatric defibrillation dosage than adult dosage in a swine model of pediatric ventricular fibrillation. J Am Coll Cardiol 45(5):786–789

    Article  PubMed  Google Scholar 

  60. Berg MD et al (2005) Pediatric defibrillation doses often fail to terminate prolonged out-of-hospital ventricular fibrillation in children. Resuscitation 67(1):63–67

    Article  PubMed  Google Scholar 

  61. Meaney PA et al (2011) Effect of defibrillation energy dose during in-hospital pediatric cardiac arrest. Pediatrics 127(1):e16–e23

    Article  PubMed  Google Scholar 

  62. Bar-Cohen Y et al (2005) First appropriate use of automated external defibrillator in an infant. Resuscitation 67(1):135–137

    Article  PubMed  Google Scholar 

  63. Walsh CK, Krongrad E (1983) Terminal cardiac electrical activity in pediatric patients. Am J Cardiol 51(3):557–561

    Article  CAS  PubMed  Google Scholar 

  64. DeBehnke DJ et al (1995) The hemodynamic and arterial blood gas response to asphyxiation: a canine model of pulseless electrical activity. Resuscitation 30(2):169–175

    Article  CAS  PubMed  Google Scholar 

  65. Kramer-Johansen J et al (2006) Quality of out-of-hospital cardiopulmonary resuscitation with real time automated feedback: a prospective interventional study. Resuscitation 71(3):283–292

    Article  PubMed  Google Scholar 

  66. Berg RA et al (1996) Ventricular fibrillation in a swine model of acute pediatric asphyxial cardiac arrest. Resuscitation 33(2):147–153

    Article  CAS  PubMed  Google Scholar 

  67. Donoghue AJ et al (2006) Effect of hospital characteristics on outcomes from pediatric cardiopulmonary resuscitation: a report from the national registry of cardiopulmonary resuscitation. Pediatrics 118(3):995–1001

    Article  PubMed  Google Scholar 

  68. del Nido PJ et al (1992) Extracorporeal membrane oxygenator rescue in children during cardiac arrest after cardiac surgery. Circulation 86(5 Suppl):II300–II304

    PubMed  Google Scholar 

  69. Duncan BW et al (1998) Use of rapid-deployment extracorporeal membrane oxygenation for the resuscitation of pediatric patients with heart disease after cardiac arrest. J Thorac Cardiovasc Surg 116(2):305–311

    Article  CAS  PubMed  Google Scholar 

  70. Alsoufi B et al (2007) Survival outcomes after rescue extracorporeal cardiopulmonary resuscitation in pediatric patients with refractory cardiac arrest. J Thorac Cardiovasc Surg 134(4):952–959.e2

    Article  PubMed  Google Scholar 

  71. Morris MC, Wernovsky G, Nadkarni VM (2004) Survival outcomes after extracorporeal cardiopulmonary resuscitation instituted during active chest compressions following refractory in-hospital pediatric cardiac arrest. Pediatr Crit Care Med 5(5):440–446

    Article  PubMed  Google Scholar 

  72. Thiagarajan RR et al (2007) Extracorporeal membrane oxygenation to aid cardiopulmonary resuscitation in infants and children. Circulation 116(15):1693–1700

    Article  PubMed  Google Scholar 

  73. Raymond TT et al (2010) Outcomes among neonates, infants, and children after extracorporeal cardiopulmonary resuscitation for refractory inhospital pediatric cardiac arrest: a report from the National Registry of Cardiopulmonary Resuscitation. Pediatr Crit Care Med 11(3):362–371

    PubMed  Google Scholar 

  74. Wright WL, Geocadin RG (2006) Postresuscitative intensive care: neuroprotective strategies after cardiac arrest. Semin Neurol 26(4):396–402

    Article  PubMed  Google Scholar 

  75. Popp E, Bottiger BW (2006) Cerebral resuscitation: state of the art, experimental approaches and clinical perspectives. Neurol Clin 24(1):73–87, vi

    Article  PubMed  Google Scholar 

  76. Sunde K et al (2007) Implementation of a standardised treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation 73(1):29–39

    Article  PubMed  Google Scholar 

  77. Kilgannon JH et al (2010) Association between arterial hyperoxia following resuscitation from cardiac arrest and in-hospital mortality. JAMA 303(21):2165–2171

    Article  CAS  PubMed  Google Scholar 

  78. Bernard SA et al (2002) Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 346(8):557–563

    Article  PubMed  Google Scholar 

  79. Hypothermia after Cardiac Arrest Study Group (2002) Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med 346(8):549–556

    Article  Google Scholar 

  80. Fink EL et al (2010) A tertiary care center’s experience with therapeutic hypothermia after pediatric cardiac arrest. Pediatr Crit Care Med 11(1):66–74

    Article  PubMed  PubMed Central  Google Scholar 

  81. Doherty DR et al (2009) Hypothermia therapy after pediatric cardiac arrest. Circulation 119(11):1492–1500

    Article  PubMed  Google Scholar 

  82. Zaritsky A et al (1987) CPR in children. Ann Emerg Med 16(10):1107–1111

    Article  CAS  PubMed  Google Scholar 

  83. Nichols DG et al (1986) Factors influencing outcome of cardiopulmonary resuscitation in children. Pediatr Emerg Care 2(1):1–5

    Article  CAS  PubMed  Google Scholar 

  84. Rhodes JF et al (1999) Cardiac arrest in infants after congenital heart surgery. Circulation 100(19 Suppl):II194–II199

    CAS  PubMed  Google Scholar 

  85. Reis AG et al (2002) A prospective investigation into the epidemiology of in-hospital pediatric cardiopulmonary resuscitation using the international Utstein reporting style. Pediatrics 109(2):200–209

    Article  PubMed  Google Scholar 

  86. Meaney PA et al (2006) Higher survival rates among younger patients after pediatric intensive care unit cardiac arrests. Pediatrics 118(6):2424–2433

    Article  PubMed  Google Scholar 

  87. Young KD, Seidel JS (1999) Pediatric cardiopulmonary resuscitation: a collective review. Ann Emerg Med 33(2):195–205

    Article  CAS  PubMed  Google Scholar 

  88. Kuisma M, Suominen P, Korpela R (1995) Paediatric out-of-hospital cardiac arrests–epidemiology and outcome. Resuscitation 30(2):141–150

    Article  CAS  PubMed  Google Scholar 

  89. Suominen P et al (1997) Paediatric cardiac arrest and resuscitation provided by physician-staffed emergency care units. Acta Anaesthesiol Scand 41(2):260–265

    Article  CAS  PubMed  Google Scholar 

  90. Sirbaugh PE et al (1999) A prospective, population-based study of the demographics, epidemiology, management, and outcome of out-of-hospital pediatric cardiopulmonary arrest. Ann Emerg Med 33(2):174–184

    Article  CAS  PubMed  Google Scholar 

  91. Schindler MB et al (1996) Outcome of out-of-hospital cardiac or respiratory arrest in children. N Engl J Med 335(20):1473–1479

    Article  CAS  PubMed  Google Scholar 

  92. Dieckmann RA, Vardis R (1995) High-dose epinephrine in pediatric out-of-hospital cardiopulmonary arrest. Pediatrics 95(6):901–913

    CAS  PubMed  Google Scholar 

  93. Gerein RB et al (2006) What are the etiology and epidemiology of out-of-hospital pediatric cardiopulmonary arrest in Ontario, Canada? Acad Emerg Med 13(6):653–658

    Article  PubMed  Google Scholar 

  94. Tunstall-Pedoe H et al (1992) Survey of 3765 cardiopulmonary resuscitations in British hospitals (the BRESUS Study): methods and overall results. BMJ 304(6838):1347–1351

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  95. Lopez-Herce J et al (2005) Outcome of out-of-hospital cardiorespiratory arrest in children. Pediatr Emerg Care 21(12):807–815

    Article  PubMed  Google Scholar 

  96. Dean JM et al (1987) Age-related changes in chest geometry during cardiopulmonary resuscitation. J Appl Physiol (Bethesda, Md: 1985) 62(6):2212–22129

    Article  CAS  PubMed  Google Scholar 

  97. Chaplik S, Neafsey PJ (1998) Pre-existing variables and outcome of cardiac arrest resuscitation in hospitalized patients. Dimens Crit Care Nurs 17(4):200–207

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Maryam Y. Naim .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag London

About this entry

Cite this entry

Naim, M.Y., Rossano, J.W., Nadkarni, V.M., Berg, R.A. (2014). Current CPR Recommendations. In: Da Cruz, E., Ivy, D., Jaggers, J. (eds) Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care. Springer, London. https://doi.org/10.1007/978-1-4471-4619-3_59

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-4619-3_59

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-4618-6

  • Online ISBN: 978-1-4471-4619-3

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Navigation