Ready to Use Therapeutic Food (RUTF) in the Management of Severe Acute Malnutrition in India

correspondence

Indian Pediatr 2011;48: 821-823

Pediatric BLS Updates 2010

Shalu Gupta

Associate Professor, Department of Pediatrics, Chacha Nehru Bal Chikitsalya, Geeta Colony, Delhi 110 031,
Email: [email protected]

Pediatric basic life support forms the basis of rapid and effective Cardio pulmonary resuscitation (CPR) in infants and children, which ultimately is associated with return of spontaneous circulation. The main emphasis is on high quality CPR. Recent pediatric data shows an overall survival of 33% for pulseless arrest from in-hospital pediatric arrests [1].

The new guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care were published in October, 2010, by American Heart Association, in accordance with the established five yearly changes in the guidelines [1]. In the same month, almost a similar set of revised guidelines for cardiopulmonary resuscitation were published by European Resuscitation Council [2]. Both these guidelines for basic Life Support recommend that all rescuers should start with chest compressions on a victim who is found unresponsive and not breathing (or gasping). However, asphyxial arrests are more common than cardiac arrest in infants and children, and ventilation are important for resuscitation in pediatric age group, which is further substantiated by a recent pediatric study which showed that resuscitation results for asphyxia arrests are better with a combination of compressions and ventilation [3]. Some of these major changed in the pediatric basic life support are highlighted in Table I.

TABLE I Changes in the Pediatric Basic Life Support

	2005 recommendations	2010 recommendation [1]	Reasons for change
1.	Use of the “A-B-C” ( Airway,	A change in sequence to C-A-B”	• Majority of victims who require CPR are adults
	Breathing/ventilation, Chest	(Chest compressions, Airway,	with VF in whom chest compression are more
	compression) in basic life	Breathing) for adults and pediatric	important than ventilations [4].
	support sequence.	patients (children and infants,	• There is a delay in ventilations by about 18
		excluding newborns). “Look,	seconds for the lone rescuer and by even
		Listen, and Feel” has been	a shorter interval for 2 rescuers.
		removed.	• It offers consistency in teaching, for all
			age groups.
2.	Recovery position was not	Recovery position is	If there is no evidence of trauma, recovery
	recommended in infants	recommended in children.	position helps to maintain a patent airway
	and small children.		and decrease the risk of aspiration
3.	Rescuer should press down	Rescuer should press atleast 1/3	Inadequate chest compression depth is
	1/3 to ½ the depth of the	the anterior – posterior diameter	common even by the health care providers [5].
	chest with each compression.	of the chest or approximately 1½ inches (4 cms) in infants and 2	Compression to ½ the anterior- posterior diameter may not be possible.
		2 inches (5 cm) in children
4.	A chest compression rate of	A chest compression rate of atleast	Delivery of more compressions during CPR
	approximately 100 per	100 per minute.	is associated with better survival and an
	minute		important determinant of return of spontaneous circulation.
5.	In 2 thumb- encircling hands	Not recommended	There is no data which shows the benefit from
	technique, thorax is to be squeezed at the time of chest compression.		a circumferential squeeze.
6.	There are no different	If a lay rescuer is not trained in	High quality chest compressions generate
	recommendations for trained versus lay rescuer.	providing ventilations, or is unable to do so, the rescuer	blood flow to the vital organs. Compressions only are easier for an untrained rescuer to
		should continue with chest comp-	perform.
		ressions ( Hands – Only or comp-
		ression – only CPR) until help
		arrives
7.	No recommendations for use	For infants a manual defibrillator is	Shockable rhythms respond to electric
	of Automated External	preferred. If a manual defibrillator	shocks (Defibrillation) which ultimately decides
	defibrillator (AED) in infants	is not available, an AED with a	the survival.
	less than 1 year of age [6].	pediatric attenuator is preferred	There is minimal myocardial damage with
		for infants. If neither is available,	good neurological outcomes [7].
		an AED without a pediatric dose
		attenuator may be used.

References

1. Berg MD, Schexnayder SM, Chameides L, Terry M, Donoghue A, Hickey RW, et al. Part 13: Pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular care. Circulation. 2010; 122:S862–75.

2. Nolan JP, Soar J, Zideman DA, Biarent D, Bossaert LL, Deakin C, et al. European Resuscitation Council Guidelines for Resuscitation 2010: section 1. Executive summary. Resuscitation. 2010;81:1219–76.

3. Kitamura T, Iwami T, kawamura T, Nagao K, Tanaka H, Nadkarni VM, et al. 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. 2010;375:1347-54.

4. Rea TD, Cook AJ, Stiell IG, Powell J, Bigham B, Callaway CW, et al. Predicting survival after out-of- hospital cardiac arrest: role of the Utstein data elements. Ann Emerg Med. 2010;55:249–57.

5. Sutton RM, Niles D, Nysaether j, Abella BS, Arbogast KB, Nishisaki A, et al. Quantitative analysis of CPR quality during in-hospital resuscitation of older children and adolescents. Pediatrics. 2009;124:494-9.

6. Samson R, Berg R, Bingham R. Pediatric Advanced life support Task force ILCoR. Use of automated external defibrillators for children: an update. An advisory statement from the pediatric Advanced Life Support Task Force, International Liaison Committee on Resuscitation. Resuscitation. 2003;57:237-43.

7. Bar-Cohen Y, Walsh EP, Love BA, Cecchin F. First appropriate use of automated external defibrillator in an infant. Resuscitation. 2005;67:135-7.