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Pulmonary cardiac resuscitation in children. Algorithm of actions for cardiopulmonary resuscitation in children, its purpose and types

The neonatal department has been part of the Central Clinical Hospital since 1989. The department organizes the joint stay of mothers and newborns from the first minutes of life. We provide support for breastfeeding, which is important from the first hours of a child’s life, and teach mothers the skills to care for their baby. Our caring and experienced nurses will help you care for your newborn, and qualified neonatologists will monitor him daily.

If you are expecting a baby, know that you are not the only one waiting for him! They are waiting for him in the newborn department, because people who love their profession work here.

The structure of the department includes a resuscitation and intensive care ward, a room for preparing baby food, as well as a room for storing vaccines and conducting vaccinations.

A neonatologist is the first doctor in your child’s life; he meets the little person who has been born, takes him in his arms, places him on the mother’s breast, and observes him in the first hours, days and weeks of his life. A neonatologist is always present during childbirth and is ready to help a weakened or premature baby. For this purpose, the neonatal department has everything necessary. After the child’s condition has stabilized, you will have the opportunity to be in the same room with the child.

The department is equipped with modern diagnostic and treatment equipment: incubators; breathing apparatus for artificial ventilation of the lungs; monitors to monitor blood pressure, oxygen saturation, temperature, respiratory rate and heart rate; heated resuscitation tables; electric pumps; perfusers for long-term infusion therapy; phototherapy lamps, as well as a centralized oxygen system; oxygen dosimeters; sets for puncture of the spinal canal; Brownule sets for puncture of peripheral veins; catheters for catheterization of the umbilical vein; replacement blood transfusion kits; intragastric probes.

Laboratory tests for newborns are carried out at the hospital laboratory: clinical blood test, acid-base balance, electrolyte composition, determination of blood group and Rh factor, Coombs reaction, bilirubin and its fractions, glucose level, biochemical blood test, blood coagulation factors, urinalysis, analysis cerebrospinal fluid, it is possible to conduct immunological and microbiological blood tests. The following examinations can also be performed: radiography, ECG, ECHO-CG, ultrasound of internal organs and neurosonography. If necessary, children in the department will be consulted by otolaryngologists, ophthalmologists, surgeons, dermatologists from other departments of the Central Clinical Hospital, cardiologists of the Scientific Center of the Cardiovascular Surgery named after. A.N. Bakuleva and consultant neurologist Professor A.S. Petrukhin. The department screens all newborns for phenylketonuria, hypothyroidism, adrenogenital syndrome, cystic fibrosis, and galactosemia. According to the national vaccination calendar, vaccination against tuberculosis with the BCG-M vaccine and vaccination against hepatitis B with the Engerix B vaccine, and audiological screening are carried out. Compliance with all requirements for the sanitary and epidemiological regime is the most important section of the department’s work. As a result of the measures taken, there were no nosocomial infections during the operation of the department. The greatest attention in our department is paid to breastfeeding and the joint stay of mother and child.

Cardiopulmonary resuscitation for children

CPR in children under 1 year of age

Sequence of actions:

1. Lightly shake or pat your baby if you suspect he or she is unconscious

2. Place the baby on his back;

3. Call someone for help;

4. Clear your airways

Remember! When straightening the baby's head, avoid bending it!

5. Check if there is breathing, if not, start mechanical ventilation: take a deep breath, cover the baby’s mouth and nose with your mouth and take two slow, shallow breaths;

6. Check for a pulse for 5 - 10 seconds. (in children under 1 year of age, the pulse is determined on the brachial artery);

Remember! If you are offered help at this time, ask to call an ambulance.

7. If there is no pulse, place the 2nd and 3rd fingers on the sternum, one finger below the nipple line and begin chest compressions

Frequency of at least 100 per minute;

Depth 2 - 3 cm;

The ratio of sternum thrusts and blows is 5:1 (10 cycles per minute);

Remember! If there is a pulse, but breathing is not detected; Ventilation is performed at a frequency of 20 breaths per minute. (1 blow every 3 seconds)!

8. After performing indirect cardiac massage, they proceed to mechanical ventilation; do 4 full cycles

In children under 1 year of age, breathing problems are most often caused by a foreign body in the respiratory tract.

As in an adult victim, the airway may be partially or completely blocked. If the airways are partially blocked, the baby is frightened, coughs, and inhales with difficulty and noisily. If the respiratory tract is completely blocked, the skin turns pale, the lips become bluish, and there is no cough.

The sequence of actions when resuscitating a baby with complete blockage of the airways:

1. Place the baby face down on your left forearm so that the baby's head hangs over the rescuer's arm;

2. Make 4 claps on the victim’s back with the heel of your palm;

3. Place your baby face up on your other forearm;

4. Make 4 compressions on the chest, as with chest compressions;

5. Follow steps 1 - 4 until the airway is restored or the baby loses consciousness;

Remember! An attempt to remove a foreign body blindly, as in adults, is not acceptable!

6. If the baby has lost consciousness, do a cycle of 4 claps on the back, 4 pushes on the sternum;

7. Examine the victim's mouth:

If a foreign body is visible, remove it and perform mechanical ventilation (2 injections);

If the foreign body is not removed, repeat back slaps, sternum thrusts, mouth inspection, and mechanical ventilation until baby's chest rises:
- after 2 successful insufflations, check the pulse in the brachial artery.

Features of mechanical ventilation in children

To restore breathing in children under 1 year of age, mechanical ventilation is performed “mouth to mouth and nose”, in children over 1 year of age - by the “mouth to mouth” method. Both methods are carried out with the child in the supine position. For children under 1 year of age, a low cushion (for example, a folded blanket) is placed under the back, or the upper part of the body is slightly raised with an arm placed under the back, and the child’s head is slightly thrown back. The person providing assistance takes a shallow breath, tightly covers the mouth and nose of a child under 1 year old, or only the mouth in children older than one year, and blows air into the respiratory tract, the volume of which should be smaller the smaller the child. In newborns, the volume of inhaled air is 30-40 ml. When there is a sufficient volume of air blown in and the air enters the lungs (and not the stomach), movements of the chest appear. Having finished insufflation, you need to make sure that the chest descends.

Blowing in a volume of air that is too large for the child can lead to serious consequences - rupture of the alveoli and lung tissue and the release of air into the pleural cavity.

Remember!

The frequency of insufflations should correspond to the age-related frequency of respiratory movements, which decreases with age.

On average, the respiratory rate per minute is:

In newborns and children up to 4 months - 40

In children 4-6 months - 35-40

In children 7 months - 35-30

For children 2-4 years old - 30-25

For children 4-6 years old - about 25

For children 6-12 years old - 22-20

For children 12-15 years old - 20-18 years old.

Features of indirect cardiac massage in children

In children, the chest wall is elastic, so indirect cardiac massage is performed with less effort and with greater efficiency.

The technique of chest compressions in children depends on the age of the child. For children under 1 year old, it is enough to press on the sternum with 1-2 fingers. To do this, the person providing assistance places the child on his back with his head facing him, covers him so that the thumbs are located on the front surface of the chest, and their ends are on the lower third of the sternum, the remaining fingers are placed under the back.

For children over 1 to 7 years of age, heart massage is performed while standing on the side, with the base of one hand, and for older children - with both hands (like adults).

During the massage, the chest should bend by 1-1.5 cm in newborns, 2-2.5 cm in children 1-12 months old, 3-4 cm in children over one year old.

The number of compressions on the sternum for 1 minute should correspond to the average age pulse rate, which is:

In newborns - 140

In children 6 months - 130-135

In children 1 year old - 120-125

In children 2 years old - 110-115

In children 3 years old - 105-110

In children 4 years old - 100-105

For children 5 years old - 100

For children 6 years old - 90-95

For children 7 years old - 85-90

For children 8-9 years old - 80-85

For children 10-12 years old - 80

For children 13-15 years old - 75

Educational literature

UMP on Fundamentals of Nursing, edited by Ph.D. A.I. Shpirna, M., GOU VUNMC, 2003, pp. 683-684, 687-988.

S.A. Mukhina, I.I. Tarnovskaya, Atlas on manipulative techniques of nursing care, M., 1997, pp. 207-211.

A neonatal center is a place where babies who need special care are helped. At the Mother and Child clinics, professional neonatologists are on duty around the clock, ready to provide assistance to newborns. When placing a baby in a neonatal center, we also take care of creating comfortable conditions for the mother. We strive for the mother to be as close to the child as possible, then the recovery process will be faster and easier.

Intensive care for newborns

In the intensive care unit, babies are under constant supervision of highly qualified staff. Children who require special attention, treatment or complex procedures and examinations are sent here.

The neonatal intensive care unit at the Mother and Child clinics is equipped with everything necessary to provide emergency medical care at the modern level.

The intensive care and resuscitation unit has 24-hour access to doctors of various specialties to provide comprehensive care to the baby.

Caring for newborns with low and very low body weight

Premature babies with low body weight need special care and conditions. We create living conditions as close as possible to intrauterine conditions: temperature, humidity, sound, light - everything should be comfortable. Doctors at Mother and Child clinics have extensive experience in caring for premature babies with low body weight. The medical staff provides comprehensive support to newborns and their mothers around the clock.

Treatment of neonatal pathology

The neonatal pathology department of the Mother and Child clinic is ready to accept babies and provide the full range of neonatal care. Children are also transferred here after being in intensive care and neonatal intensive care.

Comfort for mother and baby

In the neonatal center, babies are kept in special boxes; it is impossible to stay with their mother. However, we always do everything to ensure that mother and child spend as much time as possible together. Peace of mind for the mother, a comfortable stay next to the child and maximum possible contact - this is what our doctors always insist on. Special rooms for parents are located next to the neonatal center; the room is equipped with everything necessary: ​​TV, refrigerator, separate bathroom, Internet access. It is also possible for the mother to be with the child only during the daytime, if for some reason it is impossible to be nearby around the clock.

The sequence of the three most important techniques of cardiopulmonary resuscitation is formulated by P. Safar (1984) in the form of the “ABC” rule:

  1. Aire way orep (“open the way for air”) means the need to free the airways from obstacles: recessed root of the tongue, accumulation of mucus, blood, vomit and other foreign bodies;
  2. Breath for victim (“breathing for the victim”) means mechanical ventilation;
  3. Circulation his blood (“circulation of his blood”) means performing indirect or direct cardiac massage.

Measures aimed at restoring airway patency are carried out in the following sequence:

  • the victim is placed on a rigid base supine (face up), and if possible, in the Trendelenburg position;
  • straighten the head in the cervical region, bring the lower jaw forward and at the same time open the victim’s mouth (triple maneuver by R. Safar);
  • free the patient's mouth from various foreign bodies, mucus, vomit, blood clots using a finger wrapped in a scarf and suction.

Having ensured airway patency, begin mechanical ventilation immediately. There are several main methods:

  • indirect, manual methods;
  • methods of directly blowing air exhaled by a resuscitator into the victim’s respiratory tract;
  • hardware methods.

The former are mainly of historical significance and are not considered at all in modern guidelines for cardiopulmonary resuscitation. At the same time, manual ventilation techniques should not be neglected in difficult situations when it is not possible to provide assistance to the victim in other ways. In particular, you can apply rhythmic compression (simultaneously with both hands) of the lower ribs of the victim's chest, synchronized with his exhalation. This technique may be useful during transportation of a patient with severe status asthmaticus (the patient lies or half-sits with his head thrown back, the doctor stands in front or to the side and rhythmically squeezes his chest from the sides during exhalation). Admission is not indicated for rib fractures or severe airway obstruction.

The advantage of direct inflation methods for the victim’s lungs is that a lot of air (1-1.5 liters) is introduced with one breath, with active stretching of the lungs (Hering-Breuer reflex) and the introduction of an air mixture containing an increased amount of carbon dioxide (carbogen) , the patient's respiratory center is stimulated. The methods used are “mouth to mouth”, “mouth to nose”, “mouth to nose and mouth”; the latter method is usually used in the resuscitation of young children.

The rescuer kneels at the side of the victim. Holding his head in an extended position and holding his nose with two fingers, he tightly covers the victim’s mouth with his lips and makes 2-4 vigorous, not rapid (within 1-1.5 s) exhalations in a row (excursion of the patient’s chest should be noticeable). An adult is usually provided with up to 16 respiratory cycles per minute, a child - up to 40 (taking into account age).

Ventilators vary in design complexity. At the prehospital stage, you can use breathing self-expanding bags of the “Ambu” type, simple mechanical devices of the “Pneumat” type or constant air flow interrupters, for example, using the Eyre method (through a tee - with your finger). In hospitals, complex electromechanical devices are used that provide mechanical ventilation for a long period (weeks, months, years). Short-term forced ventilation is provided through a nasal mask, long-term - through an endotracheal or tracheotomy tube.

Typically, mechanical ventilation is combined with external, indirect cardiac massage, achieved through compression - compression of the chest in the transverse direction: from the sternum to the spine. In older children and adults, this is the border between the lower and middle third of the sternum; in young children, it is a conventional line passing one transverse finger above the nipples. The frequency of chest compressions in adults is 60-80, in infants - 100-120, in newborns - 120-140 per minute.

In infants, one breath occurs per 3-4 chest compressions; in older children and adults, this ratio is 1:5.

The effectiveness of indirect cardiac massage is evidenced by a decrease in cyanosis of the lips, ears and skin, constriction of the pupils and the appearance of a photoreaction, an increase in blood pressure, and the appearance of individual respiratory movements in the patient.

Due to incorrect placement of the resuscitator's hands and excessive efforts, complications of cardiopulmonary resuscitation are possible: fractures of the ribs and sternum, damage to internal organs. Direct cardiac massage is done for cardiac tamponade and multiple rib fractures.

Specialized cardiopulmonary resuscitation includes more adequate mechanical ventilation techniques, as well as intravenous or intratracheal administration of medications. When administered intratracheally, the dose of drugs should be 2 times higher in adults, and 5 times higher in infants, than when administered intravenously. Intracardiac administration of drugs is not currently practiced.

The condition for the success of cardiopulmonary resuscitation in children is the release of the airways, mechanical ventilation and oxygen supply. The most common cause of circulatory arrest in children is hypoxemia. Therefore, during CPR, 100% oxygen is supplied through a mask or endotracheal tube. V. A. Mikhelson et al. (2001) supplemented the “ABC” rule by R. Safar with 3 more letters: D (Drag) - drugs, E (ECG) - electrocardiographic control, F (Fibrillation) - defibrillation as a method of treating cardiac arrhythmias. Modern cardiopulmonary resuscitation in children is unthinkable without these components, however, the algorithm for their use depends on the type of cardiac dysfunction.

For asystole, intravenous or intratracheal administration of the following drugs is used:

  • adrenaline (0.1% solution); 1st dose - 0.01 ml/kg, subsequent doses - 0.1 ml/kg (every 3-5 minutes until the effect is obtained). When administered intratracheally, the dose is increased;
  • atropine (in asystole is ineffective) is usually administered after adrenaline and ensuring adequate ventilation (0.02 ml/kg of 0.1% solution); repeat no more than 2 times in the same dose after 10 minutes;
  • sodium bicarbonate is administered only in conditions of prolonged cardiopulmonary resuscitation, and also if it is known that circulatory arrest has occurred against the background of decompensated metabolic acidosis. The usual dose is 1 ml of 8.4% solution. The drug can be administered again only under the supervision of CBS;
  • dopamine (dopamine, dopmin) is used after restoration of cardiac activity against the background of unstable hemodynamics at a dose of 5-20 mcg/(kg min), to improve diuresis 1-2 mcg/(kg min) for a long time;
  • lidocaine is administered after restoration of cardiac activity against the background of post-resuscitation ventricular tachyarrhythmia as a bolus at a dose of 1.0-1.5 mg/kg, followed by infusion at a dose of 1-3 mg/kg-h), or 20-50 mcg/(kg-min) .

Defibrillation is performed against the background of ventricular fibrillation or ventricular tachycardia in the absence of a pulse in the carotid or brachial artery. The power of the 1st discharge is 2 J/kg, subsequent ones - 4 J/kg; the first 3 discharges can be done in a row without monitoring with an ECG monitor. If the device has a different scale (voltmeter), the 1st digit in infants should be in the range of 500-700 V, repeated ones - 2 times more. In adults, 2 and 4 thousand, respectively. V (maximum 7 thousand V). The effectiveness of defibrillation is increased by repeated administration of the entire complex of drug therapy (including a polarizing mixture, and sometimes magnesium sulfate, aminophylline);

For EMD in children with no pulse in the carotid and brachial arteries, the following intensive therapy methods are used:

  • adrenaline intravenously, intratracheally (if catheterization is impossible after 3 attempts or within 90 s); 1st dose 0.01 mg/kg, subsequent doses - 0.1 mg/kg. Administration of the drug is repeated every 3-5 minutes until the effect is obtained (restoration of hemodynamics, pulse), then in the form of infusions at a dose of 0.1-1.0 μg/(kgmin);
  • fluid to replenish the central nervous system; It is better to use a 5% solution of albumin or stabizol, you can use rheopolyglucin in a dose of 5-7 ml/kg quickly, drip-wise;
  • atropine at a dose of 0.02-0.03 mg/kg; possible repeated administration after 5-10 minutes;
  • sodium bicarbonate - usually 1 time 1 ml of 8.4% solution intravenously slowly; the effectiveness of its introduction is questionable;
  • if the listed means of therapy are ineffective, electrical cardiac pacing (external, transesophageal, endocardial) is performed immediately.

If in adults ventricular tachycardia or ventricular fibrillation are the main forms of circulatory arrest, then in young children they are observed extremely rarely, so defibrillation is almost never used in them.

In cases where the damage to the brain is so deep and extensive that it becomes impossible to restore its functions, including brain stem functions, brain death is diagnosed. The latter is equated to the death of the organism as a whole.

Currently, there are no legal grounds for stopping initiated and actively ongoing intensive care in children before natural circulatory arrest. Resuscitation does not begin and is not carried out in the presence of a chronic disease and pathology incompatible with life, which is determined in advance by a council of doctors, as well as in the presence of objective signs of biological death (cadaveric spots, rigor mortis). In all other cases, cardiopulmonary resuscitation in children should begin in case of any sudden cardiac arrest and be carried out according to all the rules described above.

The duration of standard resuscitation in the absence of effect should be at least 30 minutes after circulatory arrest.

With successful cardiopulmonary resuscitation in children, it is possible to restore cardiac function, sometimes simultaneously and respiratory function (primary revival) in at least half of the victims, but in the future, preservation of life in patients is much less common. The reason for this is post-resuscitation illness.

The outcome of recovery is largely determined by the conditions of the blood supply to the brain in the early post-resuscitation period. In the first 15 minutes, blood flow can exceed the initial one by 2-3 times, after 3-4 hours it drops by 30-50% in combination with an increase in vascular resistance by 4 times. Repeated deterioration of cerebral circulation may occur 2-4 days or 2-3 weeks after CPR against the background of almost complete restoration of central nervous system function - delayed posthypoxic encephalopathy syndrome. By the end of the 1st to the beginning of the 2nd day after CPR, a repeated decrease in blood oxygenation may be observed, associated with nonspecific lung damage - respiratory distress syndrome (RDS) and the development of shunt-diffusion respiratory failure.

Complications of post-resuscitation illness:

  • in the first 2-3 days after CPR - swelling of the brain, lungs, increased tissue bleeding;
  • 3-5 days after CPR - dysfunction of parenchymal organs, development of manifest multiple organ failure (MOF);
  • at a later date - inflammatory and suppurative processes. In the early post-resuscitation period (1-2 weeks) intensive therapy
  • is carried out against the background of impaired consciousness (somnolence, stupor, coma) of mechanical ventilation. Its main tasks in this period are stabilization of hemodynamics and protection of the brain from aggression.

Restoration of the central nervous system and rheological properties of blood is carried out with hemodilutants (albumin, protein, dry and native plasma, rheopolyglucin, saline solutions, less often a polarizing mixture with the administration of insulin at the rate of 1 unit per 2-5 g of dry glucose). Plasma protein concentration should be at least 65 g/l. Improved gas exchange is achieved by restoring the oxygen capacity of the blood (transfusion of red blood cells), mechanical ventilation (with the oxygen concentration in the air mixture preferably less than 50%). With reliable restoration of spontaneous breathing and stabilization of hemodynamics, it is possible to carry out HBOT, for a course of 5-10 procedures daily at 0.5 ATI (1.5 ATA) and a plateau of 30-40 minutes under the cover of antioxidant therapy (tocopherol, ascorbic acid, etc.). Maintaining blood circulation is ensured by small doses of dopamine (1-3 mcg/kg per minute for a long time) and maintenance cardiotrophic therapy (polarizing mixture, panangin). Normalization of microcirculation is ensured by effective pain relief for injuries, neurovegetative blockade, administration of antiplatelet agents (Curantyl 2-3 mg/kg, heparin up to 300 IU/kg per day) and vasodilators (Cavinton up to 2 ml drip or Trental 2-5 mg/kg per day drip, Sermion , aminophylline, nicotinic acid, complamin, etc.).

Antihypoxic therapy is carried out (Relanium 0.2-0.5 mg/kg, barbiturates in a saturation dose of up to 15 mg/kg on the 1st day, on subsequent days - up to 5 mg/kg, GHB 70-150 mg/kg after 4-6 hours , enkephalins, opioids) and antioxidant (vitamin E - 50% oil solution at a dose of 20-30 mg/kg strictly intramuscularly daily, for a course of 15-20 injections) therapy. To stabilize membranes and normalize blood circulation, large doses of prednisolone and metipred (up to 10-30 mg/kg) are prescribed intravenously as a bolus or in fractions over 1 day.

Prevention of post-hypoxic cerebral edema: cranial hypothermia, administration of diuretics, dexazone (0.5-1.5 mg/kg per day), 5-10% albumin solution.

Correction of VEO, CBS and energy metabolism is carried out. Detoxification therapy is carried out (infusion therapy, hemosorption, plasmapheresis according to indications) to prevent toxic encephalopathy and secondary toxic (autotoxic) organ damage. Intestinal decontamination with aminoglycosides. Timely and effective anticonvulsant and antipyretic therapy in young children prevents the development of post-hypoxic encephalopathy.

Prevention and treatment of bedsores (treatment with camphor oil, curiosin of places with impaired microcirculation), hospital infections (asepsis) are necessary.

If the patient quickly recovers from a critical condition (within 1-2 hours), the complex of therapy and its duration should be adjusted depending on the clinical manifestations and the presence of post-resuscitation illness.

Treatment in the late post-resuscitation period

Therapy in the late (subacute) post-resuscitation period is carried out for a long time - months and years. Its main focus is restoration of brain function. Treatment is carried out jointly with neurologists.

  • The administration of drugs that reduce metabolic processes in the brain is reduced.
  • Drugs that stimulate metabolism are prescribed: cytochrome C 0.25% (10-50 ml/day 0.25% solution in 4-6 doses depending on age), Actovegin, solcoseryl (0.4-2.00 intravenous drips for 5 % glucose solution for 6 hours), piracetam (10-50 ml/day), Cerebrolysin (up to 5-15 ml/day) for older children intravenously during the day. Subsequently, encephabol, acephen, and nootropil are prescribed orally for a long time.
  • 2-3 weeks after CPR, a (primary or repeated) course of HBO therapy is indicated.
  • The introduction of antioxidants and disaggregants is continued.
  • Vitamins B, C, multivitamins.
  • Antifungal drugs (Diflucan, Ancotil, Candizol), biological products. Discontinuation of antibacterial therapy if indicated.
  • Membrane stabilizers, physiotherapy, physical therapy (physical therapy) and massage according to indications.
  • General restorative therapy: vitamins, ATP, creatine phosphate, biostimulants, adaptogens in long-term courses.

The main differences between cardiopulmonary resuscitation in children and adults

Conditions preceding circulatory arrest

Bradycardia in a child with respiratory disorders is a sign of circulatory arrest. Newborns, infants and young children develop bradycardia in response to hypoxia, while older children initially develop tachycardia. In newborns and children with a heart rate less than 60 beats per minute and signs of low organ perfusion in the absence of improvement after the start of artificial respiration, closed cardiac massage should be performed.

After adequate oxygenation and ventilation, epinephrine is the drug of choice.

Blood pressure must be measured with a correctly sized cuff; invasive blood pressure measurement is indicated only in cases of extreme severity of the child.

Since blood pressure depends on age, it is easy to remember the lower limit of normal as follows: less than 1 month - 60 mm Hg. Art.; 1 month - 1 year - 70 mm Hg. Art.; more than 1 year - 70 + 2 x age in years. It is important to note that children are able to maintain pressure for a long time due to powerful compensatory mechanisms (increased heart rate and peripheral vascular resistance). However, hypotension is quickly followed by cardiac and respiratory arrest. Therefore, even before the onset of hypotension, all efforts should be aimed at treating shock (manifestations of which are increased heart rate, cold extremities, capillary refill more than 2 s, weak peripheral pulse).],

Equipment and external conditions

Equipment size, drug dosage, and CPR parameters depend on age and body weight. When choosing doses, the child’s age should be rounded down, for example, at the age of 2 years, a dose for the age of 2 years is prescribed.

In newborns and children, heat transfer is increased due to the larger body surface area relative to body weight and the small amount of subcutaneous fat. The ambient temperature during and after cardiopulmonary resuscitation should be constant, ranging from 36.5 °C in newborns to 35 °C in children. When basal body temperature is below 35 "C CPR becomes problematic (in contrast to the beneficial effect of hypothermia in the post-resuscitation period).

Rhythm disturbances

For asystole, atropine and artificial rhythm stimulation are not used.

VF and VT with unstable hemodynamics occurs in 15-20% of cases of circulatory arrest. Vasopressin is not prescribed. When using cardioversion, the shock force should be 2-4 J/kg for a monophasic defibrillator. It is recommended to start with 2 J/kg and increase as necessary to a maximum of 4 J/kg for the third shock.

Statistics show that cardiopulmonary resuscitation in children allows at least 1% of patients or accident victims to return to a full life.