European Resuscitation Council Guidelines for Resuscitation ... - CPR

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18 de 0ctubre de 2010 www.elsuapdetodos.com1378 D. Biarent et al. / Resuscitation 81 (2010) 1364–1388Bystander CPR is associated with a better neurological outcomein adults and children. 277–279 The most common ECGpatterns in infants, children and adolescents with cardiopulmonaryarrest are asystole and PEA. PEA is characterised byorganised, wide or narrow complex electrical activity, usually(but not always) at a slow rate, and absent pulses. It commonlyfollows a period of hypoxia or myocardial ischaemia,but occasionally can have a reversible cause (i.e., one of the 4Hs and 4 Ts) that led to a sudden impairment of cardiac output.Fig. 6.10. Paediatric algorithm for non-shockable rhythm.Fig. 6.11. Paediatric algorithm for shockable rhythm.www.elsuapdetodos.comfor every minute delay in defibrillation (without any CPR), survivaldecreases by 7–10%. Survival after more than 12 min of VF in adultvictims is 50% survival. However, the success of defibrillationdecreases dramatically the longer the time until defibrillation:Adrenaline (epinephrine)Adrenaline is given every 3–5 min by the IV or IO route in preferenceto the tracheal tube route.Amiodarone in VF/pulseless VTAmiodarone is indicated in defibrillation-resistant VF/pulselessVT. Experimental and clinical experience with amiodarone in childrenis scarce; evidence from adult studies 236,285,286 demonstratesincreased survival to hospital admission, but not to hospital dis-
charge. One paediatric case series demonstrates the effectiveness ofamiodarone for life-threatening ventricular arrhythmias. 287 Therefore,IV amiodarone has a role in the treatment of defibrillationrefractory or recurrent VF/pulseless VT in children.Extracorporeal life supportExtracorporeal life support should be considered for childrenwith cardiac arrest refractory to conventional CPR, if the arrestoccurs in a highly supervised environment and available expertiseand equipment to rapidly initiate extracorporeal life support(ECLS).ArrhythmiasUnstable arrhythmiasCheck for signs of life and the central pulse of any child with anarrhythmia; if signs of life are absent, treat as for cardiopulmonaryarrest. If the child has signs of life and a central pulse, evaluatethe haemodynamic status. Whenever the haemodynamic status iscompromised, the first steps are:1. Open the airway.2. Give oxygen and assist ventilation as necessary.3. Attach ECG monitor or defibrillator and assess the cardiacrhythm.4. Evaluate if the rhythm is slow or fast for the child’s age.5. Evaluate if the rhythm is regular or irregular.6. Measure QRS complex (narrow complexes: 0.08 s).7. The treatment options are dependent on the child’s haemodynamicstability.BradycardiaBradycardia is caused commonly by hypoxia, acidosis and/orsevere hypotension; it may progress to cardiopulmonary arrest.Give 100% oxygen, and positive pressure ventilation if required, toany child presenting with bradyarrhythmia and circulatory failure.If a poorly perfused child has a heart rate
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