How much do you know about cardiopulmonary resuscitation for children?

Author: Cui Tiantian Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine

Reviewer: Xie Wei, deputy chief physician, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine

When it comes to cardiopulmonary resuscitation, everyone is familiar with it, but what about pediatric cardiopulmonary resuscitation? In recent years, with the promotion of cardiopulmonary resuscitation, everyone must have a certain degree of understanding of it, but for children, this special group may still be relatively unfamiliar. This article will tell you in detail.

What is CPR?

Cardiopulmonary resuscitation (abbreviated as "CPR") refers to the first aid measures taken to restore circulation and breathing for patients with cardiac and respiratory arrest caused by various reasons, so as to maintain life. It is usually applicable to coma, respiratory and cardiac arrest caused by children's respiratory failure, neonatal asphyxia, trauma, shock, nervous system diseases, drowning, poisoning, etc.

Figure 1 Copyright image, no permission to reprint

Why CPR?

Because time is life, relevant practice shows that when a person's heart stops beating, brain edema will occur within 3 minutes, and irreversible damage to brain cells may occur within 4 to 6 minutes. The golden time for rescue is only 4 minutes, and the success rate will drop by 10% for every 1 minute of delay. Therefore, it is urgent to master the skill of cardiopulmonary resuscitation. Let's learn how to operate it together!

How to perform CPR?

1. Determine whether the surrounding environment is safe

When we suddenly find a child fainted on the ground, we must first determine whether the surrounding environment is safe. We must ensure that both the rescuer and the patient are in a safe environment (for example, when rescuing in thunderstorms, we should avoid large trees, and when rescuing a patient with electric shock, we should cut off the power supply).

2. Determine whether there is consciousness, pulse and breathing

Step 1: Pat the patient's shoulders gently with both hands and shout loudly in his ear, "What's wrong?" If the patient does not respond, it means he has lost consciousness. Immediately call for other people to help and dial the "120" emergency number as soon as possible.

Step 2: If the patient does not react, unbutton the shirt to expose the anterior chest wall. When assessing the presence of large arterial pulsation, use the index and middle fingers together to touch the carotid artery pulsation (the carotid artery pulsation point is located in the depression between the trachea and the sternocleidomastoid muscle). For infants, the brachial artery can be touched (i.e., 2 cm above the cubital fossa on the inner side of the upper arm). At the same time, observe whether the patient's chest is rising or falling (i.e., whether there is any breathing movement). The entire assessment time should be greater than 5 seconds, but less than 10 seconds.

3. Chest compressions

1. Body position: Place the patient in supine position on a hard bed or flat ground.

2. Pressing position: 1/3 below the sternum or the midpoint of the line connecting the two nipples.

3. Pressing technique

(1) For newborns or infants: Hold your hands and use the thumbs to apply pressure (hold your palms and four fingers on both sides of the back, and use the thumbs of both hands to apply pressure).

(2) Children: Two-handed pressure method (place the base of the left hand on the pressure area, overlap the right hand on the back of the left hand, overlap the base of the two palms, interlock the fingers, lift the left fingers away from the chest wall, and press vertically).

4. Compression depth: ≥ 1/3 of the anterior-posterior diameter of the chest (approximately 4 cm for infants and approximately 5 cm for children). The chest should fully rebound each time. At the same time, the base of the palm should not leave the chest wall and press at a constant speed.

5. Pressing frequency: 100-120 times/minute.

Figure 2 Copyright image, no permission to reprint

4. Airway Management

1. Clear the airway: Asphyxia is the main cause of respiratory and cardiac arrest in children, it is particularly important to promptly clear oral and nasal secretions, foreign objects or vomit and keep the airway open.

2. Open the airway:

(1) Head tilt and chin lift: The technique is to place the hypothenar of one hand on the patient's forehead, and the index and middle fingers of the other hand on the chin to lift the mandible so that the line connecting the mandibular angle and the earlobe is perpendicular to the ground.

(2) Jaw support method: Suitable for those who are suspected of having cervical spine injury. The technique is to place both hands on both sides of the patient's head, hold the mandibular angle and lift the lower jaw upward.

5. Establish Breathing

1. Mouth-to-mouth artificial respiration: The rescuer takes a deep breath first. For infants under 1 year old, the rescuer can cover the mouth and nose with his mouth. If it is a larger infant or child, pinch the child's nostrils with one hand, cover the child's lips tightly with his lips, and blow air into the child.

2. Observe whether the patient's chest is lifted. Each blowing time is 1 second.

3. After you stop blowing, separate your lips and open your nostrils to let the air out.

6. How to coordinate chest compression and artificial respiration

1. Single-person cardiopulmonary resuscitation: After 30 chest compressions and opening the airway, immediately give 2 effective artificial respirations, that is, the ratio of chest compressions to artificial respiration is 30:2.

2. Two-person CPR: The ratio of chest compressions to artificial respiration is 15:2.

3. Assessment: After 5 cycles of CPR, the patient’s consciousness needs to be assessed. If not, continue 5 cycles of CPR until consciousness is restored or medical staff arrives.

This is the end of the story about pediatric cardiopulmonary resuscitation. Have you learned it? I hope that everyone can master the key points of pediatric cardiopulmonary resuscitation through this article, and "save" them by your side, so that life will no longer wait!