Pediatric Cardiopulmonary Resuscitation

Pulseless cardiac arrest is typically defi ned as the documented cessation of cardiac mechanical activity, determined by the absence of a palpable central pulse, unresponsiveness, and apnea. Separation of severe hypoxic–ischemic shock with poor perfusion from the nonpulsatile state of cardiac arrest can be challenging at any age. This separation can be especially diffi cult in neonates and infants because of their anatomic and physiologic differences. A rescuer’s ability to determine cardiac arrest by a pulse check is neither sensitive nor specifi c in adults [1]. Not surprisingly, the pulse check is even more problematic in children. In adults, pulses can typically be palpated until the systolic pressure is <50 mm Hg. Because the normal systolic blood pressure in neonates is generally in the 60s, a decrease in blood pressure to nonpalpable pulse may occur earlier in the continuum from hypoxic–ischemic shock to nonpulsatile cardiac standstill. Furthermore, the best arterial pulse to palpate in an adult is the carotid pulse; however, the short, fl eshy neck of a baby with potential to compress the airway and impede respiration limits the effectiveness of carotid pulse palpation in babies.