Pediatric basic life support: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

For best survival and quality of life, pediatric basic life support (BLS) should be part of a community effort that includes prevention, early cardiopulmonary resuscitation (CPR), prompt access to the emergency response system, and rapid pediatric advanced life support (PALS), followed by integrated post– cardiac arrest care. These 5 links form the American Heart Association (AHA) pediatric Chain of Survival (Figure 1), the first 3 links of which constitute pediatric BLS. Rapid and effective bystander CPR can be associated with successful return of spontaneous circulation (ROSC) and neurologically intact survival in children following out-of-hospital cardiac arrest.1–3 Bystander resuscitation may have the greatest impact for out-of-hospital respiratory arrest,4 because survival rates 70% have been reported with good neurologic outcome.5,6 Bystander resuscitation may also have substantial impact on survival from primary ventricular fibrillation (VF), because survival rates of 20% to 30% have been documented in children with sudden out-of-hospital witnessed VF.7 Overall about 6%8 of children who suffer an out-ofhospital cardiac arrest and 8% of those who receive prehospital emergency response resuscitation survive, but many suffer serious permanent brain injury as a result of their arrest.7,9 –14 Out-of-hospital survival rates and neurological outcome can be improved with prompt bystander CPR,3,6,15–17 but only about one third to one half of infants and children who suffer cardiac arrest receive bystander CPR.3,9,12,18 Infants are less likely to survive out-ofhospital cardiac arrest (4%) than children (10%) or adolescents (13%), presumably because many infants included in the arrest figure are found dead after a substantial period of time, most from sudden infant death syndrome (SIDS).8 As in adults, survival is greater in pediatric patients with an initial rhythm of VF or pulseless ventricular tachycardia (VT) than in those with asystole or pulseless electric activity.7,8 Results of in-hospital resuscitation are better with an overall survival of 27%.19 –21 The 2008 pediatric data from the National Registry of CardioPulmonary Resuscitation (NRCPR) recorded an overall survival of 33% for pulseless arrests among the 758 cases of in-hospital pediatric arrests that occurred in the participating hospitals. Pediatric patients with VF/pulseless VT had a 34% survival to discharge, while patients with pulseless electric activity had a 38% survival. The worst outcome was in patients with asystole, only 24% of whom survived to hospital discharge. Infants and children with a pulse, but poor perfusion and bradycardia who required CPR, had the best survival (64%) to discharge. Children are more likely to survive in-hospital arrests than adults,19 and infants have a higher survival rate than children.20