Regulations 

Resuscitation in children of different ages. Cardiopulmonary resuscitation in children. What is resuscitation

In children, circulatory arrest due to cardiac causes occurs very rarely. In newborns and infants, the causes of circulatory arrest can be: asphyxia, syndrome sudden death newborns, pneumonia and bronchial spasm, drowning, sepsis, neurological diseases. In children of the first years of life, the main cause of death is injuries (road, pedestrian, bicycle), asphyxia (as a result of diseases or aspiration of foreign bodies), drowning,

burns and gunshot wounds. The technique of manipulation is approximately the same as in adults, but there are some features.

It is quite difficult to determine the pulse on the carotid arteries in newborns due to the short and round neck. Therefore, it is recommended to check the pulse in children under one year old on the brachial artery, and in children over one year old - on the carotid artery.

Airway patency is achieved by simply lifting the chin or pushing the mandible forward. If there is no spontaneous breathing in a child of the first years of life, then the most important resuscitation measure is mechanical ventilation. When conducting mechanical ventilation in children, they are guided the following rules. In children under 6 months of age, mechanical ventilation is carried out by blowing air into the mouth and nose at the same time. In children older than 6 months, breathing is carried out from mouth to mouth, while pinching the nose of the child with I and II fingers. Care must be taken regarding the volume of air blown and the airway pressure created by this volume. Air is blown in slowly for 1-1.5 s. The volume of each breath should cause a gentle rise in the chest. The frequency of mechanical ventilation for children of the first years of life is 20 respiratory movements per 1 min. If the chest does not rise during mechanical ventilation, then this indicates an obstruction. respiratory tract. The most common cause obstruction - incomplete opening of the airways due to insufficiently correct position of the head of the resuscitated child. You should carefully change the position of the head and then start ventilation again.

Tidal volume is determined by the formula: DO (ml) = body weight (kg) x10. In practice, the effectiveness of mechanical ventilation is assessed by chest excursion and airflow during exhalation. The rate of ventilation in newborns is approximately 40 per minute, in children over 1 year old - 20 per minute, in adolescents - 15 per minute.

External heart massage in infants is carried out with two fingers, and the compression point is located 1 finger below the internipple line. The caregiver supports the child's head in a position that ensures airway patency.

The depth of compression of the sternum is from 1.5 to 2.5 cm, the frequency of pressure is 100 per minute (5 compressions in 3 seconds or faster). Compression ratio: ventilation = 5:1. If the child is not intubated, the respiratory cycle is given 1-1.5 s (in the pause between compressions). After 10 cycles (5 compressions: 1 breath), you should try to determine the pulse on the brachial artery for 5 seconds.

In children aged 1-8 years, they press on the lower third of the sternum (the thickness of a finger above the xiphoid process) with the base of the palm. The depth of compression of the sternum is from 2.5 to 4 cm, the frequency of massage is at least 100 per minute. Every 5th compression is followed by a pause for inspiration. The ratio of the frequency of compressions to the rate of ventilation for children of the first years of life should be 5:1, regardless of how many people are involved in resuscitation. The child's condition (carotid pulse) is reassessed 1 min after the start of resuscitation, and then every 2-3 min.

In children older than 8 years, the CPR technique is the same as in adults.

Dosage of drugs in children with CPR: adrenaline - 0.01 mg / kg; lido-caine - 1 mg / kg = 0.05 ml of 2% solution; sodium bicarbonate - 1 mmol / kg \u003d 1 ml of an 8.4% solution.

With the introduction of 8.4% sodium bicarbonate solution to children, it should be diluted in half with isotonic sodium chloride solution.

Defibrillation in children under 6 years of age is performed with a discharge of 2 J / kg of body weight. If repeated defibrillation is required, the shock may be increased to 4 J/kg body weight.

POST-resuscitation period

Patients who have undergone cardiac arrest should be under constant medical supervision. First of all, a full clinical assessment of the patient's status and data from non-invasive research methods should be taken into account. Indications for other, more complex research methods (monitoring of intracranial pressure, measurement of PAWP, etc.) must be strictly reasoned.

Monitoring of cardio-vascular system includes constant monitoring of blood pressure, heart rate, CVP, ECT, BCC. It is important to prevent hyperperfusion and maintain normotension. To eliminate the stasis of microcirculation are recommended: mild arterial hypertension on a short time, the use of rheological agents and moderate hemodilution. It is important to promptly identify and eliminate cardiac arrhythmias, depending on the initial pathology (ischemia, AV blockade, etc.) and catecholamine-induced disorders associated with the use of inotropic and other agents. ECG diagnosis of rhythm disturbances requires a clear interpretation of the wave R and complex QRS(V, and II standard lead). These indicators are not enough to detect ischemia. Episodes of latent ischemia may go unnoticed. The chest lead V5 or its modifications indicate ischemia of the septum and the left side wall, and the bipolar lead II from the extremities indicates ischemia of the lower part of the myocardium in the territory of the right coronary artery.

Important information is provided by measuring the parameters of central hemodynamics. For this, the domestic apparatus "Reodin" can be recommended.

In order to prevent recurrent VF after successful cardioversion and to treat multiple ventricular extrasystoles, lidocaine can be prescribed as an intravenous infusion of 1-4 mg/min.

In bradyarrhythmias (sinus bradycardia, complete AV block) that do not respond to atropine treatment, pacing may be required, especially in cases where AV block or slow idioventricular rhythm is accompanied by hemodynamic disturbances.

In cardiogenic shock caused by a decrease in the pumping function of the heart, dobutamine (3-12 mcg / kg / min) and dopamine (2-10 mcg / kg / min) intravenously are indicated.

Monitoring of the respiratory system. In the postresuscitation period, it is important to reduce the concentration of Oz in the inhaled air to 50% in order to avoid the consequences of hyperoxygenation. It is necessary to maintain PaOz at a level close to 100 mm Hg. Art. The recommended level of PaCO2 is 25-35 mm Hg, and with an increase in intracranial pressure, an average of 25 mm Hg. Correction of blood gases is achieved with mechanical ventilation in the light PEEP mode. IVL continues until the most important functions are fully restored (consciousness, adequate spontaneous breathing, stable hemodynamics).

Monitoring of neurological functions. A reliable basis for monitoring the CNS in patients who have undergone circulatory arrest is the Glasgow scale with the eye opening reaction, motor and verbal response in combination with EEG data. AT medicinal purposes"brain protection" is indicated by the appointment of high doses of corticosteroids (for example, celeston 8-12 mg every 6 hours intravenously).

With an increase in EEG activity and a tendency to convulsions, diazepam (seduxen, valium, relanium, sibazon, apaurin) is indicated - an anxiolytic, anticonvulsant, sedative. With pronounced convulsive syndrome- sodium thiopental (5 mg / kg), according to indications - sedatives and analgesics. Maintaining normothermia is important.

Water-electrolyte and acid-base balance. Carry out constant monitoring of the amount of fluid injected, diuresis and possible extrarenal losses. For infusion, isotonic electrolyte solutions are recommended in combination with non-aqueous 10% glucose solutions. Ht is maintained at 0.30-0.35; Plasma CODE - 20-25 mm Hg; plasma osmolarity and the content of electrolytes and glucose in it are within the normal range. Moderate metabolic acidosis is acceptable and desirable (pH = 7.25-7.35), since under these conditions tissues are better oxygenated and CO increases. In addition, serum K-^ levels are often reduced after successful resuscitation, and overcorrection of acidosis can exacerbate hypokalemia and lead to new cardiac arrest.

The outcome of treatment depends on the main cause that caused cardiac arrest, the duration of its effect, the timeliness and quality of resuscitation and highly qualified intensive care in the post-resuscitation period. The most important link in therapy is the restoration of CNS function. The CPR technique is constantly being improved and, perhaps, will undergo significant changes in the near future.


Chapter 33

NEW PRINCIPLES OF REANIMATION

Until recent years, it was considered an unshakable rule to conduct CPR in accordance with the well-known resuscitation algorithm, which includes the main points of resuscitation.

Stage A (Air way) in standard transcription means carrying out emergency measures to restore the patency of the respiratory tract, i.e. prevention of retraction of the tongue, early tracheal intubation is possible with full recovery patency of the tracheobronchial tree.

Stage B (Breathing) requires immediate ventilation different ways, from the simplest ("mouth to mouth", "mouth to nose") to the most advanced (mechanical ventilation).

Stage C (Circulation) provides restoration of blood circulation, which in last years was interpreted as an indirect or closed method of heart massage. Historically, the method of direct heart massage was earlier, but in the 60s it was actually replaced by the closed method.

heart massage, and open massage was carried out only for limited indications.

Stage D (Differentiation, Drugs, Defibrillation) required rapid diagnosis of a form of cardiac arrest, the use of drug therapy and electrical defibrillation of the heart in the presence of tonic ventricular fibrillation.

Regardless of the form of cardiac arrest, all of the above stages of resuscitation were recommended. It must be said that this doctrine of resuscitation was held long time, it is still in use today. Thanks to the clear argumentation of the stages of ABCD, a huge number of people again received the right to life.

In recent years, experimental and clinical studies of new alternative methods, which should improve blood flow during CPR and patient survival. Technologies have been proposed that include methods of intermittent compression of the chest and abdomen with simultaneous ventilation of the lungs. Clinical studies have shown that survival is improved with these methods compared with conventional CPR for in-hospital resuscitation. For CPR, mechanical compressors are most often used, which do not replace manual chest compression, but only supplement it. The results obtained allow us to take a fresh look at the possibility of more effective ways CPR.

The procedure for resuscitation in cardiac arrest caused by arrhythmias has undergone the greatest changes - VF and VT. The rapid restoration of the intrinsic heart rhythm with the help of immediate antiarrhythmic therapy (mainly cardiac defibrillation, less often - precordial shock) even before the application of the ABC stages is quite possible and is confirmed by a large number of clinical observations.

We believe that significant changes will occur at all stages of CPR. The argumentation of new views is based on the fact that chest compressions in best case provides 30% of proper perfusion and thus cannot restore sufficient cerebral and coronary blood flow. Dissatisfaction with the standard method of CPR using manual chest compression, leading to the restoration of low blood circulation, requires the development of new approaches to solve this problem. Currently, there are no good prognostic criteria for evaluating the effectiveness of CPR. Animal studies have shown that the best prognostic criterion is aortic, myocardial and right atrial pressure, which correlates with successful resuscitation outcomes. Highest value is given to coronary perfusion pressure, on which the success of resuscitation directly depends. If the coronary perfusion pressure is less than 15 mmHg, the percentage of survivors is 0. If the coronary perfusion pressure is greater than 25 mmHg. Hg, then resuscitation is effective in 80% of cases. The creation of high coronary perfusion pressure is possible only under certain conditions. To do this, it is necessary to increase the intra-aortic pressure, create a significant pressure gradient between the aorta and the right atrium, i.e. reduce pressure as much as possible. One of these conditions is a decrease in intramyocardial resistance, which increases with the progression of ischemia of the heart muscle and its compliance.

The new methods, which have not yet received universal recognition, promote the use of not only compression, but also decompression of the chest and the creation of negative intrathoracic pressure. Between successive thoracic compressions, compression of the abdomen is produced, which increases the pressure in the aorta. At the moment of passive relaxation of the chest, the right heart and pulmonary veins are filled.

Infrequently, but there are such cases: a person was walking down the street, evenly, confidently, and suddenly he fell, stopped breathing, turned blue. In such cases, people around usually call an ambulance and wait a long time. Five minutes later, the arrival of specialists is no longer necessary - the person has died. And extremely rarely there is a person nearby who knows the algorithm for conducting cardiopulmonary resuscitation and is able to apply his actions in practice.

Causes of cardiac arrest

In principle, any disease can cause cardiac arrest. Therefore, listing all those hundreds of diseases that are known to specialists is pointless and there is no need. However, the most common causes of cardiac arrest are:

  • heart diseases;
  • trauma;
  • drowning;
  • electric shocks;
  • intoxication;
  • infections;
  • respiratory arrest in case of aspiration (inhalation) of a foreign body - this cause most often occurs in children.

However, regardless of the cause, the algorithm of actions for cardiopulmonary resuscitation always remains the same.

Movies very often show the attempts of heroes to resuscitate a dying person. Usually it looks like this - a positive character runs up to a motionless victim, falls on his knees next to him and begins to intensely press on his chest. With all his artistry, he shows the drama of the moment: he jumps over a person, trembles, cries or screams. If the case occurs in the hospital, the doctors always report that "he is leaving, we are losing him." If, according to the scriptwriter's plan, the victim should live, he will survive. However, the chances of salvation in real life such a person does not, since the "resuscitator" did everything wrong.

In 1984, the Austrian anesthesiologist Peter Safar proposed the ABC system. This complex formed the basis modern recommendations in cardiopulmonary resuscitation and for more than 30 years, this rule has been used by all doctors without exception. In 2015, the American Heart Association released an updated guide for practitioners, which covers all the nuances of the algorithm in detail.

ABC algorithm- this is a sequence of actions that give the victim the maximum chance for survival. Its essence lies in its very name:

  • airway- respiratory tract: detection of their blockage and its elimination in order to ensure the patency of the larynx, trachea, bronchi;
  • breathing- breathing: performing artificial respiration special technique with a certain frequency;
  • Circulation- ensuring blood circulation during cardiac arrest by its external (indirect massage).

Cardiopulmonary resuscitation according to the ABC algorithm can be carried out by any person, even without medical education. This is the basic knowledge that everyone should have.

How is cardiopulmonary resuscitation performed in adults and adolescents

First of all, you should ensure the safety of the victim, not forgetting about yourself. If you remove a person from a car that has been in an accident, immediately pull him away from it. If a fire is raging nearby, do the same. Move the victim to any nearest safe place and proceed to the next step.

Now we need to make sure that the person really needs CPR. To do this, ask him "What is your name?" It is this question that will best attract the attention of the victim if he is conscious, even clouded.

If he does not answer, shake him up: lightly pinch his cheek, pat him on the shoulder. Do not move the victim unnecessarily, as you cannot be sure of the absence of injuries if you find him already unconscious.

In the absence of consciousness, check for the presence or absence of breathing. To do this, put your ear to the mouth of the victim. Here the rule “See. Hear. Touch":

  • you see chest movements;
  • you hear the sound of exhaled air;
  • you feel the movement of air with your cheek.

In movies, this is often done by putting the ear to the chest. This method is relatively effective only if the patient's chest is completely exposed. Even one layer of clothing will distort the sound and you will not understand anything.

Simultaneously with the breath check, you can check for the presence of a pulse. Don't look for it on your wrist: The best way pulse detection - palpation of the carotid artery. To do this, place the index and ring finger at the top of the "Adam's apple" and move them towards the back of the neck until the fingers rest on the muscle that runs from top to bottom. If there is no pulsation, then cardiac activity has stopped and it is necessary to start saving lives.

Attention! You have 10 seconds to check for pulse and breathing!

The next step is to make sure that there are no foreign bodies in the victim's mouth. In no case look for them by touch: a person may have convulsions and your fingers will simply be bitten off, or you may accidentally tear off an artificial tooth crown or bridge, which will fall into the airways and cause asphyxia. You can remove only those foreign bodies that are visible from the outside and are close to the lips.

Now attract the attention of others, ask them to call an ambulance, and if you are alone, do it yourself (calling the emergency services is free), and then start cardiopulmonary resuscitation.

Lay the person on their back on a hard surface - earth, asphalt, table, floor. Tilt his head back, push lower jaw forward and slightly open the victim's mouth - this will prevent the retraction of the tongue and allow effective artificial respiration ( triple Safar maneuver).

If a neck injury is suspected, or if the person has been found already unconscious, limit yourself to lower jaw protrusion and mouth opening ( double Safar maneuver). Sometimes this is enough for a person to start breathing.

Attention! The presence of breathing is almost one hundred percent evidence that the human heart is working. If the victim is breathing, he should be turned on his side and left in this position until the arrival of doctors. Observe the casualty, checking for pulse and respiration every minute.

In the absence of a pulse, start an external cardiac massage. To do this, if you are right-handed, then place the base of your right palm on the lower third of the sternum (2-3 cm below the conditional line passing through the nipples). Put the base of your left palm on it and interlace your fingers, as shown in the figure.

Hands must be straight! Press with your whole body chest the victim with a frequency of 100-120 clicks per minute. The depth of pressing is 5-6 cm. Do not take long breaks - you can rest for no more than 10 seconds. Let the chest expand completely after pressing, but do not take your hands off it.

Most effective method artificial respiration - "mouth to mouth". To carry it out, after the triple or double Safar maneuver, cover the victim's mouth with your mouth, pinch his nose with the fingers of one hand and exhale vigorously for 1 second. Let the patient breathe.

The effectiveness of artificial respiration is determined by the movements of the chest, which must rise and fall during inhalation and exhalation. If this is not the case, then the person's airways are clogged. Check your mouth again - you might see foreign body, which can be extracted. In any case, do not interrupt cardiopulmonary resuscitation.

ATTENTION! The American Heart Association recommends that you do not need to administer artificial respiration, as chest compressions provide the body with necessary minimum air. However, artificial respiration increases the chance of positive effect from CPR. Therefore, if possible, it should still be carried out, remembering that a person may be sick with an infectious disease such as hepatitis or HIV infection.

One person is not able to simultaneously press on the chest and carry out artificial respiration, so the actions should be alternated: after every 30 presses, 2 respiratory movements should be performed.

Stop every two minutes and check for a pulse. If it appears, pressing on the chest should be stopped.

A detailed algorithm for conducting cardiopulmonary resuscitation for adults and adolescents is presented in the video review:

When to Stop CPR

Termination of cardiopulmonary resuscitation:

  • when spontaneous breathing and pulse;
  • when signs of biological death appear;
  • 30 minutes after the start of resuscitation;
  • if the rescuer is completely exhausted and unable to continue CPR.

Numerous studies show that CPR for more than 30 minutes can lead to heart rate. However, during this time the cerebral cortex dies and the person is not able to recover. That is why a half-hour interval has been set, during which the victim has a chance of recovery.

AT childhood a more common cause of clinical death is asphyxia. Therefore, it is especially important for this category of patients to carry out the full range of resuscitation measures - both external heart massage and artificial respiration.

Note: if an adult is allowed to be left for a very short time in order to call for help, then the child must first carry out CPR for two minutes, and only then can he be absent for a few seconds.

To carry out chest compressions in a child should be with the same frequency and amplitude as in adults. Depending on his age, you can press with two or one hand. In infants, an effective method is when the baby’s chest is clasped with both palms, placing the thumbs in the middle of the sternum, and the rest are pressed tightly against the sides and back. Clicks produce thumbs.

The ratio of compressions and respiratory movements in children can be either 30:2, or if there are two resuscitators - 15:2. In newborns, the ratio is 3 clicks per breath.


Cardiac arrest is not as rare as it seems, and timely assistance can give a person a good chance of later life. Learn the algorithm of actions in emergency situations everyone can. You don't even need to go to medical school to do it. It is enough to watch high-quality training videos on cardiopulmonary resuscitation, a few lessons with an instructor and periodically update your knowledge - and you can become a lifeguard, albeit an unprofessional one. And who knows, maybe someday you will give someone a chance at life.

Bozbey Gennady Andreevich, emergency doctor

There are three groups of patients that differ in their approach to cardiopulmonary resuscitation.

  1. Cardiopulmonary resuscitation in children with sudden circulatory arrest - in this case, the process of dying lasts as long as resuscitation continues. The main outcomes of resuscitation measures are: successful resuscitation and subsequent post-resuscitation illness (with a different outcome), the development of a persistent vegetative state, unsuccessful resuscitation, after the termination of which death is declared.
  2. Carrying out CPR against the background of a severe potentially treatable pathology - most often this is a group of children with severe concomitant trauma, shock, severe purulent-septic complications - in this case, the prognosis of CPR is often unfavorable.
  3. Carrying out CPR against the background of an incurable pathology: congenital malformations, trauma incompatible with life, oncological patients - a careful, if possible, pre-planned approach to CPR is required.

The main task of cardiopulmonary resuscitation in children is to maintain blood circulation and mechanical ventilation, which does not allow irreversible changes in the brain, myocardium until the restoration of blood circulation and respiration.

First of all, the presence of consciousness should be determined by shouting and shaking (no need to subject the head to sudden movements until injury is ruled out). Check the presence of exhalation and pulse; if they are not detected, CPR should be started immediately. Revitalization consists of a number of activities:

Primary resuscitation - life support measures, which are formulated in the form of the "ABC" rule. When initiating CPR in children, call for help from colleagues or others nearby.

Restoration of vital functions - restoration of independent blood circulation, activity of the pulmonary system; introduction of pharmacological preparations, infusion of solutions, electrography and, if necessary, electrical defibrillation.

Primary resuscitation

Stage 1 cardiopulmonary resuscitation in children includes 3 stages:

  • A (air) - airway patency.
  • B (breath) - ventilation of the lungs.
  • C (circulation) - artificial maintenance of blood circulation (heart).

Airway patency

Stage 1 is the most important. It is necessary to give the patient an appropriate position: put on his back; head, neck and chest should be on the same plane. With hypovolemia, you should slightly raise your legs. Tilt your head back - if there is no neck injury, if there is - remove the lower jaw. Excessive overextension of the head in infants may exacerbate airway obstruction. Incorrect head position is a common cause of ineffective ventilation.

If necessary, clean the mouth of foreign bodies. Insert an airway or, if possible, intubate the trachea; if not, take two mouth-to-mouth or mouth-to-mouth-nose breaths.

Throwing the head back is an important and primary task of resuscitation.

Circulatory arrest in children is often secondary to airway obstruction, the latter being caused by:

  • infectious or disease;
  • the presence of a foreign body;
  • retraction of the tongue, mucus, vomit, blood.

Artificial lung ventilation

It is carried out by mechanical ventilation by actively blowing air into the lungs using the mouth-to-mouth or mouth-to-mouth and nose methods; but better through an air duct, a face mask with an Ambu bag.

To prevent hyperdistension of the stomach, it is necessary to carry out mechanical ventilation so that only an excursion of the chest is observed, but not abdominal wall. The method of emptying the stomach from gas by pressing on the epigastrium against the background of turning to the side is acceptable only at the prehospital stage (due to the danger of regurgitation and aspiration of the contents of the stomach). In such situations, you need to put the probe into the stomach.

Sequencing:

Lay the patient on hard surface, tilt your head slightly.

Breathing is observed for 5 s, in its absence, 2 breaths are taken, after which a pause is made to exhale. The child is blown in air very carefully to avoid rupture of the lung (for a newborn, an infant - with the help of the cheeks); be sure to watch the chest - when blowing it rises; the inspiratory time is 1.5-2 s.

If the chest rises, the inhalation is stopped and a passive exhalation is allowed to pass.

After the end of the exhalation, a second inflation is made; after it, the presence of a pulse is determined.

With preserved activity of the heart, regardless of the age of the patient, artificial respiratory cycles of the lungs are repeated 8-12 times / minute (every 5-6 s); in the absence of a pulse, heart massage and other activities begin.

If the blowing fails, check the position of the head, repeat the blowing; if again ineffective, an airway foreign body should be suspected. In this case, open the mouth and clear the throat; the liquid is brought out by turning the head to one side (it is impossible with a spinal injury).

Extraction of foreign bodies in infants has its own specifics. With them, the technique described by Heimlich (a sharp push in the epigastric region towards the diaphragm) is unacceptable due to real threat traumatization of organs abdominal cavity especially the liver. infants laid on the forearm so that the head is lower than the body, but does not hang down passively, but is supported by the index finger, thumb behind the lower jaw. After that, 5 gentle blows between the shoulder blades are carried out.

If the size of the child does not allow you to fully perform this technique, holding it with one hand, then the doctor’s thigh and knee are used as a support. Blows on the back are, in fact, an artificial cough that allows you to "push out" a foreign body.

Closed heart massage

Stage 3 aims to restore blood circulation. The essence of the method is the compression of the heart. Blood circulation is provided not so much by compression, but by an increase in intrathoracic pressure, which contributes to the ejection of blood from the lungs. The maximum compression falls on the lower third of the sternum: in children - the width of the transverse finger below the line of the nipples in the center of the sternum; in adolescents and adults - 2 fingers above the xiphoid process. The depth of pressure is about 30% of the anterior-posterior size of the chest. Heart massage technique differs depending on age:

  • children under one year old - compressions are carried out with their thumbs,
  • children from one year to 8 years old - compressions are performed with one hand,
  • children from 8 years old, adults - pressure on the chest is done with both hands, straight at the elbows.

With the work of one doctor, the ratio of ventilation: massage is 2:30 at any age (for every 30 compressions of the sternum, 2 breaths are produced). When two doctors work, they use the 2:15 technique (2 breaths, 15 compressions). During mechanical ventilation through the endotracheal tube, massage is done without pauses, it is not synchronized with respect to artificial respiratory cycles, the ventilation rate is 8-12 per minute.

Precordial stroke is not recommended even in adults, especially in the out-of-hospital setting. In the ICU (in adults), it is carried out only under the condition of ECG monitoring. Striking against the background of ventricular tachycardia can lead to asystole or the development of ventricular fibrillation.

The frequency of compressions does not depend on age, it is at least 100, but not more than 120 compressions per minute. In newborns, resuscitation (including cardiac massage) is started at a rate of 60 per minute.

Efficiency control cardiopulmonary resuscitation in children is carried out by a doctor conducting ventilation of the lungs; he checks the pulse one minute after the start of resuscitation, then every 2-3 minutes during the end of the massage (for 5 seconds). Periodically, the same doctor monitors the condition of the pupils. The appearance of their reaction indicates the restoration of the brain, their persistent expansion is an unfavorable indicator. Resuscitation should not be stopped for more than 5 seconds, except during the period when tracheal intubation or defibrillation is performed. The pause for intubation should not exceed 30 s.

The article was prepared and edited by: surgeon

Statistics show that every year the number of children who die in early childhood is steadily increasing. But if next to right moment turned out to be a person who knows how to provide first aid and knowledgeable cardiopulmonary resuscitation in children ... In a situation where the life of children hangs in the balance, there should be no "if". We, adults, have no right to assumptions and doubts. Each of us is obliged to master the technique of conducting cardiopulmonary resuscitation, to have a clear algorithm of actions in our head in case the case suddenly forces us to be in the same place, at the same time ... After all, the most important thing depends on the correct, well-coordinated actions before the arrival of an ambulance - life little man.

1 What is cardiopulmonary resuscitation?

This is a set of measures that should be carried out by any person in any place before the arrival of an ambulance, if children have symptoms that indicate respiratory and / or circulatory arrest. Further, we will focus on basic resuscitation measures that do not require specialized equipment or medical training.

2 Causes leading to life-threatening conditions in children

Respiratory and circulatory arrest is most common among children in the neonatal period, as well as in children under the age of two years. Parents and others need to be extremely attentive to the children of this age category. Often the causes of the development of a life-threatening condition can be a sudden blockage of the respiratory organs by a foreign body, and in newborns - by mucus, the contents of the stomach. Often there is a syndrome of sudden death, congenital malformations and anomalies, drowning, suffocation, injuries, infections and respiratory diseases.

There are differences in the mechanism of development of circulatory and respiratory arrest in children. They are as follows: if in an adult, circulatory disorders are more often associated directly with problems of the cardiac plan (heart attacks, myocarditis, angina pectoris), then in children this relationship is almost not traced. At the forefront in children comes a progressive respiratory failure without damage to the heart, and then circulatory failure develops.

3 How to understand that a violation of blood circulation has occurred?

If there is a suspicion that something is wrong with the baby, you need to call him, ask simple questions“What's your name?”, “Is everything all right?” If you have a child 3-5 years old and older. If the patient does not respond, or is completely unconscious, it is necessary to immediately check whether he is breathing, whether he has a pulse, a heartbeat. A violation of blood circulation will indicate:

  • lack of consciousness
  • violation / lack of breathing,
  • pulse on large arteries is not determined,
  • heartbeats are not audible,
  • pupils are dilated,
  • reflexes are absent.

The time during which it is necessary to determine what happened to the child should not exceed 5-10 seconds, after which it is necessary to start cardiopulmonary resuscitation in children, call ambulance. If you do not know how to determine the pulse, do not waste time on this. First of all, make sure that consciousness is preserved? Lean over him, call, ask a question, if he does not answer - pinch, squeeze his arm, leg.

If the child does not react to your actions, he is unconscious. You can make sure that there is no breathing by leaning your cheek and ear as close as possible to his face, if you do not feel the victim’s breathing on your cheek, and also see that his chest does not rise from respiratory movements, this indicates a lack of breathing. You can't delay! It is necessary to move on to resuscitation techniques in children!

4 ABC or CAB?

Until 2010, there was a single standard for the provision of resuscitation care, which had the following abbreviation: ABC. It got its name from the first letters English alphabet. Namely:

  • A - air (air) - ensuring the patency of the respiratory tract;
  • B - breathe for victim - ventilation of the lungs and access to oxygen;
  • C - circulation of blood - compression of the chest and normalization of blood circulation.

After 2010, the European Resuscitation Council changed the recommendations, according to which chest compressions (point C), and not A, come first in resuscitation. The abbreviation changed from “ABC” to “CBA”. But these changes had an effect among the adult population, in whom the cause critical situations is mostly cardiac disease. Among the child population, as mentioned above, respiratory disorders prevail over cardiac pathology, therefore, among children, the ABC algorithm is still guided, which primarily ensures airway patency and respiratory support.

5 Resuscitation

If the child is unconscious, there is no breathing or there are signs of its violation, it is necessary to make sure that the airways are passable and take 5 mouth-to-mouth or mouth-to-nose breaths. If a baby under 1 year old is in critical condition, you should not take too strong artificial breaths into his airways, given the small capacity of small lungs. After 5 breaths into the patient's airways, the vital signs should be checked again: respiration, pulse. If they are absent, it is necessary to start an indirect heart massage. To date, the ratio of the number of chest compressions and the number of breaths is 15 to 2 in children (in adults 30 to 2).

6 How to create airway patency?

If a small patient is unconscious, then often the tongue sinks into his airways, or in the supine position, the back of the head contributes to the flexion of the cervical spine, and the airways will be closed. In both cases, artificial respiration will not bring any positive results - the air will rest against the barriers and will not be able to get into the lungs. What should be done to avoid this?

  1. It is necessary to straighten the head in the cervical region. Simply put, tilt your head back. Too much tilting should be avoided, as this may move the larynx forward. The extension should be smooth, the neck should be slightly extended. If there is a suspicion that the patient has an injury to the spine in the cervical region, do not tilt back!
  2. Open the victim's mouth, trying to bring the lower jaw forward and towards you. Inspect the oral cavity, remove excess saliva or vomit, foreign body, if any.
  3. The criterion of correctness, which ensures the patency of the airways, is the following such position of the child, in which his shoulder and the external auditory meatus are located on one straight line.

If, after the above actions, breathing is restored, you feel the movements of the chest, abdomen, the flow of air from the child's mouth, and a heartbeat, pulse is heard, then other methods of cardiopulmonary resuscitation in children should not be performed. It is necessary to turn the victim into a position on his side, in which his upper leg will be bent in knee joint and pushed forward, while the head, shoulders and body are located on the side.

This position is also called "safe", because. it prevents reverse obturation of the airways with mucus, vomit, stabilizes the spine, and provides good access to monitor the child's condition. After the little patient is placed in a safe position, his breathing is preserved and his pulse is felt, heart contractions are restored, it is necessary to monitor the child and wait for the ambulance to arrive. But not in all cases.

After fulfilling criterion "A", breathing is restored. If this does not happen, there is no breathing and cardiac activity, artificial ventilation and chest compressions should be carried out immediately. First, 5 breaths are performed in a row, the duration of each breath is approximately 1.0-.1.5 seconds. In children older than 1 year, mouth-to-mouth breaths are performed, in children under one year old - mouth-to-mouth, mouth-to-mouth and nose, mouth-to-nose. If after 5 artificial breaths there are still no signs of life, then proceed to an indirect heart massage in a ratio of 15: 2

7 Features of chest compressions in children

In cardiac arrest in children, indirect massage can be very effective and “start” the heart again. But only if it is carried out correctly, taking into account age features little patients. When conducting an indirect heart massage in children, the following features should be remembered:

  1. The recommended frequency of chest compressions in children is 100-120 per minute.
  2. The depth of pressure on the chest for children under 8 years old is about 4 cm, over 8 years old is about 5 cm. The pressure should be strong and fast enough. Do not be afraid to make deep pressure. Since too superficial compressions will not lead to a positive result.
  3. In children in the first year of life, pressure is performed with two fingers, in older children - with the base of the palm of one hand or both hands.
  4. Hands are located on the border of the middle and lower thirds of the sternum.

Restoring the normal functioning of the circulatory system, maintaining air exchange in the lungs is the primary goal. Timely resuscitation measures allow avoiding the death of neurons in the brain and myocardium until blood circulation is restored and breathing becomes independent. Cardiac arrest in a child due to a cardiac cause is extremely rare.

CPR in children

For infants and newborns, the following causes are distinguished: suffocation, SIDS - sudden infant death syndrome, when an autopsy cannot establish the cause of termination of life, pneumonia, bronchospasm, drowning, sepsis, neurological diseases. In children after twelve months, death occurs most often due to various injuries, strangulation due to illness or a foreign body entering the respiratory tract, burns, gunshot wounds, and drowning.

Doctors divide little patients into three groups. The algorithm for resuscitation is different for them.

  1. Sudden circulatory arrest in a child. Clinical death during the entire period of resuscitation. Three main outcomes:
  • CPR ended with a positive outcome. At the same time, it is impossible to predict what the patient's condition will be after the clinical death he has suffered, how much the functioning of the body will be restored. There is a development of the so-called postresuscitation disease.
  • The patient does not have the possibility of spontaneous mental activity, the death of brain cells occurs.
  • Resuscitation does not bring positive result, doctors ascertain the death of the patient.
  1. The prognosis is unfavorable during cardiopulmonary resuscitation in children with severe trauma, in a state of shock, and complications of a purulent-septic nature.
  2. Resuscitation of a patient with oncology, developmental anomalies internal organs, severe injuries whenever possible carefully planned. Immediately proceed to resuscitation in the absence of a pulse, breathing. Initially, it is necessary to understand whether the child is conscious. This can be done by shouting or lightly shaking, while eliminating jerky movements patient's head.

Indications for resuscitation - sudden circulatory arrest

Primary resuscitation

CPR in a child includes three stages, which are also called ABC - Air, Breath, Circulation:

  • Air way open. The airway needs to be cleared. Vomiting, retraction of the tongue, foreign body may be an obstruction in breathing.
  • Breath for the victim. Carrying out measures for artificial respiration.
  • Circulation his blood. Closed heart massage.

When performing cardiopulmonary resuscitation of a newborn baby, the first two points are most important. Primary cardiac arrest in young patients is uncommon.

Ensuring the child's airway

The first stage is considered the most important in the CPR process in children. The algorithm of actions is the following.

The patient is placed on his back, neck, head and chest are in the same plane. If there is no trauma to the skull, it is necessary to throw back the head. If the victim has an injury to the head or upper cervical region, it is necessary to push the lower jaw forward. In case of loss of blood, it is recommended to raise the legs. Violation of the free flow of air through the respiratory tract in baby may be exacerbated by excessive flexion of the neck.

The reason for the ineffectiveness of measures for pulmonary ventilation can be not correct position child's head relative to the body.

If available in oral cavity foreign objects that make it difficult to breathe, they must be removed. If possible, tracheal intubation is performed, an airway is introduced. If it is impossible to intubate the patient, mouth-to-mouth and mouth-to-nose and mouth-to-mouth breathing is performed.


Algorithm of actions for ventilation of the lungs "mouth to mouth"

Solving the problem of tilting the patient's head is one of the primary tasks of CPR.

Airway obstruction leads to cardiac arrest in the patient. This phenomenon causes allergies, inflammatory infectious diseases, foreign objects in the mouth, throat or trachea, vomit, blood clots, mucus, sunken tongue of the child.

Algorithm of actions during ventilation

Optimal for implementation artificial ventilation lung will be the application of an air duct or face mask. If it is not possible to use these methods, Alternative option actions - active blowing of air into the nose and mouth of the patient.

To prevent the stomach from stretching, it is necessary to ensure that there is no excursion of the peritoneum. Only the volume of the chest should decrease in the intervals between exhalation and inhalation when carrying out measures to restore breathing.


Duct application

When carrying out the procedure of artificial ventilation of the lungs, the following actions are carried out. The patient is placed on a hard, flat surface. The head is slightly thrown back. Observe the child's breathing for five seconds. In the absence of breathing, take two breaths lasting one and a half to two seconds. After that, stand for a few seconds to release air.

When resuscitating a child, inhale air very carefully. Careless actions can provoke a rupture of lung tissue. Cardiopulmonary resuscitation of the newborn and infant is carried out using the cheeks for blowing air. After the second inhalation of air and its exit from the lungs, a heartbeat is probed.

Air is blown into the lungs of a child eight to twelve times per minute with an interval of five to six seconds, provided that the heart is functioning. If the heartbeat is not established, proceed to other life-saving actions.

You need to carefully check for foreign objects in the oral cavity and upper respiratory tract. This kind of obstruction will prevent air from entering the lungs.

The sequence of actions is as follows:

  • the victim is placed on the arm bent at the elbow, the baby's torso is above the level of the head, which is held with both hands by the lower jaw.
  • after the patient is laid in the correct position, five gentle strokes are made between the patient's shoulder blades. The blows must have a directed action from the shoulder blades to the head.

If the child cannot be placed in the correct position on the forearm, then the thigh and the leg bent at the knee of the person involved in resuscitation of the child are used as a support.

Closed heart massage and chest compressions

Closed massage of the heart muscle is used to normalize hemodynamics. It is not carried out without the use of IVL. An increase in intrathoracic pressure causes blood to be ejected from the lungs into circulatory system. The maximum air pressure in the lungs of a child falls on the lower third of the chest.

The first compression should be a trial, it is carried out to determine the elasticity and resistance of the chest. The chest is squeezed during a heart massage by 1/3 of its size. Chest compression is performed differently for different age groups patients. It is carried out due to pressure on the base of the palms.


Closed heart massage

Features of cardiopulmonary resuscitation in children

Features of cardiopulmonary resuscitation in children are that it is necessary to use the fingers or one palm for compression due to the small size of the patients and the fragile physique.

  • Infants are pressed on the chest only with their thumbs.
  • For children from 12 months to eight years old, massage is performed with one hand.
  • For patients older than eight years, both palms are placed on the chest. like adults, but measure the force of pressure with the size of the body. The elbows of the hands during the massage of the heart remain in a straightened state.

There are some differences in CPR that is cardiac in nature in patients over 18 years of age and CPR resulting from strangulation in children with cardiopulmonary insufficiency, so resuscitators are advised to use a special pediatric algorithm.

Compression-ventilation ratio

If only one physician is involved in resuscitation, he should deliver two breaths of air into the patient's lungs for every thirty compressions. If two resuscitators are working at the same time - compression 15 times for every 2 air injections. When using a special tube for IVL, a non-stop heart massage is performed. The frequency of ventilation in this case is from eight to twelve beats per minute.

A blow to the heart or in children is not used - the chest can be seriously affected.

The frequency of compressions is from one hundred to one hundred and twenty beats per minute. If the massage is performed on a child under 1 month old, then you should start with sixty beats per minute.


Remember that the child's life is in your hands.

CPR should not be stopped for more than five seconds. 60 seconds after the start of resuscitation, the doctor should check the patient's pulse. After that, the heartbeat is checked every two to three minutes at the moment the massage is stopped for 5 seconds. The state of the pupils of the reanimated indicates his condition. The appearance of a reaction to light indicates that the brain is recovering. Persistent dilation of the pupils is an unfavorable symptom. If it is necessary to intubate the patient, do not stop resuscitation for more than 30 seconds.