Witnessing a cardiac arrest is never pleasant. If the victim is a child, however, it can be a truly traumatic experience.
That is why it is even more important to know what to do so that you can keep your nerve and act quickly.
The most common causes of cardiac arrest in an adult and a child are different, but so is the life-saving procedure to be performed for a paediatric cardiac arrest, from the technique with which cardiac massage should be performed, to the power of the automatic external defibrillator (AED) discharges.
Differences also exist according to the age of the child: the life-saving procedure differs in the case of an infant/infant (from or up to 1 year) or a child (from 1 year up to the attainment of the minimum standards for BLSD Adult, i.e. more than 25 kg or more than 8 years).
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Cardiac arrest in a child: the causes
In the event of having to rescue a person suffering from cardiac arrest, before using the semi-automatic external defibrillator (Dae), it is a good idea, in addition to immediately contacting 118, to assess the situation and act accordingly.
First of all, it should be pointed out that, as you can well imagine, the body of an adult works differently from that of a child.
And cardiac arrest also has a different origin in most cases:
– in an adult, there is a high incidence of arrests that have properly defined cardiac causes;
– in children and infants, on the other hand, secondary cardio-respiratory arrests, caused by respiratory or circulatory failure, are more frequent than those caused by arrhythmias.
There are also important differences between the anatomy and physiology of an adult and that of an infant or child, such as the size of the head, which is larger in children in relation to the size of the body, the calibre of the airways, which is smaller than in adults, and the size of the tongue, which is very large in relation to the mouth.
Also for this reason, defibrillation in children cardiopulmonary resuscitation manoeuvres (chest compressions and ventilation) differ.
How to Rescue a Child in Cardiac Arrest
If you witness a cardiac arrest, regardless of the victim’s age, the first thing to do is to call 112/118 and be guided on what to do.
Knowing what to do is important in order not to be caught unprepared at such a delicate moment, when a child’s life is at risk.
Pediatric Basic Life Support Defibrillation (PBLSD) is based on a few specific steps
Place the child on a rigid surface, including the floor, in a supine position, with head, trunk and limbs aligned and uncover the chest.
Opening of the airway: whereas in the adult it is necessary to hyperextend the head, in the child it is sufficient to extend it, with an infant the head remains in a neutral position.
Keeping the airway open, watch, listen and listen for signs of normal breathing by placing your face close to the child’s face and observing the chest:
Look at the chest to observe any movements.
Listen close to the child’s nose and mouth for breathing noises.
Feel the flow of air on your cheek.
If breathing is found, maintain airway patency and, if trauma is not suspected, place the child in the lateral safety position (PLS).
If no breath is detected, insufflations are performed: five, slow, progressive insufflations lasting one second.
Rescue ventilations for the infant
Ensure a neutral head position as an infant’s head is usually flexed in a supine position, it is necessary to achieve extension (a towel or blanket rolled under the upper back can help to maintain this position) and elevation of the chin.
Inhale and cover the infant’s mouth and nose with your mouth, making sure it fits snugly. In the older infant, if you are unable to cover both the nose and mouth, you may choose to use one or the other (if you decide to use the nose, close the patient’s mouth so as to prevent air escaping).
Insufflate steadily into the infant’s nose and mouth for about 1 second, enough to see the chest rise.
Maintain head position and chin lift, move your mouth away and watch the chest drop as the air escapes.
Inhale again and repeat this sequence five times.
Rescue ventilations for children over one year old
Ensure that the head is extended and the chin is raised.
Close nostrils with index finger and thumb of the hand resting on forehead.
Allow the mouth to open, keeping the chin raised.
Inhale and place your lips around the baby’s mouth so that they fit tightly.
Insufflate steadily for about 1 second, checking that the chest rises.
Keep the head extended and the chin raised, pull the mouth away from the victim and watch the chest drop as the air escapes.
Inhale again and repeat this sequence five times.
In both infants and children, if you have difficulty obtaining effective breathing, the airway may be obstructed: open the airway, and remove any visible foreign bodies. Do not perform a blind mouth inspection with your fingers
Take no more than ten seconds to search for vital signs: any movement, coughing or signs of normal breathing (not gasping or irregular, rare breaths)
In order to restart the heart of a person in cardiac arrest, it is first necessary to proceed with cardiac massage.
However, compressions on the chest of a child or infant must be less deep than those required to resuscitate an adult:
Cardiac massage in a child is performed with one hand.
Only in the case of older children or slim rescuers can this manoeuvre be performed with both hands, as for adults.
With an infant, the thumbs should be placed side by side on the lower half of the sternum, with the tips pointing towards the infant’s head, and the other fingers of both hands should be extended so that they encircle the ribcage and support the infant’s back.
Alternatively, one can place the infant on a flat surface and perform the two-finger massage.
Depth of compressions
The depth of compressions also differs in the rescue of a baby compared to that of an adult:
In an adult they must be around 5 centimetres, but no more than 6;
- in children they must not exceed 5 centimetres;
- in infants the limit is set at 4 centimetres.
In a child it must be 15 compressions to 2 ventilations, compared to 30 compressions and 2 ventilations in an adult.
This is however after the initial 5 ventilations mentioned above.
Child in cardiac arrest, the Paediatric Defibrillator: How it works
The use of the semi-automatic external defibrillator (Dae) is the last step in rescuing a child in cardiac arrest.
The life-saving device has instructions, written and in most cases spoken, that can guide the rescuer in starting the defibrillator, which works differently in the case of a child.
The heart of a child under the age of 8 needs a lower power discharge than that of an adult. For this reason, it is necessary to reduce the power delivered by the defibrillator. Doing so is not complicated:
Many defibrillator models offer, in addition to adult pads, the purchase of paediatric pads, which automatically reduce the power of the shocks emitted by the Dae.
Other defibrillator models are equipped with a paediatric activator, which automatically reduces the energy when inserted.
With regard to the placement of paediatric electrodes, they are usually placed, as for adults, in an antero-lateral position, i.e. one below the right clavicle and one on the left mid-axillary line.
If paediatric plates are not available or if these are too wide and there is a risk of an arc between them, one plate should be placed on the dorsum, under the left scapula, and the other anteriorly, to the left of the sternum; this is known as the antero-posterior position.