Cardiopulmonary resuscitation and Basic life support in Office Practice in Children: IAP Guidelines
The Indian Academy of Pediatrics (IAP) has released Standard Treatment Guidelines 2022 for CPR/BLS in Office Practice in Children. The lead author for these guidelines on CPR/BLS in Office Practice in Children is Dr. LN Taneja along with co-author Dr. Samarendra Mahapatro and Dr. Pranam Gowdar. The guidelines come Under the Auspices of the IAP Action Plan 2022, and the members of the IAP Standard Treatment Guidelines Committee include Chairperson Remesh Kumar R, IAP Coordinator Vineet Saxena, National Coordinators SS Kamath, Vinod H Ratageri, Member Secretaries Krishna Mohan R, Vishnu Mohan PT and Members Santanu Deb, Surender Singh Bisht, Prashant Kariya, Narmada Ashok, Pawan Kalyan.
Following are the major recommendations of guidelines:
Causes:
Physiological derangements of:
Circulation (shock) and/or
Respiration (respiratory insufficiency) and/or
Brain (cortical or brainstem dysfunction). Either suddenly or due to underlying infections, injuries, toxins, animal bites, or comorbidities result in cardiac arrest situations in any age group. Sudden cardiac arrest in adults is often due to cardiac causes including rhythm abnormalities like ventricular fibrillation or pulseless ventricular tachycardia. On the other hand, major cause of cardiac arrest in children is due to respiratory failure and/ or shock. A victim of cardiac arrest has the best chance of recovery, if the CPR is administered by the person standing next to the victim immediately on recognition of the condition.
How to Identify Cardiac Arrest?
A victim is in cardiac arrest if he/she suddenly becomes:
Unconscious and unresponsive,
Stops breathing or is gasping with ineffective breaths and
Does not have a pulse.
A child is labeled as "in cardiac arrest" even if there is a pulse beating below or up to 60 bpm without features of circulation along with "unresponsiveness" and "ineffective or not breathing"
Assessment of a Victim of Cardiac Arrest:
Three things you should look for to diagnose cardiac arrest.
"Firmly" tap the victim on shoulder and ask a question "loudly" in a language he/she would understand like—Are you okay? or How are you? or Do you need some help?
It usually takes <5 seconds to elicit (un)responsiveness of a victim. One expects the small child to cry or react in response to the tap, if not unresponsive.
If there is no response, check for the surroundings. Remove the victim to a safe area, if there is an imminent danger to any life such as fire, smoke, electric current, and building collapse.
Breathing Assessment:
Check breathing simultaneously if the victim is unresponsive.
Look and listen while bringing your ears close to the mouth of the victim observing the chest wall movements at the same time.
"Open the airway" in case the neck is too flexed or extended to appreciate breathing.
One should not take >5–10 seconds to make an assessment of breathing.
There may be three situations—the victim might be breathing normally, or not breathing at all or might be gasping, i.e., ineffective breathing efforts—not sufficient for adequate inflow of air in lungs. The latter two conditions—not breathing and gasping are dealt as "not breathing".
Assessment of Pulse:
Presence (or its absence) is checked in the carotid area in adults.
In children the pulse is checked in the femoral areas and in infants it is checked in brachial areas.
Palpating a pulse with confidence in an emergency is not easy even for a trained person. CPR should not be delayed by >10 seconds while checking for pulse in an unresponsive and not breathing victim.
Steps of Cardiopulmonary Resuscitation:
Complications of Cardiopulmonary Resuscitation:
Fracture of ribs or the sternum may occur, if chest compressions are not performed correctly; however the incidence of increased mortality from such fractures is low as compared to benefits of CPR. One must learn the proper technique.
Aspiration and vomiting: The most common problem encountered during CPR. If the secretions are not cleared properly and immediately, the victim is likely to aspirate it into his lungs leading to aspiration pneumonia.
Abdominal distension: Due to inappropriate ventilation by bag and mask. Again, using proper technique is the key to avoiding complications.
Cardiopulmonary resuscitation has been described as "violent, painful, and undignified" in the past. With increasing public awareness and its widely documented benefits, one has to provide CPR in indicated patients as it provides a four-fold increase in survival rate, even if it is performed by bystanders.
Conclusion:
Cardiopulmonary resuscitation/basic life support is an essential skill that every healthcare provider must master to support life immediately, if a patient or victim collapses or develops a cardiac arrest. The Indian Academy of Pediatrics through its IAP ALS BLS group trains healthcare professionals and lay persons through its variety of modules suiting individual requirements. We also have an "e-Sanjeevani" module for learning the steps of CPR at our convenience accessible at https://forms.gle/jpZnatDQMNUGgGt76 free of cost. This may be followed by practicing skills on mannequins supervised by trained instructors at IAP accredited CPR centers spread across the country after which a completion certificate is also available. Contact zone coordinators of IAP ALS BLS group of your geographical IAP zone through the central IAP office for organizing the course for your colleagues or friends.
Reference:
- Garg R, Ahmed SM, Kapoor MC, Mishra BB, Rao SC, Kalandoor MV, et al. Basic cardiopulmonary life support for resuscitation by trained paramedics and medics outside the hospital. Indian J Anaesth. 2017;61:874-82.
- Taneja LN, Tiwari L. BLS for Professionals, 3rd edition. Indian Academy of Pediatrics ALS BLS Group; 2018.
The guidelines can be accessed on the official site of IAP: https://iapindia.org/standard-treatment-guidelines/
