PALS-2015, NRP-2015, AAP, AHA

1. CPR IN NEONATES,
INFANTS & CHILDREN
-DR.MURTAZA KAMAL
CLINICAL FELLOW PEDIATRIC CARDIOLOGY
MURTAZA.VMMC@GMAIL.COM
DOP: 16/01/2018
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2. 2

3. PEDIATRIC BASIC LIFE
SUPPORT
AND CPR
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4. KEY ISSUES AND MAJOR CHANGES
• REAFFIRMING C-A-B SEQUENCE AS PREFERRED SEQUENCE FOR
PEDIATRIC CPR
• NEW ALGORITHMS FOR 1-RESCUER+ MULTIPLE-RESCUER
PEDIATRIC HCP CPR IN CELL PHONE ERA
• ESTABLISHING UPPER LIMIT OF 6CM FOR CC IN ADOLESCENT
• MIRRORING ADULT BLS RECOMMENDED CC OF 100-120/MI
• STRONGLY REAFFIRMING THAT COMPRESSIONS+ VENTILATION
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5. C-A-B SEQUENCE
• 2015 (UPDATED)
• AMOUNT+ QUALITY OF SUPPORTING DATA : LIMITED
• MAY BE REASONABLE TO MAINTAIN SEQUENCE FROM 2010
GUIDELINES BY INITIATING CPR WITH C-A-B OVER A-B-C
• KNOWLEDGE GAPS EXIST, AND SPECIFIC RESEARCH : REQUIRED
TO EXAMINE BEST SEQUENCE FOR CPR IN CHILDREN
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6. C-A-B SEQUENCE
• 2010 (OLD)
• INITIATE CPR FOR INFANTS+ CHILDREN WITH CC RATHER THAN
RESCUE BREATHS (C-A-B RATHER THAN A-B-C)
• BEGIN WITH 30 COMPRESSIONS (BY A SINGLE RESCUER) OR 15
COMPRESSIONS (FOR RESUSCITATION OF INFANTS AND CHILDREN
BY 2 HCPS) RATHER THAN WITH 2 VENTILATIONS
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7. C-A-B SEQUENCE
• WHY
• IN ABSENCE OF NEW DATA, 2010 SEQUENCE HAS NOT BEEN
CHANGED
• CONSISTENCY IN ORDER OF C-A-B FOR CPR IN VICTIMS OF ALL
AGES: EASIEST FOR RESCUERS WHO TREAT PEOPLE OF ALL AGES
TO REMEMBER AND PERFORM
• MAINTAINING SAME SEQUENCE FOR ADULTS+ CHILDREN OFFERS
CONSISTENCY IN TEACHING
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8. NEW ALGORITHMS FOR 1-
RESCUER+ MULTIPLE-
RESCUER HCP CPR
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9. ALGORITHMS
• ALGORITHMS FOR 1-RESCUER+ MULTIPLE-RESCUER PEDIATRIC
CPR: SEPARATED
• BETTER GUIDE RESCUERS THROUGH INITIAL STAGES OF
RESUSCITATION IN ERA OF CELLULAR PHONES WITH SPEAKERS
• CAN ENABLE A SINGLE RESCUER TO ACTIVATE EMERGENCY
RESPONSE WHILE BEGINNING CPR
• RESCUER CAN CONTINUE CONVERSATION WITH A DISPATCHER
DURING CPR
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10. ALGORITHMS
• THESE ALGORITHMS CONTINUE TO EMPHASIZE:
• HIGH PRIORITY FOR HIGH-QUALITY CPR
• IN CASE OF SUDDEN, WITNESSED COLLAPSE, FOR OBTAINING
AN AED QUICKLY
• SUCH EVENT LIKELY TO HAVE CARDIAC ETIOLOGY
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12. SINGLE RESCUER
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13. SINGLE RESCUER
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14. ≥2 RESCUERS
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15. ≥2 RESCUERS
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16. CHEST COMPRESSION DEPTH
• 2015 (UPDATED)
• CC: AT LEAST 1/3RD A-P DIAMETER :INFANTS TO CHILDREN
(PUBERTY)
• 1.5 INCHES (4 CM) IN INFANTS TO 2 INCHES (5 CM) IN CHILDREN
• ONCE REACHED PUBERTY (IE, ADOLESCENTS), RECOMMENDED
ADULT COMPRESSION DEPTH OF AT LEAST 2 INCHES (5 CM) BUT
NO GREATER THAN 2.4 INCHES (6 CM) 16

17. CHEST COMPRESSION DEPTH
• 2010 (OLD)
• FOR EFFECTIVE CC: SHOULD COMPRESS AT LEAST 1/3RD AP
DIAMETER
• CORRESPONDS TO APPROXIMATELY:
• 1.5 INCHES (ABOUT 4 CM) IN INFANTS AND
• 2 INCHES (5 CM) IN CHILDREN
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18. CHEST COMPRESSION DEPTH
• WHY
• 1 ADULT STUDY SUGGESTED HARM WITH CC > 2.4 INCHES (6 CM)
• RESULTED IN CHANGE IN ADULT RECOMMENDATION TO UPPER
LIMIT FOR CC
• PEDIATRIC EXPERTS ACCEPTED THIS FOR ADOLESCENTS
• 1 PEDIATRIC STUDY: IMPROVED 24-HOUR SURVIVAL WHEN
COMPRESSION DEPTH > 2 INCHES (5 CM)
• JUDGMENT OF COMPRESSION DEPTH DIFFICULT AT BEDSIDE, USE
OF FEEDBACK DEVICE THAT PROVIDES SUCH INFORMATION MAY
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19. CHEST COMPRESSION RATE
• 2015 (UPDATED)
• TO MAXIMIZE SIMPLICITY IN CPR TRAINING
• ABSENCE OF SUFFICIENT PEDIATRIC EVIDENCE
• REASONABLE TO USE RECOMMENDED ADULT CC RATE OF 100-
120/MIN FOR INFANTS AND CHILDREN
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20. CHEST COMPRESSION RATE
• 2010 (OLD)
• “PUSH FAST”
• PUSH AT A RATE OF AT LEAST 100 COMPRESSIONS PER MINUTE
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21. CHEST COMPRESSION RATE
• WHY
• 1 ADULT REGISTRY STUDY DEMONSTRATED INADEQUATE CC
DEPTH WITH EXTREMELY RAPID COMPRESSION RATES
• TO MAXIMIZE EDUCATIONAL CONSISTENCY AND RETENTION
• ABSENCE OF PEDIATRIC DATA
• PEDIATRIC EXPERTS ADOPTED SAME RECOMMENDATION FOR
COMPRESSION RATE AS IS MADE FOR ADULT BLS
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22. COMPRESSION-ONLY CPR
• 2015 (UPDATED)
• CONVENTIONAL CPR (RESCUE BREATHS AND CC) SHOULD BE
PROVIDED FOR INFANTS AND CHILDREN IN CARDIAC ARREST
• ASPHYXIAL NATURE OF MOST PEDIATRIC CARDIAC ARRESTS
NECESSITATES VENTILATION AS PART OF EFFECTIVE CPR
• HOWEVER, BECAUSE COMPRESSION-ONLY CPR CAN BE
EFFECTIVE IN PATIENTS WITH PRIMARY CARDIAC ARREST IF
RESCUERS ARE UNWILLING/ UNABLE TO DELIVER BREATHS,
RECOMMEND RESCUERS TO PERFORM COMPRESSION-ONLY CPR
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23. COMPRESSION-ONLY CPR
• 2010 (OLD)
• OPTIMAL CPR IN INFANTS+CHILDREN: COMPRESSIONS AND
VENTILATIONS
• BUT COMPRESSIONS ALONE PREFERABLE TO NO CPR
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24. COMPRESSION-ONLY CPR
• WHY
• LARGE REGISTRY STUDIES: WORSE OUTCOMES FOR PRESUMED
ASPHYXIAL PEDIATRIC CARDIAC ARRESTS TREATED WITH
COMPRESSION-ONLY CPR
• VAST MAJORITY OF OUT-OF-HOSPITAL PEDIATRIC CARDIAC
ARRESTS
• IN 2 STUDIES, WHEN CONVENTIONAL CPR (COMPRESSIONS+
BREATHS) WAS NOT GIVEN IN PRESUMED ASPHYXIAL ARREST,
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25. COMPRESSION-ONLY CPR
• WHEN A PRESUMED CARDIAC ETIOLOGY WAS PRESENT,
OUTCOMES WERE SIMILAR WHETHER CONVENTIONAL OR
COMPRESSION-ONLY CPR WAS PROVIDED
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26. CARDIAC ARREST
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27. 27

28. ARRESTS
• HYPOXIC/ASPHYXIAL ARREST
• MCC OF CARDIAC ARREST IN
INFANTS, CHILDREN, AND
ADOLESCENTS
• TISSUE HYPOXIA AND ACIDOSIS DUE
TO RESPIRATORY FAILURE /SHOCK
• SUDDEN CARDIAC ARREST
• LESS COMMON IN CHILDREN THAN
IN ADULTS
• MOST COMMONLY DUE TO THE
• CAUSES OF SUDDEN CARDIAC
ARREST:
• HYPERTROPHIC CARDIOMYOPATHY
• ANOMALOUS CORONARY ARTERY
• LONG QT SYNDROME OR OTHER
CHANNELOPATHIES
• MYOCARDITIS
• DIGOXIN, COCAINE INTOXICATION
• COMMOTIO CORDIS CAUSED BY A
BLOW TO THE CHEST
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29. REVERSIBLE CAUSES OF CARDIAC ARREST
• H'S
• HYPOVOLEMIA
• HYPOXIA
• HYDROGEN ION (ACIDOSIS)
• HYPOGLYCEMIA
• HYPO/HYPERKALEMIA
• HYPOTHERMIA
• T'S
• TENSION PNEUMOTHORAX
• TAMPONADE (CARDIAC)
• TOXINS
• THROMBOSIS, CORONARY
• THROMBOSIS, PULMONARY
• TRAUMA 29

30. IF A CHILD IS UNRESPONSIVE AND NOT
BREATHING
• PALPATE A CENTRAL PULSE:
• BRACHIAL –INFANT
• CAROTID –CHILD
• IF NO PULSE: START CPR, BEGINNING WITH CHEST
COMPRESSIONS
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31. CARDIAC ARREST RHYTHMS
• ASYSTOLE
• PULSELESS ELECTRICAL ACTIVITY (PEA)
• VENTRICULAR FIBRILLATION
• PULSELESS VT, INCLUDING TORSADES DE POINTES
• ASYSTOLE AND PEA: MC INITIAL RHYTHMS OF PEDIATRIC
CARDIAC ARREST
• VF AND VT USUALLY OCCUR IN OLDER CHILDREN WITH SUDDEN
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32. ASYSTOLE
• CARDIAC STANDSTILL WITHOUT ELECTRICAL ACTIVITY
• FLAT LINE ON ECG
• ALWAYS CONFIRM ASYSTOLE CLINICALLY: "FLAT LINE" LOOSE ECG
LEAD
• CAUSES OF ASYSTOLE : H'S AND T'S
• OTHER CAUSES: DROWNING AND SEPSIS
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33. PULSELESS ELECTRICAL ACTIVITY
• ANY ORGANIZED ELECTRICAL ACTIVITY ON CARDIAC MONITOR
ASSOCIATED WITH NO PALPABLE PULSES
• RATE OF ELECTRICAL ACTIVITY MAY BE SLOW (MC)/ NORMAL/ FAST
• MAY BE DUE TO REVERSIBLE CONDITIONS: H'S AND T'S
• RAPID IDENTIFICATION AND TREATMENT OF CAUSE WILL PREVENT
RHYTHM FROM DETERIORATING TO ASYSTOLE
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34. ECG SIGNS OF PULSELESS ELECTRICAL
ACTIVITY
• NORMAL OR WIDE QRS COMPLEXES
• LOW- OR PEAKED T WAVES
• PROLONGED PR AND QT INTERVALS
• AV DISSOCIATION, COMPLETE HEART BLOCK
• VENTRICULAR COMPLEXES WITHOUT P WAVES
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35. VENTRICULAR FIBRILLATION
• VF PRESENT: HEART HAS NO COORDINATED CONTRACTIONS
• PULSES NOT PALPABLE
• MAY BE PRECEDED BY A BRIEF PERIOD OF VT
• UNCOMMON IN CHILDREN
• MAY OCCASIONALLY OCCUR IN HEALTHY APPEARING TEENS
DURING SPORTS
• CAUSE MAY BE HCM OR A CHANNELOPATHY, SUCH AS PROLONGED
QT SYNDROME
• SUDDEN IMPACT TO CHEST FROM COLLISION/ MOVING OBJECT
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36. VENTRICULAR FIBRILLATION
36

37. PULSELESS VENTRICULAR TACHYCARDIA
• VT MAY PRODUCE PULSES OR MAY CAUSE A PULSELESS ARREST
• PULSELESS VT MANIFESTS WITH ORGANIZED, WIDE QRS
COMPLEXES
• PULSELESS VT IS TREATED SAME AS VF
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38. TORSADES DE POINTES
• PULSELESS VT MAY BE:
• MONOMORPHIC: QRS COMPLEXES HAVE UNIFORM SHAPES
OR
• POLYMORPHIC: QRS COMPLEXES HAVE DIFFERENT SHAPES
• TORSADES DE POINTES: A FORM OF POLYMORPHIC VT SEEN IN
CONDITIONS ASSOCIATED WITH A PROLONGED QT INTERVAL
INCLUDING:
• CONGENITAL LONG QT SYNDROME
• HYPOMAGNESEMIA
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40. BLS COMPONENTS
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Defibrillation I Attatch and use AED asa possible. After shock resume CPR with
compressions

41. MONITORING CPR QUALITY
• CONTINUOUS MONITORING OF END-TIDAL CO2 (PETCO2)
REFLECTS QUALITY OF CC
• IF PETCO2 IS <20 MM HG, CPR INADEQUATE
• EFFECTIVE CARDIAC COMPRESSIONS : PETCO2 OF >20 MM HG
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42. DRUG ADMINISTRATION INTO A PERIPHERAL IV LINE
• GIVE DRUG BY BOLUS INJECTION
• CONTINUE CHEST COMPRESSIONS WHILE GIVING DRUG
• FOLLOW WITH A 5-ML FLUSH OF NS
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43. INTRAOSSEOUS MEDICATION ROUTE
• IF IV ACCESS NOT AVAILABLE: DRUGS AND FLUIDS CAN BE
DELIVERED VIA IO ROUTE
• MAY BE USED FOR VASCULAR ACCESS IN CARDIAC ARREST IN ALL
AGE GROUPS
• ANY DRUG OR FLUID THAT CAN BE GIVEN IV CAN BE
ADMINISTERED IO
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44. ENDOTRACHEAL MEDICATION ROUTE
• IV+ IO ROUTES: PREFERABLE TO ET ROUTE
• IV/ IO DRUG ADMINISTRATION PROVIDES MORE PREDICTABLE
DELIVERY AND EFFECT THAN ET ADMINISTRATION
• DRUGS THAT CAN BE GIVEN BY ET ROUTE: LIDOCAINE,
EPINEPHRINE, ATROPINE, NALOXONE (LEAN), AND VASOPRESSIN
• RECOMMENDED ET DOSE OF EPINEPHRINE :10X IV/IO DOSE
• TYPICAL ET DOSE OF OTHER DRUGS: 2-3X IV/IO DOSE
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45. MEDICATIONS
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46. SHOCKABLE RHYTHM: VF/VT
• IF RHYTHM: SHOCKABLE, DELIVER 1 UNSYNCHRONIZED SHOCK
• PERFORM CPR WHILE DEFIBRILLATOR IS CHARGING
• AFTER SHOCK DELIVERY, RESUME CPR, BEGINNING WITH CC
• A SHARP ELEVATION IN EXHALED CO2 PRESSURE (PETCO2)
INDICATES ROSC
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47. DEFIBRILLATION
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Place one paddle pad on the upper right side of the victim's chest below the right clavicle. Place the other
paddle/electrode to the patient’s left of the left nipple in the anterior axillary line

48. PEA OR ASYSTOLE(NON SHOCKABLE)
• IF NON SHOCKABLE RHYTHM CHECK FOR AN ORGANIZED
RHYTHM ( REGULAR COMPLEXES)
• IF RHYTHM ORGANISED PALPATE FOR A PULSE
• PULSE +NTPOST RESUSCITATION CARE
• IF RHYTHM NON ORGANISED RESUME CPR
• IF PEA (ORGANISED RHYTHM WITHOUT A PULSE) OR ASYSTOLE
RESUME CPR BEGINNING WITH COMPRESSIONS AND FOLLOW
PULSELESS ARREST ALOGORITHM
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49. MANUAL DEFIBRILLATION FOR VF,
PULSELESS VENTRICULAR TACHYCARDIA
• CONTINUE CPR WITHOUT INTERRUPTIONS DURING ALL STEPS
UNTIL STEP 8.
• 1. TURN ON DEFIBRILLATOR
• 2. SET LEAD SWITCH TO PADDLES
• 3. SELECT ADHESIVE PADS/ PADDLES, USE LARGEST PADS/
PADDLES THAT CAN FIT ON PATIENT'S CHEST WITHOUT TOUCHING
• 4. IF USING PADDLES, APPLY CONDUCTIVE GEL/ PASTE
• 5. POSITION ADHESIVE PADS ON PATIENT: RIGHT ANTERIOR CHEST
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50. MANUAL DEFIBRILLATION FOR VF,
PULSELESS VENTRICULAR TACHYCARDIA
6. SELECT ENERGY DOSE: INITIAL DOSE: 2 J/KG, SUBSEQUENT DOSES: 4 J/KG
OR HIGHER (NOT > 10 J/KG OR 200J)
7. ANNOUNCE "CHARGING DEFIBRILLATOR," PRESS CHARGE ON
DEFIBRILLATOR
8. WHEN DEFIBRILLATOR IS FULLY CHARGED, STATE: "I AM GOING TO SHOCK
ON 3."COUNT. “1, 2, 3” AND STATE: "ALL CLEAR!" (CC SHOULD CONTINUE UNTIL
THIS ANNOUNCEMENT)
9. AFTER CONFIRMING ALL PERSONNEL ARE CLEAR OF PATIENT, PRESS SHOCK
BUTTON ON DEFIBRILLATOR OR PRESS 2 PADDLE DISCHARGE BUTTONS
SIMULTANEOUSLY
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51. PERSISTENT VENTRICULAR FIBRILLATION
AND VENTRICULAR TACHYCARDIA
• IF RHYTHM CHECK REVEALS A SHOCKABLE RHYTHM (PERSISTENT
VF/VT): PREPARE TO DELIVER A SECOND SHOCK WITH A MANUAL
DEFIBRILLATOR (4 J/KG) OR AED
• RESUME CC WHILE DEFIBRILLATOR IS CHARGING
• ADMINISTER EPINEPHRINE(0.01MG/KG, X 3-5 MINS) WHILE
COMPRESSIONS CONTINUE
• INSERT ADVANCED AIRWAY
• ONCE DEFIBRILLATOR IS CHARGED, "CLEAR" THE PATIENT AND
DELIVER A SHOCK
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52. PERSISTENT VENTRICULAR FIBRILLATION AND
VENTRICULAR TACHYCARDIA
• CHECK RHYTHM
• AFTER 2 MINUTES OF CPR+ EPINEPHRINE ADMINISTRATION,
RECHECK RHYTHM:
• TERMINATION OF VF/VT:
• NO ORGANIZED RHYTHM (ASYSTOLE/PEA): GO TO RIGHT
SIDE OF ALGORITHM
• ORGANIZED RHYTHM: CHECK PULSE. IF PULSE PRESENT,
BEGIN POST-RESUSCITATION CARE. IF NO PULSE PRESENT
(PEA/ ASYSTOLE), GO TO RIGHT SIDE OF ALGORITHM
52

53. PERSISTENT VENTRICULAR FIBRILLATION
AND VENTRICULAR TACHYCARDIA
• DELIVER SHOCK
• IF VF/VT PERSISTS, DELIVER 1 SHOCK (4 J/KG OR MORE, UP TO 10
J/KG OR MAX ADULT DOSE OF 200 J)
• PERFORM CC WHILE DEFIBRILLATOR IS CHARGING
• AFTER DEFIBRILLATOR IS CHARGED, "CLEAR" VICTIM AND
DELIVER SHOCK
• IMMEDIATELY AFTER SHOCK, RESUME CPR, BEGINNING WITH CC
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54. ANTIARRHYTHMIC MEDICATIONS
• AFTER RESUMING CC, IMMEDIATELY ADMINISTER AMIODARONE
• AMIODARONE 5 MG/KG IV/IO BOLUS (MAX DOSE 300 MG); MAY
REPEAT 5 MG/KG IV/IO BOLUS UP TO TOTAL DOSE OF 15
MG/KG (2.2 G IN ADOLESCENTS) IV PER 24 HOURS
• IF RHYTHM CHECK SHOWS TORSADES DE POINTES MAGNESIUM
• MAGNESIUM 25 TO 50 MG/KG IV/IO, MAX 2 G
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55. TRAUMATIC CARDIAC ARREST
• HYPOXIA CAUSED BY RESPIRATORY ARREST/ AIRWAY
OBSTRUCTION/ TRACHEOBRONCHIAL INJURY
• INJURY TO HEART/ AORTA/ PULMONARY ARTERIES/ LUNGS
• SEVERE BRAIN INJURY WITH SECONDARY CARDIOVASCULAR
COLLAPSE
• UPPER CERVICAL SPINAL CORD INJURY WITH RESPIRATORY
ARREST AND SPINAL SHOCK
• DECREASED CARDIAC OUTPUT OR PEA FROM TENSION
55

56. TREATMENT OF TRAUMATIC ARREST
• PERFORM CPR. CONTROL HEMORRHAGE WITH DIRECT PRESSURE
• INITIATE IO/IV ACCESS AND REPLACE FLUIDS RAPIDLY. GIVE NON-
CROSSMATCHED BLOOD
• PERFORM PERICARDIOCENTESIS FOR CARDIAC TAMPONADE
• SPINAL SHOCK (LOSS OF SYMPATHETIC INNERVATION) MAY CAUSE FLUID-
REFRACTORY HYPOTENSION AND BRADYCARDIA: NOREPINEPHRINE IS
INDICATED
• VENTILATE WITH BAG-MASK DEVICE USING 100% OXYGEN
• IF ET INTUBATION ATTEMPTED: 1RESCUER SHOULD STABILIZE HEAD+ NECK
• PERFORM B/L NEEDLE DECOMPRESSION IF TENSION PNEUMOTHORAX
56

57. TREATMENT OF CARDIAC ARREST BY DROWNING
• PERFORM CPR. WIPE WATER OFF OF CHEST+ATTACH A
MONITOR/DEFIBRILLATOR. CHECK RHYTHM, AND DEFIBRILLATE V.
FIBRILLATION OR PULSELESS VENTRICULAR TACHYCARDIA
• OPEN AIRWAY. VENTILATE WITH BAG-MASK DEVICE USING 100% OXYGEN
• ADMINISTER EPINEPHRINE FOR PULSELESS ARREST OR BRADYCARDIA
• SUCTION AIRWAY: DROWNING VICTIMS OFTEN VOMIT
• DECOMPRESS STOMACH WITH NG TUBE AFTER AN ADVANCED AIRWAY HAS
BEEN INSERTED
• IF CERVICAL SPINE INJURY IS SUSPECTED (EG, DIVING INJURY) RESTRICT
SPINAL MOTION
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58. CARDIAC ARREST CAUSED BY
ANAPHYLAXIS
• CAUSES PROFOUND VASODILATION, WHICH CAUSES
HYPOVOLEMIA
• ANAPHYLAXIS IS COMMONLY ASSOCIATED WITH
BRONCHOCONSTRICTION
• IF PULSELESS DO CC. ADMINISTER LARGE VOLUMES OF
ISOTONIC CRYSTALLOID ASAP-> 2 IO CATHETERS/LARGE-BORE IVS
WITH PRESSURE BAGS
• EPINEPHRINE 0.01M/KGIO/IV . INITIATE EPINEPHRINE INFUSION
• MAINTAIN AIRWAY. PERFORM BAG-MASK VENTILATION USING 100%
58

59. CARDIAC ARREST ASSOCIATED WITH
POISONING
• EFFECTS OF DRUG TOXICITY USUALLY TEMPORARY
• PROLONGED RESUSCITATION EFFORTS WILL OFTEN RESULT IN
GOOD LONG-TERM SURVIVAL FROM POISONING
• ADVANCED LIFE SUPPORT MEASURES SHOULD BE INITIATED
WHILE SEARCHING FOR AND TREATING REVERSIBLE CAUSES OF
CARDIAC ARREST
59

60. RESUSCITATION OF CHD WITH SINGLE
VENTRICLE
• ADMINISTER HEPARIN FOR CHILDREN WITH SHUNTS IF SHUNT
PATENCY IS CONCERN
• AFTER RESUSCITATION, TITRATE OXYGEN TO ACHIEVE
SATURATION OF 80%
• END-TIDAL CO2 (PETCO2) MAY NOT BE RELIABLE INDICATOR OF
CPR QUALITY IN PATIENT WITH SINGLE-VENTRICLE
• CONSIDER PERMISSIVE HYPOVENTILATION/ NEGATIVE-PRESSURE
VENTILATION
60

61. PULMONARY HYPERTENSION
• CAUSES IMPAIRED CO BY INCREASING RESISTANCE TO BLOOD
FLOW THROUGH LUNGS
• CORRECT HYPERCARBIA
• BOLUS OF ISOTONIC SALINE MAY BE USEFUL TO MAINTAIN
VENTRICULAR PRELOAD
• IF PATIENT WAS RECEIVING PULMONARY VASODILATORS
(PROSTACYCLIN) PRIOR TO ARREST CONTINUE
• ADMINISTER PROSTACYCLIN TO REDUCE PVR
• ECLS (ECMO) MAY BE USEFUL
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62. NEONATAL CPR
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