The American Heart Association (AHA) constantly provides guidelines on caring for pediatric patients and persons with heart disease based on research and scientific findings. The recent guidelines released in October 2020 base emphasis on the following areas:
- Improved algorithms and visual aids to guide resuscitation procedures.
- Significance of early CPR by lay rescuers.
- Importance of early epinephrine administration.
- Real-time audio-visual feedback in the delivery of high-quality CPR.
- Ongoing measurement of end-tidal carbon dioxide (ETCO2) blood pressure during Advanced Life Support resuscitation.
- Patient care after the return of spontaneous circulation (ROSC).
- Care for pediatric patients after discharge from the hospital.
- Management of cardiac arrest in expectant mothers.
- Handling of opioid emergencies and early CPR by bystanders.
Advanced Life Support
The American Heart Association findings suggest that less than 40 percent of adults receive CPR from a layperson. Out of these, only 12 percent have an Automated External Defibrillator administered before the arrival of emergency medical services. Therefore, whenever resuscitation attempts fail, the rescuer should administer epinephrine. This provision also applies to pediatric patients with non-shockable rhythms.
Activate emergency response
When someone collapses and isn't responsive, shout for help. If more than one person is present, let one person dial emergency response (911) while the other starts CPR. Request for an Automated External Defibrillator device to be availed immediately.
Most often, cardiac arrest strikes without warning signs. The signs of cardiac arrest are loss of responsiveness and lack of normal breathing. When a victim collapses, it should take a health provider a few seconds to check for breathing and a pulse.
The American Heart Association recognizes that it is difficult for non-medical professionals to detect a pulse. Therefore, the risk of causing harm to the victim is very low. For this reason, if the pediatric patient doesn't have a pulse or you aren't sure, begin CPR immediately. Chest compressions do not harm the victim if they are not indeed experiencing cardiac arrest.
Provide high-quality CPR
According to the American Heart Association guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care, for a rescuer to give high-quality CPR, they should focus on the following:
- The required rate and depth of chest compressions. Locate the center of the chest and push hard enough to achieve the recommended depth. For adults, use the heels of your hand with fingers interlocked, while pediatric patients and infants require less pressure.
- The pressure and depth of chest compressions differ in adults and pediatric patients. Rescuers should, therefore, apply the required pressure, which is enough to maintain blood circulation.
- Ensure there are minimum interruptions between the compressions. You should do the compressions interchanging whenever the compressor every two minutes or if fatigued. It will help if you avoid excessive ventilation. The ventilation should be at 30:2 (30 chest compressions should follow each two ventilation sessions).
For better results, use the Automated External Defibrillator as soon as it is available. Research findings do not support double defibrillation, which uses two defibrillators simultaneously.
The same findings apply to pediatric BLS algorithm and adult CPR, emphasizing the provision of high-quality CPR. For high-quality CPR, American Heart Association recommends:
- Minimized interruptions between the chest compressions
- Allowing the chest to recoil after every compression
- Avoiding excessive ventilation
- The right depth of chest compressions
In laypersons, the CPR process entails 30 chest compressions alternating with two rescue breaths. The rescuer must provide rescue breaths for infants and children in cardiac arrest. In hospitality, the respiratory rate should be 20 to 30 breaths per minute. It applies to infants with a pulse receiving rescue breathing. The same also applies to those with advanced airways.
If not able to provide rescue breaths, they should give chest compressions only (hands-only CPR). The rescuer should apply pressure on the infant's sternum using two fingers, two thumbs, or the heel of one hand. The chest compressions should be 1.5 inches deep.
For cardiac arrest patients with non-shockable rhythms, early administration of epinephrine increases the chances of survival. American Heart Association findings show that during using bag-mask ventilation, cricoid pressure will not lower regurgitation risk.
Bag-mask ventilation provides similar results to advanced airway interventions when giving CPR to in-hospital cardiac arrest victims. However, after successful resuscitation, cardiac arrest victims require post-cardiac arrest care since it doesn't return spontaneous circulation (ROSC) is not certain.
Post-cardiac arrest care
Even after discharge from the hospital, cardiac arrest care is critical in cardiac arrest patients' recovery. Victims often experience emotional, physical, and cognitive challenges. Thus, the patients require continued care and support, which can be in the former therapies and interventions.
Upon recovery, cardiac arrest patients need proper post-cardiac arrest syndrome management, which presents ischemia or reperfusion injury, myocardial dysfunction with low cardiac output, and brain dysfunction. The management of these conditions prevents the risk of secondary damage. Appropriate neuroprognosis is critical in proper caregiver guidance. Since cardiac arrest survivors are at a high risk of neurodevelopmental impairment, there is a need for early referral for a rehabilitation assessment.
In infants, the process involves continuous electroencephalography monitoring and targeted temperature management. The care also entails treating certain conditions such as hypercapnia/hypocapnia, hyperoxia/hypoxia, and hypotension.
When attending to victims suspected of opioid poisoning, rescuers should aim at providing high-quality CPR. The use of naloxone is helpful in victims of opioid overuse who experience respiratory arrest. However, the drug is ineffective for cardiac arrest victims; this makes the Cardiopulmonary Resuscitation procedure critical in these cases to keep the victims alive.
Steps for attending opioid poisoning victims
- Check the victim for responsiveness.
- Yell for help and call emergency medical services.
- Get or request naloxone and an automated defibrillator.
- If the victim is breathing, reposition him or her and administer naloxone if necessary. Observe the victim until emergency medical services.
- If the victim is not breathing, start CPR immediately, and give naloxone. Use the Automated Externalnal Defibrillator if available.
- Continue performing Cardiopulmonary Resuscitation until medical help arrives.
- If the victim is breathing, provide a bag device mask or rescue breathing for health care providers, then administer naloxone.
- If the victim is not breathing, begin CPR immediately. Give naloxone if necessary, and then move on to the basic life support cardiac arrest algorithm.
Debriefing for lay rescuers
Rescuers may experience posttraumatic stress and anxiety after providing or failing to provide basic life support—hospital-based healthcare providers, in particular, experience psychological and emotional effects after caring for cardiac arrest victims. American Heart Association guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care advise follow-up emotional support to hospital-based health workers, emergency responders, and lay rescuers after a cardiac arrest event. Health facilities should assess stressors associated with critically ill patients and review team performance and the quality of services they offer.
Over 350,000 people experience out-of-hospital cardiac arrest annually in the United States, with only 10% surviving Rescuers may experience posttraumatic stress and anxiety after providing or failing to provide basic life support.
The rate of survival for in-hospital cardiac arrest is 25%. The American Heart Association believes more can be done to increase survival rates. It emphasizes the need for early high-quality CPR and epinephrine administration for unshockable rhythm. American Heart Association findings show that during using bag-mask ventilation, cricoid pressure will not lower regurgitation risk. For better results, it is recommended to use the Automated External Defibrillator as soon as it is available.
For cases suspected to be opioid overdoses, naloxone is critical for respiratory arrest. More people need to acquire CPR skills, and real-time audio-visual feedback is the best way to ensure high-quality CPR.