2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients

Pediatric basic life support

Dianne L. Atkins, Marc D. Berg, Robert A. Berg, Adnan T. Bhutta, Dominique Biarent, Robert Bingham, Dana Braner, Renato Carrera, Leon Chameides, Ashraf Coovadia, Allan De Caen, Douglas S. Diekema, Diana G. Fendya, Melinda L. Fiedor, Richard T. Fiser, Susan Fuchs, Mike Gerardi, Wiliam Hammill, George W. Hatch, Mary Fran Hazinski & 27 others Robert W. Hickey, John Kattwinkel, Monica E. Kleinman, Jesús López-Herce, Peter Morley, Marilyn Morris, Vinay M. Nadkarni, Jerry Nolan, Jeffrey Perlman, Lester T. Proctor, Linda Quan, Amelia Gorete Reis, Sam Richmond, Antonio Rodriguez-Nuñez, Ricardo Samson, Anthony J. Scalzo, L. R. Scherer, Stephen M. Schexnayder, Charles L. Schleien, Naoki Shimizu, Paul M. Shore, Vijay Srinivasan, Edward R. Stapleton, James Tibballs, Elise W. Van Der Jagt, Arno Zaritsky, David Zideman

Research output: Contribution to journalArticle

138 Citations (Scopus)

Abstract

This publication presents the 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of the pediatric patient and the 2005 American Academy of Pediatrics/AHA guidelines for CPR and ECC of the neonate. The guidelines are based on the evidence evaluation from the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, hosted by the American Heart Association in Dallas, Texas, January 23-30, 2005. The "2005 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" contain recommendations designed to improve survival from sudden cardiac arrest and acute life-threatening cardiopulmonary problems. The evidence evaluation process that was the basis for these guidelines was accomplished in collaboration with the International Liaison Committee on Resuscitation (ILCOR). The ILCOR process is described in more detail in the "International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations." The recommendations in the "2005 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" confirm the safety and effectiveness of many approaches, acknowledge that other approaches may not be optimal, and recommend new treatments that have undergone evidence evaluation. These new recommendations do not imply that care involving the use of earlier guidelines is unsafe. In addition, it is important to note that these guidelines will not apply to all rescuers and all victims in all situations. The leader of a resuscitation attempt may need to adapt application of the guidelines to unique circumstances. The following are the major pediatric advanced life support changes in the 2005 guidelines: • There is further caution about the use of endotracheal tubes. Laryngeal mask airways are acceptable when used by experienced providers. • Cuffed endotracheal tubes may be used in infants (except newborns) and children in in-hospital settings provided that cuff inflation pressure is kept 2O. • Confirmation of tube placement requires clinical assessment and assessment of exhaled carbon dioxide (CO2); esophageal detector devices may be considered for use in children weighing >20 kg who have a perfusing rhythm. Correct placement must be verified when the tube is inserted, during transport, and whenever the patient is moved. • During CPR with an advanced airway in place, rescuers will no longer perform "cycles" of CPR. Instead, the rescuer performing chest compressions will perform them continuously at a rate of 100/minute without pauses for ventilation. The rescuer providing ventilation will deliver 8 to 10 breaths per minute (1 breath approximately every 6-8 seconds). • Timing of 1 shock, CPR, and drug administration during pulseless arrest has changed and now is identical to that for advanced cardiac life support. • Routine use of high-dose epinephrine is not recommended. • Lidocaine is de-emphasized, but it can be used for treatment of ventricular fibrillation/pulseless ventricular tachycardia if amiodarone is not available. • Induced hypothermia (32-34°C for 12-24 hours) may be considered if the child remains comatose after resuscitation. • Indications for the use of inodilators are mentioned in the postresuscitation section. • Termination of resuscitative efforts is discussed. It is noted that intact survival has been reported following prolonged resuscitation and absence of spontaneous circulation despite 2 doses of epinephrine. The following are the major neonatal resuscitation changes in the 2005 guidelines: • Supplementary oxygen is recommended whenever positive-pressure ventilation is indicated for resuscitation; free-flow oxygen should be administered to infants who are breathing but have central cyanosis. Although the standard approach to resuscitation is to use 100% oxygen, it is reasonable to begin resuscitation with an oxygen concentration of less than 100% or to start with no supplementary oxygen (ie, start with room air). If the clinician begins resuscitation with room air, it is recommended that supplementary oxygen be available to use if there is no appreciable improvement within 90 seconds after birth. In situations where supplementary oxygen is not readily available, positive-pressure ventilation should be administered with room air. • Current recommendations no longer advise routine intrapartum oropharyngeal and nasopharyngeal suctioning for infants born to mothers with meconium staining of amniotic fluid. Endotracheal suctioning for infants who are not vigorous should be performed immediately after birth. • A self-inflating bag, a flow-inflating bag, or a T-piece (a valved mechanical device designed to regulate pressure and limit flow) can be used to ventilate a newborn. • An increase in heart rate is the primary sign of improved ventilation during resuscitation. Exhaled CO2 detection is the recommended primary technique to confirm correct endotracheal tube placement when a prompt increase in heart rate does not occur after intubation. • The recommended intravenous (IV) epinephrine dose is 0.01 to 0.03 mg/kg per dose. Higher IV doses are not recommended, and IV administration is the preferred route. Although access is being obtained, administration of a higher dose (up to 0.1 mg/kg) through the endotracheal tube may be considered. • It is possible to identify conditions associated with high mortality and poor outcome in which withholding resuscitative efforts may be considered reasonable, particularly when there has been the opportunity for parental agreement. The following guidelines must be interpreted according to current regional outcomes: • When gestation, birth weight, or congenital anomalies are associated with almost certain early death and when unacceptably high morbidity is likely among the rare survivors, resuscitation is not indicated. Examples are provided in the guidelines. • In conditions associated with a high rate of survival and acceptable morbidity, resuscitation is nearly always indicated. • In conditions associated with uncertain prognosis in which survival is borderline, the morbidity rate is relatively high, and the anticipated burden to the child is high, parental desires concerning initiation of resuscitation should be supported. • Infants without signs of life (no heartbeat and no respiratory effort) after 10 minutes of resuscitation show either a high mortality rate or severe neurodevelopmental disability. After 10 minutes of continuous and adequate resuscitative efforts, discontinuation of resuscitation may be justified if there are no signs of life.

Original languageEnglish (US)
JournalPediatrics
Volume117
Issue number5
DOIs
StatePublished - May 2006
Externally publishedYes

Fingerprint

Cardiopulmonary Resuscitation
Emergency Medical Services
Resuscitation
Guidelines
Pediatrics
Oxygen
American Heart Association
Epinephrine
Ventilation
Positive-Pressure Respiration
Air
Newborn Infant
Morbidity
Survival
Heart Rate
Advanced Cardiac Life Support
Parturition
Induced Hypothermia
Pressure
Laryngeal Masks

Keywords

  • Neonatal resuscitation
  • Pediatric advanced life support (PALS)
  • Resuscitation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients : Pediatric basic life support. / Atkins, Dianne L.; Berg, Marc D.; Berg, Robert A.; Bhutta, Adnan T.; Biarent, Dominique; Bingham, Robert; Braner, Dana; Carrera, Renato; Chameides, Leon; Coovadia, Ashraf; De Caen, Allan; Diekema, Douglas S.; Fendya, Diana G.; Fiedor, Melinda L.; Fiser, Richard T.; Fuchs, Susan; Gerardi, Mike; Hammill, Wiliam; Hatch, George W.; Hazinski, Mary Fran; Hickey, Robert W.; Kattwinkel, John; Kleinman, Monica E.; López-Herce, Jesús; Morley, Peter; Morris, Marilyn; Nadkarni, Vinay M.; Nolan, Jerry; Perlman, Jeffrey; Proctor, Lester T.; Quan, Linda; Reis, Amelia Gorete; Richmond, Sam; Rodriguez-Nuñez, Antonio; Samson, Ricardo; Scalzo, Anthony J.; Scherer, L. R.; Schexnayder, Stephen M.; Schleien, Charles L.; Shimizu, Naoki; Shore, Paul M.; Srinivasan, Vijay; Stapleton, Edward R.; Tibballs, James; Van Der Jagt, Elise W.; Zaritsky, Arno; Zideman, David.

In: Pediatrics, Vol. 117, No. 5, 05.2006.

Research output: Contribution to journalArticle

Atkins, DL, Berg, MD, Berg, RA, Bhutta, AT, Biarent, D, Bingham, R, Braner, D, Carrera, R, Chameides, L, Coovadia, A, De Caen, A, Diekema, DS, Fendya, DG, Fiedor, ML, Fiser, RT, Fuchs, S, Gerardi, M, Hammill, W, Hatch, GW, Hazinski, MF, Hickey, RW, Kattwinkel, J, Kleinman, ME, López-Herce, J, Morley, P, Morris, M, Nadkarni, VM, Nolan, J, Perlman, J, Proctor, LT, Quan, L, Reis, AG, Richmond, S, Rodriguez-Nuñez, A, Samson, R, Scalzo, AJ, Scherer, LR, Schexnayder, SM, Schleien, CL, Shimizu, N, Shore, PM, Srinivasan, V, Stapleton, ER, Tibballs, J, Van Der Jagt, EW, Zaritsky, A & Zideman, D 2006, '2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: Pediatric basic life support', Pediatrics, vol. 117, no. 5. https://doi.org/10.1542/peds.2006-0219
Atkins, Dianne L. ; Berg, Marc D. ; Berg, Robert A. ; Bhutta, Adnan T. ; Biarent, Dominique ; Bingham, Robert ; Braner, Dana ; Carrera, Renato ; Chameides, Leon ; Coovadia, Ashraf ; De Caen, Allan ; Diekema, Douglas S. ; Fendya, Diana G. ; Fiedor, Melinda L. ; Fiser, Richard T. ; Fuchs, Susan ; Gerardi, Mike ; Hammill, Wiliam ; Hatch, George W. ; Hazinski, Mary Fran ; Hickey, Robert W. ; Kattwinkel, John ; Kleinman, Monica E. ; López-Herce, Jesús ; Morley, Peter ; Morris, Marilyn ; Nadkarni, Vinay M. ; Nolan, Jerry ; Perlman, Jeffrey ; Proctor, Lester T. ; Quan, Linda ; Reis, Amelia Gorete ; Richmond, Sam ; Rodriguez-Nuñez, Antonio ; Samson, Ricardo ; Scalzo, Anthony J. ; Scherer, L. R. ; Schexnayder, Stephen M. ; Schleien, Charles L. ; Shimizu, Naoki ; Shore, Paul M. ; Srinivasan, Vijay ; Stapleton, Edward R. ; Tibballs, James ; Van Der Jagt, Elise W. ; Zaritsky, Arno ; Zideman, David. / 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients : Pediatric basic life support. In: Pediatrics. 2006 ; Vol. 117, No. 5.
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title = "2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients: Pediatric basic life support",
abstract = "This publication presents the 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of the pediatric patient and the 2005 American Academy of Pediatrics/AHA guidelines for CPR and ECC of the neonate. The guidelines are based on the evidence evaluation from the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, hosted by the American Heart Association in Dallas, Texas, January 23-30, 2005. The {"}2005 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care{"} contain recommendations designed to improve survival from sudden cardiac arrest and acute life-threatening cardiopulmonary problems. The evidence evaluation process that was the basis for these guidelines was accomplished in collaboration with the International Liaison Committee on Resuscitation (ILCOR). The ILCOR process is described in more detail in the {"}International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.{"} The recommendations in the {"}2005 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care{"} confirm the safety and effectiveness of many approaches, acknowledge that other approaches may not be optimal, and recommend new treatments that have undergone evidence evaluation. These new recommendations do not imply that care involving the use of earlier guidelines is unsafe. In addition, it is important to note that these guidelines will not apply to all rescuers and all victims in all situations. The leader of a resuscitation attempt may need to adapt application of the guidelines to unique circumstances. The following are the major pediatric advanced life support changes in the 2005 guidelines: • There is further caution about the use of endotracheal tubes. Laryngeal mask airways are acceptable when used by experienced providers. • Cuffed endotracheal tubes may be used in infants (except newborns) and children in in-hospital settings provided that cuff inflation pressure is kept 2O. • Confirmation of tube placement requires clinical assessment and assessment of exhaled carbon dioxide (CO2); esophageal detector devices may be considered for use in children weighing >20 kg who have a perfusing rhythm. Correct placement must be verified when the tube is inserted, during transport, and whenever the patient is moved. • During CPR with an advanced airway in place, rescuers will no longer perform {"}cycles{"} of CPR. Instead, the rescuer performing chest compressions will perform them continuously at a rate of 100/minute without pauses for ventilation. The rescuer providing ventilation will deliver 8 to 10 breaths per minute (1 breath approximately every 6-8 seconds). • Timing of 1 shock, CPR, and drug administration during pulseless arrest has changed and now is identical to that for advanced cardiac life support. • Routine use of high-dose epinephrine is not recommended. • Lidocaine is de-emphasized, but it can be used for treatment of ventricular fibrillation/pulseless ventricular tachycardia if amiodarone is not available. • Induced hypothermia (32-34°C for 12-24 hours) may be considered if the child remains comatose after resuscitation. • Indications for the use of inodilators are mentioned in the postresuscitation section. • Termination of resuscitative efforts is discussed. It is noted that intact survival has been reported following prolonged resuscitation and absence of spontaneous circulation despite 2 doses of epinephrine. The following are the major neonatal resuscitation changes in the 2005 guidelines: • Supplementary oxygen is recommended whenever positive-pressure ventilation is indicated for resuscitation; free-flow oxygen should be administered to infants who are breathing but have central cyanosis. Although the standard approach to resuscitation is to use 100{\%} oxygen, it is reasonable to begin resuscitation with an oxygen concentration of less than 100{\%} or to start with no supplementary oxygen (ie, start with room air). If the clinician begins resuscitation with room air, it is recommended that supplementary oxygen be available to use if there is no appreciable improvement within 90 seconds after birth. In situations where supplementary oxygen is not readily available, positive-pressure ventilation should be administered with room air. • Current recommendations no longer advise routine intrapartum oropharyngeal and nasopharyngeal suctioning for infants born to mothers with meconium staining of amniotic fluid. Endotracheal suctioning for infants who are not vigorous should be performed immediately after birth. • A self-inflating bag, a flow-inflating bag, or a T-piece (a valved mechanical device designed to regulate pressure and limit flow) can be used to ventilate a newborn. • An increase in heart rate is the primary sign of improved ventilation during resuscitation. Exhaled CO2 detection is the recommended primary technique to confirm correct endotracheal tube placement when a prompt increase in heart rate does not occur after intubation. • The recommended intravenous (IV) epinephrine dose is 0.01 to 0.03 mg/kg per dose. Higher IV doses are not recommended, and IV administration is the preferred route. Although access is being obtained, administration of a higher dose (up to 0.1 mg/kg) through the endotracheal tube may be considered. • It is possible to identify conditions associated with high mortality and poor outcome in which withholding resuscitative efforts may be considered reasonable, particularly when there has been the opportunity for parental agreement. The following guidelines must be interpreted according to current regional outcomes: • When gestation, birth weight, or congenital anomalies are associated with almost certain early death and when unacceptably high morbidity is likely among the rare survivors, resuscitation is not indicated. Examples are provided in the guidelines. • In conditions associated with a high rate of survival and acceptable morbidity, resuscitation is nearly always indicated. • In conditions associated with uncertain prognosis in which survival is borderline, the morbidity rate is relatively high, and the anticipated burden to the child is high, parental desires concerning initiation of resuscitation should be supported. • Infants without signs of life (no heartbeat and no respiratory effort) after 10 minutes of resuscitation show either a high mortality rate or severe neurodevelopmental disability. After 10 minutes of continuous and adequate resuscitative efforts, discontinuation of resuscitation may be justified if there are no signs of life.",
keywords = "Neonatal resuscitation, Pediatric advanced life support (PALS), Resuscitation",
author = "Atkins, {Dianne L.} and Berg, {Marc D.} and Berg, {Robert A.} and Bhutta, {Adnan T.} and Dominique Biarent and Robert Bingham and Dana Braner and Renato Carrera and Leon Chameides and Ashraf Coovadia and {De Caen}, Allan and Diekema, {Douglas S.} and Fendya, {Diana G.} and Fiedor, {Melinda L.} and Fiser, {Richard T.} and Susan Fuchs and Mike Gerardi and Wiliam Hammill and Hatch, {George W.} and Hazinski, {Mary Fran} and Hickey, {Robert W.} and John Kattwinkel and Kleinman, {Monica E.} and Jes{\'u}s L{\'o}pez-Herce and Peter Morley and Marilyn Morris and Nadkarni, {Vinay M.} and Jerry Nolan and Jeffrey Perlman and Proctor, {Lester T.} and Linda Quan and Reis, {Amelia Gorete} and Sam Richmond and Antonio Rodriguez-Nu{\~n}ez and Ricardo Samson and Scalzo, {Anthony J.} and Scherer, {L. R.} and Schexnayder, {Stephen M.} and Schleien, {Charles L.} and Naoki Shimizu and Shore, {Paul M.} and Vijay Srinivasan and Stapleton, {Edward R.} and James Tibballs and {Van Der Jagt}, {Elise W.} and Arno Zaritsky and David Zideman",
year = "2006",
month = "5",
doi = "10.1542/peds.2006-0219",
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TY - JOUR

T1 - 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of pediatric and neonatal patients

T2 - Pediatric basic life support

AU - Atkins, Dianne L.

AU - Berg, Marc D.

AU - Berg, Robert A.

AU - Bhutta, Adnan T.

AU - Biarent, Dominique

AU - Bingham, Robert

AU - Braner, Dana

AU - Carrera, Renato

AU - Chameides, Leon

AU - Coovadia, Ashraf

AU - De Caen, Allan

AU - Diekema, Douglas S.

AU - Fendya, Diana G.

AU - Fiedor, Melinda L.

AU - Fiser, Richard T.

AU - Fuchs, Susan

AU - Gerardi, Mike

AU - Hammill, Wiliam

AU - Hatch, George W.

AU - Hazinski, Mary Fran

AU - Hickey, Robert W.

AU - Kattwinkel, John

AU - Kleinman, Monica E.

AU - López-Herce, Jesús

AU - Morley, Peter

AU - Morris, Marilyn

AU - Nadkarni, Vinay M.

AU - Nolan, Jerry

AU - Perlman, Jeffrey

AU - Proctor, Lester T.

AU - Quan, Linda

AU - Reis, Amelia Gorete

AU - Richmond, Sam

AU - Rodriguez-Nuñez, Antonio

AU - Samson, Ricardo

AU - Scalzo, Anthony J.

AU - Scherer, L. R.

AU - Schexnayder, Stephen M.

AU - Schleien, Charles L.

AU - Shimizu, Naoki

AU - Shore, Paul M.

AU - Srinivasan, Vijay

AU - Stapleton, Edward R.

AU - Tibballs, James

AU - Van Der Jagt, Elise W.

AU - Zaritsky, Arno

AU - Zideman, David

PY - 2006/5

Y1 - 2006/5

N2 - This publication presents the 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of the pediatric patient and the 2005 American Academy of Pediatrics/AHA guidelines for CPR and ECC of the neonate. The guidelines are based on the evidence evaluation from the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, hosted by the American Heart Association in Dallas, Texas, January 23-30, 2005. The "2005 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" contain recommendations designed to improve survival from sudden cardiac arrest and acute life-threatening cardiopulmonary problems. The evidence evaluation process that was the basis for these guidelines was accomplished in collaboration with the International Liaison Committee on Resuscitation (ILCOR). The ILCOR process is described in more detail in the "International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations." The recommendations in the "2005 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" confirm the safety and effectiveness of many approaches, acknowledge that other approaches may not be optimal, and recommend new treatments that have undergone evidence evaluation. These new recommendations do not imply that care involving the use of earlier guidelines is unsafe. In addition, it is important to note that these guidelines will not apply to all rescuers and all victims in all situations. The leader of a resuscitation attempt may need to adapt application of the guidelines to unique circumstances. The following are the major pediatric advanced life support changes in the 2005 guidelines: • There is further caution about the use of endotracheal tubes. Laryngeal mask airways are acceptable when used by experienced providers. • Cuffed endotracheal tubes may be used in infants (except newborns) and children in in-hospital settings provided that cuff inflation pressure is kept 2O. • Confirmation of tube placement requires clinical assessment and assessment of exhaled carbon dioxide (CO2); esophageal detector devices may be considered for use in children weighing >20 kg who have a perfusing rhythm. Correct placement must be verified when the tube is inserted, during transport, and whenever the patient is moved. • During CPR with an advanced airway in place, rescuers will no longer perform "cycles" of CPR. Instead, the rescuer performing chest compressions will perform them continuously at a rate of 100/minute without pauses for ventilation. The rescuer providing ventilation will deliver 8 to 10 breaths per minute (1 breath approximately every 6-8 seconds). • Timing of 1 shock, CPR, and drug administration during pulseless arrest has changed and now is identical to that for advanced cardiac life support. • Routine use of high-dose epinephrine is not recommended. • Lidocaine is de-emphasized, but it can be used for treatment of ventricular fibrillation/pulseless ventricular tachycardia if amiodarone is not available. • Induced hypothermia (32-34°C for 12-24 hours) may be considered if the child remains comatose after resuscitation. • Indications for the use of inodilators are mentioned in the postresuscitation section. • Termination of resuscitative efforts is discussed. It is noted that intact survival has been reported following prolonged resuscitation and absence of spontaneous circulation despite 2 doses of epinephrine. The following are the major neonatal resuscitation changes in the 2005 guidelines: • Supplementary oxygen is recommended whenever positive-pressure ventilation is indicated for resuscitation; free-flow oxygen should be administered to infants who are breathing but have central cyanosis. Although the standard approach to resuscitation is to use 100% oxygen, it is reasonable to begin resuscitation with an oxygen concentration of less than 100% or to start with no supplementary oxygen (ie, start with room air). If the clinician begins resuscitation with room air, it is recommended that supplementary oxygen be available to use if there is no appreciable improvement within 90 seconds after birth. In situations where supplementary oxygen is not readily available, positive-pressure ventilation should be administered with room air. • Current recommendations no longer advise routine intrapartum oropharyngeal and nasopharyngeal suctioning for infants born to mothers with meconium staining of amniotic fluid. Endotracheal suctioning for infants who are not vigorous should be performed immediately after birth. • A self-inflating bag, a flow-inflating bag, or a T-piece (a valved mechanical device designed to regulate pressure and limit flow) can be used to ventilate a newborn. • An increase in heart rate is the primary sign of improved ventilation during resuscitation. Exhaled CO2 detection is the recommended primary technique to confirm correct endotracheal tube placement when a prompt increase in heart rate does not occur after intubation. • The recommended intravenous (IV) epinephrine dose is 0.01 to 0.03 mg/kg per dose. Higher IV doses are not recommended, and IV administration is the preferred route. Although access is being obtained, administration of a higher dose (up to 0.1 mg/kg) through the endotracheal tube may be considered. • It is possible to identify conditions associated with high mortality and poor outcome in which withholding resuscitative efforts may be considered reasonable, particularly when there has been the opportunity for parental agreement. The following guidelines must be interpreted according to current regional outcomes: • When gestation, birth weight, or congenital anomalies are associated with almost certain early death and when unacceptably high morbidity is likely among the rare survivors, resuscitation is not indicated. Examples are provided in the guidelines. • In conditions associated with a high rate of survival and acceptable morbidity, resuscitation is nearly always indicated. • In conditions associated with uncertain prognosis in which survival is borderline, the morbidity rate is relatively high, and the anticipated burden to the child is high, parental desires concerning initiation of resuscitation should be supported. • Infants without signs of life (no heartbeat and no respiratory effort) after 10 minutes of resuscitation show either a high mortality rate or severe neurodevelopmental disability. After 10 minutes of continuous and adequate resuscitative efforts, discontinuation of resuscitation may be justified if there are no signs of life.

AB - This publication presents the 2005 American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) of the pediatric patient and the 2005 American Academy of Pediatrics/AHA guidelines for CPR and ECC of the neonate. The guidelines are based on the evidence evaluation from the 2005 International Consensus Conference on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations, hosted by the American Heart Association in Dallas, Texas, January 23-30, 2005. The "2005 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" contain recommendations designed to improve survival from sudden cardiac arrest and acute life-threatening cardiopulmonary problems. The evidence evaluation process that was the basis for these guidelines was accomplished in collaboration with the International Liaison Committee on Resuscitation (ILCOR). The ILCOR process is described in more detail in the "International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations." The recommendations in the "2005 AHA Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" confirm the safety and effectiveness of many approaches, acknowledge that other approaches may not be optimal, and recommend new treatments that have undergone evidence evaluation. These new recommendations do not imply that care involving the use of earlier guidelines is unsafe. In addition, it is important to note that these guidelines will not apply to all rescuers and all victims in all situations. The leader of a resuscitation attempt may need to adapt application of the guidelines to unique circumstances. The following are the major pediatric advanced life support changes in the 2005 guidelines: • There is further caution about the use of endotracheal tubes. Laryngeal mask airways are acceptable when used by experienced providers. • Cuffed endotracheal tubes may be used in infants (except newborns) and children in in-hospital settings provided that cuff inflation pressure is kept 2O. • Confirmation of tube placement requires clinical assessment and assessment of exhaled carbon dioxide (CO2); esophageal detector devices may be considered for use in children weighing >20 kg who have a perfusing rhythm. Correct placement must be verified when the tube is inserted, during transport, and whenever the patient is moved. • During CPR with an advanced airway in place, rescuers will no longer perform "cycles" of CPR. Instead, the rescuer performing chest compressions will perform them continuously at a rate of 100/minute without pauses for ventilation. The rescuer providing ventilation will deliver 8 to 10 breaths per minute (1 breath approximately every 6-8 seconds). • Timing of 1 shock, CPR, and drug administration during pulseless arrest has changed and now is identical to that for advanced cardiac life support. • Routine use of high-dose epinephrine is not recommended. • Lidocaine is de-emphasized, but it can be used for treatment of ventricular fibrillation/pulseless ventricular tachycardia if amiodarone is not available. • Induced hypothermia (32-34°C for 12-24 hours) may be considered if the child remains comatose after resuscitation. • Indications for the use of inodilators are mentioned in the postresuscitation section. • Termination of resuscitative efforts is discussed. It is noted that intact survival has been reported following prolonged resuscitation and absence of spontaneous circulation despite 2 doses of epinephrine. The following are the major neonatal resuscitation changes in the 2005 guidelines: • Supplementary oxygen is recommended whenever positive-pressure ventilation is indicated for resuscitation; free-flow oxygen should be administered to infants who are breathing but have central cyanosis. Although the standard approach to resuscitation is to use 100% oxygen, it is reasonable to begin resuscitation with an oxygen concentration of less than 100% or to start with no supplementary oxygen (ie, start with room air). If the clinician begins resuscitation with room air, it is recommended that supplementary oxygen be available to use if there is no appreciable improvement within 90 seconds after birth. In situations where supplementary oxygen is not readily available, positive-pressure ventilation should be administered with room air. • Current recommendations no longer advise routine intrapartum oropharyngeal and nasopharyngeal suctioning for infants born to mothers with meconium staining of amniotic fluid. Endotracheal suctioning for infants who are not vigorous should be performed immediately after birth. • A self-inflating bag, a flow-inflating bag, or a T-piece (a valved mechanical device designed to regulate pressure and limit flow) can be used to ventilate a newborn. • An increase in heart rate is the primary sign of improved ventilation during resuscitation. Exhaled CO2 detection is the recommended primary technique to confirm correct endotracheal tube placement when a prompt increase in heart rate does not occur after intubation. • The recommended intravenous (IV) epinephrine dose is 0.01 to 0.03 mg/kg per dose. Higher IV doses are not recommended, and IV administration is the preferred route. Although access is being obtained, administration of a higher dose (up to 0.1 mg/kg) through the endotracheal tube may be considered. • It is possible to identify conditions associated with high mortality and poor outcome in which withholding resuscitative efforts may be considered reasonable, particularly when there has been the opportunity for parental agreement. The following guidelines must be interpreted according to current regional outcomes: • When gestation, birth weight, or congenital anomalies are associated with almost certain early death and when unacceptably high morbidity is likely among the rare survivors, resuscitation is not indicated. Examples are provided in the guidelines. • In conditions associated with a high rate of survival and acceptable morbidity, resuscitation is nearly always indicated. • In conditions associated with uncertain prognosis in which survival is borderline, the morbidity rate is relatively high, and the anticipated burden to the child is high, parental desires concerning initiation of resuscitation should be supported. • Infants without signs of life (no heartbeat and no respiratory effort) after 10 minutes of resuscitation show either a high mortality rate or severe neurodevelopmental disability. After 10 minutes of continuous and adequate resuscitative efforts, discontinuation of resuscitation may be justified if there are no signs of life.

KW - Neonatal resuscitation

KW - Pediatric advanced life support (PALS)

KW - Resuscitation

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