2010년 AHA 심폐소생술 가이드라인 설명회 Pediatric BLS 순천향대학교 서울병원 응급의학과 장혜영

Pediatric Chain of survival PBLS Prevention Early CPR Prompt access to EMS Rapid PALS Integrated post-CA care

Simplify training ABC or CAB? in PBLS ABC CAB Incidence) Asphyxial CA ≫ VF CA ( in infants and children) Ventilations are extremely important in ped resuscitation. ABC CAB makes a difference? Simplify training

C-A-B in pediatric resuscitation 2005 Guideline 2010 Guideline 심폐소생술 시행 순서는 A-B-C 먼저 기도를 개방하고 인공호흡을 2회 시행 후 흉부 압박 C-A-B 2회 인공호흡을 하기 전에 먼저 흉부압박 심폐소생술을 시행. 1인 구조자 30회, 2인 구조자 15회의 흉부 압박으로 심폐소생술 시작 기도 개방 후 “호흡 상태 확인” 과정 생략

PBLS Sequence for Lay Rescuers Safety of Rescuer and Victim Assess Need for CPR Check for Response Check for Breathing Start Chest Compressions Open the Airway and Give Ventilations Coordinate Chest Compressions and Breathing Activate Emergency Response System

High quality CPR in PBLS Push fast : at least 100 compressions / min Push hard : at least 1/3 depth of AP diameter of the chest 1.5 inches (4cm) in infants 2 inches (5cm) in children Allow complete chest recoil Minimize interruptions of chest compressions Avoid excessive ventilation

Chest compression depth in children Pediatrics. 2009;124:e69-74 : 280 consecutive CT reconstruction, < 8 yrs

Chest compression depth in children Pediatrics. 2009;124:e69-74 # Residual internal depth < 10 mm ; potential to injure the intrathoracic structures and may actually not be achievable

Chest compression depth in children Pediatrics. 2009;124:e69-74 - 1/2 compression : residual space < 10 mm: 94%, 너무 깊다 - 1/3: compression: 0.5%

2010 가이드라인 Chest compression depth in children 2005 가이드라인 흉부 전후 직경의 1/3~1/2 깊이로 흉부 압박 최소 1/3 깊이로 흉부 압박 이 깊이는 영아에서 4cm, 소아에서 5cm에 해당

Pediatric BLS Algorithm

Chest compression for infants 1 rescuer : Two finger tech 2 rescuers : Two thumb-encircling tech

Two thumb-encircling technique No data show benefit from a circumferential squeeze Higher CPP than the 2-finger technique If you cannot physically encircle the victim’s chest, compress the chest with 2 fingers.

Defibrillation in pediatric BLS For infants a manual defibrillator is preferred when a shockable rhythm is identified by a trained healthcare provider (Class IIb, LOE C). If a manual defibrillator is not available, an AED equipped with a pediatric attenuator is preferred for infants. If neither is available, an AED without a dose attenuator may be used (Class IIb, LOE C). AEDs that deliver relatively high energy doses have been successfully used in infants with minimal myocardial damage and good neurological outcomes.

2010 가이드라인 AED use in infants 2005 가이드라인 1세 미만 영아의 경우 제세동기 사용 적합/부적합을 권고하기에는 데이터가 충분하지 않다. 영아에서 수동 제세동기 사용을 권장하지만, 불가능할 경우 아동용 충격량 감쇄 시스템을 부착한 AED 사용이 권장된다. 둘 중 어느 것도 사용할 수 없는 경우, 충격량 감쇄기가 없는 AED를 사용할 수 있다. - 영아에서 AED 사용이 안전하고 효과적이었다는 증례보고가 있다. (사용의 안전성을 지지하는 근거는 아직 제한적이다)

Hands-Only CPR in PBLS Optimal CPR in infants and children includes both compressions and ventilations, but compressions alone are preferable to no CPR (Class 1 LOE B).

Hands-Only CPR in PBLS Lancet. 2010; 17: 1347-54 5,170 children, < 17 yrs 3,675 (71%) non-cardiac causes, 1,551 (30%) cardiac arrests

Lancet. 2010; 17: 1347-54 For children who have out-of-hospital cardiac arrests from non-cardiac causes, conventional CPR (with rescue breathing) by bystander is the preferable approach to resuscitation. For arrests of cardiac causes, either conventional or compression-only CPR is similarly effective.

Avoid excessive ventilation Excessive ventilation is harmful because it Increases intrathoracic pressure and impedes venous return and therefore decreases cardiac output, cerebral blood flow, and coronary perfusion. Causes air trapping and barotrauma in patients with small airway obstruction. Increases the risk of regurgitation and aspiration in patients without an advanced airway.

Other CPR Techniques and Adjuncts Insufficient data in infants and children to recommend for or against the use of the following: Mechanical devices to compress the chest Active compression-decompression CPR Interposed abdominal compression CPR (IAC-CPR) The impedance threshold device pressure sensor accelerometer (feedback) devices.

Foreign-Body Airway Obstruction No change 5 back blows + 5 chest compressions for infants Abdominal thrusts for children

Special Resuscitation Situations

BLS for injured child (X) (O) (O) Neutral Position

Thank you.