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  • Chest compressions are started once signs of circulatory arrest are identified.

  
  
  
  
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    • For the layperson, these include absence of breathing, coughing, and movement.

    
    

    • In addition, for the healthcare worker, lack of an identifiable pulse is a sign of circulatory arrest.

  
  

  • Chest compressions are started in infants and children if their heart rate is less than 60 beats per minute with signs of poor perfusion; the main mechanism for increasing cardiac output is by increasing heart rate.

  
  

  • The combination of bradycardia and poor perfusion is a sign of imminent cardiac arrest.

Absolute

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  • None. However, compressions should be started with caution if the patient has a known period of prolonged asystole.

  
  

  • Do-not-resuscitate orders are respected in patients with prior orders.

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  • No equipment is necessary when patient is on a firm, flat surface.

  
  

  • A resuscitation board is used when hospitalized patients are in a soft bed.

  
  
  
  
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    • It is placed underneath the patient for effective compressions.

    
    

    • The board extends from the shoulders to the waist and across the width of the bed.

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  • Multiple studies have shown significant complications during resuscitation of adults.

  
  

  • However, cardiopulmonary resuscitation of children results in significant injuries only about 3% of the time.

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  • Cardiac arrest in pediatric patients is most commonly due to respiratory failure. The rescuer attempts to correct any obvious respiratory compromise.

  
  

  • Infants with no signs of head or neck trauma may be carried on the rescuer’s forearm during resuscitation, which allows the lone rescuer to continue resuscitation while seeking help.

  
  

  • Compressions are coordinated with ventilation in an unintubated patient.

  
  
  
  
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    • Once the patient has been intubated, it is no longer necessary to coordinate compressions and ventilations.

    
    

    • However, coordinating compressions and ventilations is suggested in newborns because it may facilitate adequate ventilation.

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  • The patient is placed supine on a firm flat surface.

  
  

  • If the patient is in bed, then a resuscitation board is placed underneath him or her.

  
  

  • Any bulky clothing that will interfere with compressions or assessment is removed or opened up.

  
  

  • The head and neck are placed in a neutral position.

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  • The heart lies centrally in the chest between the lower part of the sternum and the thoracic spine.

  
  

  • Effective compressions squeeze the heart between the sternum and spine to eject blood; for this reason, hand placement is over the lower portion of the sternum.

  
  

  • The central pulse is located by palpating the brachial, femoral, or carotid arteries (Figure 6–1).

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    • The preferred location for checking the pulse depends on the patient’s age as well as the number and skill of the rescuers.

    
    

    • In infants, the brachial pulse is preferred but the femoral pulse can be used alternatively.

    
    

    • In older children and adults, the carotid pulse is preferred but a second or third rescuer may be better able to use the femoral pulse to monitor compressions.

    
    

    • The brachial artery is palpated just above the elbow, medial to the biceps (see Figure 6–1A).

    
    

    • The femoral artery is palpated just below the inguinal ligament half-way between the anterior superior iliac spine and the pubic tubercle (see Figure 6–1B).

    
    

    • The carotid artery is palpated just medial to the sternocleidomastoid muscle (between the muscle and the trachea) (see Figure 6–1C).