The guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care for pediatric and neonatal patients contains recommendations designed to improve survival from sudden cardiac arrest and acute life-threatening cardiopulmonary problems. They have recently been revised, but this does not imply that the use of earlier guidelines is outdated. It is important that pediatric caregivers be familiar with these guidelines and the changes. In particular, the guidelines continue to emphasize that cardiac arrest in children is most often the end result of respiratory arrest. Thus a lone rescuer for an unresponsive child should begin with 30 compressions and two breaths, then activate the emergency medical services system. This approach is thought to optimize the chances for quick resuscitation of children with primary respiratory arrest, before complete cardiopulmonary arrest occurs. Two-rescuer CPR in children is the only situation that deviates from the 30:2 ratio recommended for compressions and breaths; for two-rescuer CPR in children, two breaths should be given after every 15 compressions. Otherwise, CPR recommendations for children closely parallel those for adults where basic life support should always be remembered as an “ABCD” approach to cardiopulmonary arrest: airway, breathing, circulation, defibrillation. Guidelines for advanced life support for children also are similar to those for adults, with a few notable exceptions: vasopressin and atropine not recommended for pulseless electrical activity; defibrillation should be dosed on weight (4 joules per kg); and the use of intraosseous (IO) access is permissible if intravenous (IV) access is not established quickly.

Changes in the guidelines include caution about use of endotracheal tubes. Confirmation of tube placement requires exhaled carbon dioxide detection and is recommended especially when a prompt increase in heart rate does not occur after intubation. Furthermore, all rescue breaths given over 1 second with sufficient volume need to produce a visible chest rise. Lastly, correct placement must be verified when the tube is inserted, during transport, and whenever the patient is moved. With an advanced airway in place,
CPR is not done in cycles but rather chest compressions are performed continuously at a rate of 100 per minute without pauses for ventilation, which should be 8 to 10 breaths per minute. Remember an increase in heart rate is the primary sign of improved ventilation during resuscitation.