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Current Guidelines For Pediatric Advanced Life Support: The 2010 AHA Guidelines

April 2011

In this issue of EM Practice Guidelines Update, The 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care are reviewed, with the focus on recommendations for pediatric resuscitation, interpreted as they apply to emergency medicine.

Practice Guideline Impact

  • In pediatric cardiac arrest, chest compressions are stressed over ventilations, demonstrated with the mnemonic of CAB (compressions, airway, breathing) with at least 100 high-quality chest compressions provided per minute. However, evidence does show that optimal cardiopulmonary resuscitation (CPR) in infants and children includes both compressions and ventilations.
  • A laryngeal mask airway (LMA) is an acceptable alternative when bag-mask ventilation is not adequate and endotracheal intubation is impossible. Care should be taken with LMA use in younger children, as the rate of complication is higher than in older children and adults.
  • Intraosseous (IO) access should be used as a rapid, safe, and effective route for vascular access and administration of all intravenous (IV) medications during pediatric cardiac arrest.
  • Administration of calcium and sodium bicarbonate are to be considered only in specific situations (documented hypocalcemia, calcium-channel blocker overdose, hyperkalemia or hypermagnesemia for calcium administration, and hyperkalemic cardiac arrest or certain toxidromes for sodium bicarbonate administration).
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