Approximately 50-65% of reanimation needy children younger than 1 year, most of them even younger than 6 months. This number increases significantly once the birth weight below 1500 g. About 6% of newborns must be resuscitated immediately after birth (neonatal resuscitation).
Despite the use of cardiopulmonary resuscitation, the mortality rate of cardiac arrest is (cardiac arrest) in infants and children from 80 to 97%. At its sole apnea mortality is nearly 25%. The neurological outcome of these young patients is often highly deficient. Approximately 50-65% of reanimation needy children younger than 1 year, most of them even younger than 6 months. This number increases significantly once the birth weight below 1500 g. About 6% of newborns must be resuscitated immediately after birth (neonatal resuscitation). In order to reproduce and display the output of children’s resuscitation, standardized guidelines should be followed, such as the modified “Pittsburgh outcome Categories Scale” that both the cerebral and the entire other performance of the child maps (s. Pediatric scale cerebral functions *) , Pediatric Scale cerebral functions * Match Category Description 1 Normal Age-appropriate level of functioning For preschoolers: appropriate development For school children: attend regular classes 2 Slight disability Can age-appropriate interact Easier neurological disorder that is treated and does not affect the daily life (such as seizure disorders. ) For preschoolers: possibly minor developmental delays, but> 75% of all general developmental milestones are above the 10th percentile For school children: attending regular school, but in a class that is not appropriate for the age, with school problems Moderate because of cognitive difficulties 3 disability Below-average performance Neurological disease is not controlled, and the daily limits in children of preschool age: the most general developmental milestones are below the 10th percentile for school children: cope with activities of daily living, but need for cognitive difficulties or learning disabilities attend conveyors 4 Serious Behin alteration For preschoolers: General developmental milestones are below the 10th percentile with a strong need in daily life For school children: possibly a serious impairment that makes a normal school unmöglch and must seek help for coping with everyday life in claim For children preschool and school-age children: possibly abnormal motor movements, with aimless movements Dekortikationsreflexen or dezerebraten responses to pain 5 coma or vegetative state ignorance 6 deaths – * The worst performance level is used for each individual criterion for categorization. Deficits are mentioned only when they result from a neurological disorder. The assessment is based on medical records or an interview with the caregiver. From Recommended guidelines for uniform reporting of pediatric advanced life support: The pediatric Utstein style; statement for healthcare professionals of the Task Force of the American Academy of Pediatrics, the American Heart Association and the European Resuscitation Council; Pediatrics 96 (4): 765-779, 1995. Standards and Guidelines for resuscitation of the American Heart Association should be followed (see CPR methods for health workers.). Regulatory after a person has had a collapse of possible cardiac arrest, cardiopulmonary resuscitation (CPR) in adults: Overview and Cardiopulmonary resuscitation (CPR) in adults: bloodstream. and an examination of the heart rhythm (Cardiopulmonary resuscitation (CPR) in adults: monitoring and drug administration): After a CPR is initiated defibrillation (defibrillation Cardiopulmonary resuscitation (CPR) for adults) is made. Major differences in the resuscitation of adults and children is a sign of impending cardiac arrest immediately before cardiac arrest bradycardia in a sick child. Newborns, infants and young children more likely to develop bradycardia as a result of hypoxemia, while older children tend in similar situations rather tachycardias. An infant or small child with a heart rate less than 60 / min and signs manifest perfusion, which do not improve even after support of ventilation, must be resuscitated cardiopulmonary (s. Chest compression). Bradycardia due to cardiac conduction disturbances and block images are rare. Chest Compression A: Here the thumbs are next to each other placed. This method is suitable for compression of the thorax in neonates and infants whose chest can be easily included. For very young children, the thumbs can also be superposed. B: two-finger method for infants. Fingers should it be placed quite steep. In newborns it can in this case occur that one and gets too far inferiorly below the xiphoid. The correct finger position is located just below the Mamilarlinie. C: position of the hand in the chest compression of a child. (Adapted from: American Heart Association, Standards and Guidelines for CPR Journal of the American Medical Association. 268: 2251 to 2281.1992 Copyright 1992, American Medical Association.). After the beginning of an adequate oxygenation and ventilation Epinephrine is the drug of choice (Cardiopulmonary resuscitation (CPR) in adults: drugs of choice). Blood pressure should be determined using appropriate cuff size. The direct-invasive blood pressure detection is imperative in severely compromised children. Since the height of the blood pressure varies depending on age, a memory aid is useful. The lower limit of normal values ??(values ??below the 5th percentile) are obtained in relation to age as follows: below the first month of life 60 mmHg; between 1 month to 1 year 70 mmHg; in children older than 1 year then 70 + 2 x age in years. Thus, it follows that one then speaks of hypotension in a 5 year old child, when the blood pressure below 80 mmHg [70 + 2 × 5] is located. It is significant in this context is that children are capable of long-term due to better compensation mechanisms to maintain the blood pressure at a certain level (by increasing the heart rate, increase in peripheral vascular resistance). However, if finally to hypotension, and the cardiovascular and respiratory arrest follows very quickly. so it must be all reasonable efforts to (increase in heart rate, cold extremities, capillary reperfusion [ “capillary refill”]> 2 seconds hard palpable peripheral pulses) to treat signs of compensatory shock Promptly before it hypotension on admission come kann.Ausrüstung and work environment (equipment) instrument size, medication dosage and the parameters of resuscitation depend very much on the age and weight of young patients from (ss CPR methods for health workers, see table: drugs for fluid replacement therapy * and see table : Guidelines for pediatric resuscitation: mechanical measures). The appropriate in the size of equipment comprises defibrillator paddles or electrode pads, face masks, resuscitators, Guedel airway tubes, laryngoscope, endotracheal tubes and suction catheter. The child’s body weight should be measured and not estimated. Alternatively, commercially available calibrated measuring tapes can be used, with which one can read the standard body weight of a patient based on his height. There are these tapes are also available with the scrolled on recommended medication dosages and equipment sizes for each patient weight. Dosages may be rounded mostly. In a 2½-year-old child should follow the dosage recommendations for 2-year-old. Guidelines for pediatric resuscitation: mechanical measures Age (years) hoop Born Newborn <12 months 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Weight Slower (kg) 3.5 <10 10 12 14 16 18 20 22 25 28 30 35 40 45 50 55 60 Ventilation Rate / min (intubation) rhythm 30-60 20 Insufficient 20 12 8-10 rhythm compression rate / min 120 * 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 100 ratio of compression to ventilation (for unprotected airways) 30: 2 (1 helper) 15: 2 (2 helper) 30: 2 compression techniques thumb compression, hands placed around the chest (preferably) or with 2 fingers 1 Hand 2 hands size of the respiratory tract (Portex) in cm 000 00 00 0 0 7 7 7 7 7 7 7 7 7 8 8 8 8 3.5 5 5 6 6 Masks in Laerdal sizes or equivalent circular 0/1 Rendell-Baker type no. 1 Rendell-Baker type no. 2 dome cuff mask no. 3 dome cuff mask No. 4 Resuscitator with a reservoir for the addition of 100%. Sodium O2 infant: 240 ml child: 400-500 ml adults 1600 ml Laryngoskopspatelgröße Miller 0 Straight blade 1 1 1 2 2 2 2 2 2 2 3 3 3 3 3 3 3 Straight blade (preferred) or curved blade curved or straight blade ETT size (Portex) in mm 3 3.5 4 4.5 4.5 5 5 5.5 5.5 6 6 6 6 6.5 6.5 6.5 6.5 7 uncuffed uncuffed with Manchette Suction direct oropharyngeal By ETT 10 F Pediatric Rachenabsaugung 8 Fr Rachenabsaugung as in adults 10 Fr defibrillation (Joule) Dose (2 Joule / kg) Frequency Maximum dose (4 Joules / kg) 7 10 Pediatric paddle 20 20 30 30 30 50 50 50 50 70 70 70 100 100 200 200 paddle for adults 20 30 Who n is no reaction there is maximum dose × 2 50 50 50 70 70 100 100 100 100 100 150 150 200 200 300 300 cardioversion (Joule) synchronized current pulses (0.5 Joule / kg) 2 3 5 5 7 7 10 10 10 10 10 20 20 20 20 30 30 30 Frequency Maximum dose (1 Joule kg) 5 5 10 10 Slow increase of the dose on repeated experiment to a maximum of 10 20 20 20 20 20 30 30 30 50 50 50 50 70 * Pause for ventilation ETT = Endotrachealt UBus; Fr = French. Courtesy of Dr. B. Paes and Dr. M. Sullivan, the Departments of Pediatrics and Medicine, St. Joseph's Hospital, The Children's Hospital, Hamilton Health Sciences Corporation, McMaster University, Hamilton, Ontario, Canada. Clinical calculator: Endotrachealtubusgrößen for children (age 1 to 8 years of age) infants and young children, the sensitivity to thermal losses due to the large body surface is very strong in relation to body weight and less extensive subcutaneous tissue portion. A neutral ambient temperature during and after resuscitation is considered to be crucial. This may be at 36.5 ° C for newborns and up to 35 ° C for older children. Hypothermia with a core body temperature <35 ° C impeded the success of resuscitation significantly (possible benefits of hypothermia after resuscitation measures after resuscitation: Neurological support) .Atemwege have children compared to adults a different anatomy of the upper respiratory tract. At relatively larger cranium with smaller mandibles and outer face portion the nose openings are comparatively small, the neck is relatively short. Compared with the size of the mouth there is a large tongue and the larynx is clearly cranial created and tilted more forward. It is found quite a long epiglottis. The smallest Trachealdurchmesser is applied below the vocal cords at the level of cricoid. Therefore, only endotracheal tubes without cuff should be used. For smaller children allows the laryngoscope with a straight spatula better visibility of the vocal cords as the curved design. This is due to the more anterior position of the larynx and the larger and schlaffere Epiglottis.Rhythmusstörungen In asystole neither atropine is yet to Pacer be used. Ventricular fibrillation and pulseless ventricular tachycardia are found only in about 15- 20% of cardiac arrests. Vasopressin is not indicated. If a cardioversion is performed, the maximum dose is less than in adults. The pulses can be monophasic or biphasic (s guidelines for pediatric resuscitation. Mechanical measures). For both pulses, the recommended dose of energy is energy 2 Joules / kg for the first pulse, with an increase of 4 joules / kg for subsequent attempts (if necessary, cardiopulmonary resuscitation (CPR) in adults: defibrillation). Automated external defibrillators (AED) with cable connections as in adults can be used in 1-year-old children may already have. However, in children between 1 and 8 years old AEDs are with pediatric cables (maximum biphasic shock of 50 joules) are preferred. There is insufficient evidence for or against the use of AED in children <1 year. (CPR) in adults for placement of the pads, Cardiopulmonary resuscitation: defibrillation.