Special Resuscitation Situations

Background Children who require basic life support (BLS) and advanced life support (ALS) interventions account for 5% to 10% of all ambulance runs and approximately one quarter of emergency department visits in the United States. The principles, equipment, and drugs used for pediatric BLS and ALS are similar to those used for adults. However, the care of seriously ill or injured children requires specific knowledge of pediatric anatomy, physiology, and psychology plus practical pediatric expertise. ### Key Interventions to Prevent Arrest In infants and children, respiratory distress and failure is a much more common cardiac arrest etiology than sudden dysrhythmia or ventricular fibrillation. As a result, hypoxia, hypercarbia, and global ischemia often precede cardiac arrest. Critical organ perfusion is dependent on more rapid heart and respiratory rates than for adults. Therefore, additional attention is focused on early recognition and intervention for respiratory failure and shock, and less emphasis is placed on rapid early defibrillation than for adult cardiac arrest victims. ### BLS and ALS Interventions During Arrest Commentary on the specific application of BLS and ALS principles to pediatric patients is contained in the accompanying ILCOR pediatric advisory statements. 1. Tsai A, Kallsen G. Epidemiology of pediatric prehospital care. Ann Emerg Med . 1987;16:284-292. 2. Cummins RO, ed. Textbook of Advanced Cardiac Life Support. Dallas, Tex: American Heart Association; 1994:60-68. 3. Zaritsky A, Nadkarni V, Getson P, Kuehl K. CPR in children. Ann Emerg Med . 1987;16:1107-1111. ### Background Cardiac arrest due to electrolyte abnormalities is uncommon except in the case of hyperkalemia. Electrolyte concentrations change during cardiac arrest due to the rapidly changing acid-base status, catecholamine levels, and hypoxia. These changes do not require intervention unless the cardiac arrest is primarily caused by the electrolyte abnormality. ### Key Interventions to Prevent Arrest