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Education And Debate

Guidelines for paediatric life support

BMJ 1994; 308 doi: (Published 21 May 1994) Cite this as: BMJ 1994;308:1349

This article has a correction. Please see:

  1. Paediatric Life Support Working Party of the European Resuscitation Council
  1. Correspondence to: Dr D A Zideman, Department of Anaesthetics, Hammersmith Hospital, London W12 0HS. Requests for reprints to: European Resuscitation Council Secretariat, PO Box 13, UIA-Library, B-2610 Antwerp, Belgium.
  • Accepted 11 April 1994

The paediatric life support working party of the European Resuscitation Council was set up in 1992 with the aim of producing guidelines for basic and advanced paediatric resuscitation that would be acceptable throughout Europe. The commonest cause of cardiac arrest in children is problems with the airway. The resulting difficulties in breathing and the associated hypoxia rapidly cause a severe bradycardia or asystole. In contrast, adults have primary cardiac events resulting in ventricular fibrillation. This important difference in the pathogenesis of paediatric and adult cardiac arrest is reflected in these European Resuscitation Council guidelines, which complement those already published for adults.

Reported outcomes of cardiopulmonary resuscitation in infancy and childhood are variable.*RF 1-16* Some of the variability arises from the poor distinction in many reports between a respiratory arrest, which more often has a good outcome,3 5 6 and a cardiac arrest, which has a much worse outcome.2 3 78 A poorer outcome is also seen when arrests occur outside hospital rather than in hospital.45 14 Overall, the outcome from cardiac arrest is worse in children than in adults15 because of the differences in the pathogenesis of cardiac arrest. In adults the commonest cause of cardiac arrest is heart disease but other causes predominate in children.

The commonest underlying cause of cardiac arrest in children is respiratory failure. This may result from lung or airway disease such as croup, bronchiolitis, asthma, or pneumonia, or from injury such as birth asphyxia, inhalation of a foreign body, or pneumothorax. Respiratory depression caused by prolonged convulsions, raised intracranial pressure, neuromuscular problems, or poisoning can also lead to cardiac arrest. The second commonest cause of cardiac arrest is circulatory failure, usually due to loss of fluid or blood or to sepsis. Cardiac arrests of primarily cardiac origin, for …

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