Practice ABC of Resuscitation, 6th Edition

Paediatric Resuscitation

BMJ 2014; 348 doi: (Published 08 April 2014) Cite this as: BMJ 2014;348:bmj.g1732
  1. Ian K. Maconochie1,
  2. Robert Bingham2
  1. St. Mary's Hospital London, UK
  2. Great Ormond Street Children's Hospital London, UK

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  • Early detection and treatment of the deteriorating child can prevent cardiac arrest

  • High-quality chest compressions with ventilations are important to improve outcomes

  • Once CPR has started, minimise interruptions in chest compressions for other interventions such as defibrillation and tracheal intubation


Paediatric cardiorespiratory arrest is often caused by hypoxia, as the body has limited compensatory mechanisms to deal with severe illness or injury. Ventricular fibrillation or pulseless ventricular tachycardia is uncommon in children compared to adults, as primary heart disease occurs infrequently. Pronounced hypoxia arising from progressive illness (or the effects of injury) causes myocardial dysfunction, leading to profound bradycardia, which can degenerate to asystole or pulseless electrical activity (PEA). Other vital organs also suffer from severe hypoxia. Both asystole and PEA have poor outcomes.

The body's initial response is to adapt by altering respiratory or circulatory parameters, depending on the underlying condition, for example respiratory disease such as asthma will lead to changes in respiratory parameters which may lead in turn to changes in the circulation. If the body is unable to deal with the illness/injury, the compensatory changes may not be sustainable, leading to decompensated respiratory and/or circulatory failure (Figure 1).

Figure 1 

The sequence of events in the seriously ill/injured child who deteriorates over time (with permission from Resuscitation Council UK).

These may combine as the body's physiological responses further decline, leading to cardiorespiratory failure and, if unchecked, cardiorespiratory arrest.

Morbidity and mortality remain high if cardiorespiratory arrest occurs, as the profound hypoxia leads to multi-organ failure in many cases. …

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