With focus and determination, the nurse worked over her little patient, alternating two rescue breaths and 30 chest compressions to pump life back into the young victim. The setting was a pediatric office, and the patient, a plastic CPR torso with inflatable lungs, pulled through with flying colors. So did the successful nurse, who was brushing up on her basic life-support skills while participating in the office's annual healthcare workers CPR re-certification class.
The American Academy of Pediatrics notes that CPR training is vital, as rapid initiation of bystander CPR can improve survival rates in both adults and children following cardiac arrest. In certain cases, emergency use of CPR skills can also help prevent common respiratory emergencies from progressing to full cardiac arrest.
Training in CPR - cardiopulmonary resuscitation - encompasses resuscitation of adults, children and infants, and covers both cardiac and respiratory emergencies. As primary caregivers, parents are actively encouraged to take local CPR classes. Even children as young as the sixth-grade level have been shown to be capable of successful CPR certification. Training before an emergency happens allows non-medical laypersons to become both familiar with and comfortable performing lifesaving skills that can safeguard children and relatives, as well as friends and passing strangers.
In 2008, the American Heart Association recommended that untrained bystanders witnessing an adult out-of-hospital sudden cardiac arrest first call emergency medical services (9-1-1) and then perform hands-only CPR. This compression-only CPR differs from conventional CPR in that it does not involve any rescue breathing. The emphasis here is on "hard and fast" chest compressions delivered to the middle of an adult victim's chest, with minimal interruptions. CPR-trained laypersons can still use conventional CPR if they feel confident they can still provide fast, high-quality chest compressions to the adult victim.
The newer hands-only CPR recommendation does not apply when the victim is an infant or child. The rationale behind this difference in AHA pediatric/adult CPR recommendations is that pediatric cardiac arrest typically follows respiratory failure and/or circulatory collapse due to blood loss. Pediatric arrest is rarely due to primary cardiac events, such as those commonly experienced by adults with coronary artery disease.
The AHA stresses that rescue breathing should continue to be performed along with chest compressions when the victim is an infant or child, and in both pediatric and adult cases of unwitnessed cardiac arrest, or in any cardiac arrest thought to be of "non-cardiac origin." The association states that rescue breathing is a necessary and "critical component" of CPR when cardiac arrest follows respiratory emergencies such as near-drowning, trauma, airway obstruction, acute respiratory disease, apnea, drug overdose and prolonged cardiac arrest, as well as in any case of pediatric arrest.
• Dr. Helen Minciotti is a mother of five and a pediatrician with a practice in Schaumburg. She formerly chaired the Department of Pediatrics at Northwest Community Hospital in Arlington Heights.