Child Basic Life Support

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Child Basic Life Support (BLS) is a critical skill set for healthcare professionals, enabling them to provide immediate care in the event of cardiac arrest or other life-threatening emergencies in children. The following guide covers the essential components of child BLS, following the latest guidelines from the American Heart Association (AHA).

Paediatric Chain of Survival

The Paediatric Chain of Survival consists of five critical steps:

  1. Prevention of Arrest: Recognise and manage early signs of respiratory distress and shock.
  2. Early CPR: Provide high-quality CPR immediately to support circulation and oxygenation.
  3. Activation of Emergency Response: Call for help early to bring advanced care.
  4. Effective Advanced Life Support: Provide advanced interventions when available.
  5. Integrated Post-Cardiac Arrest Care: Ensure comprehensive care following resuscitation.

High-Quality CPR for Children

1. Initial Assessment:

  • Ensure scene safety.
  • Check for responsiveness by tapping and shouting.
  • If unresponsive, shout for help and activate the emergency response system. If alone, call emergency services before starting CPR if the child is not breathing or only gasping.

2. Assess Breathing and Pulse:

  • Check for normal breathing and a pulse (carotid or femoral artery) for no more than 10 seconds.
  • If the child is not breathing normally but has a pulse, provide rescue breaths at a rate of 1 breath every 2-3 seconds (20-30 breaths per minute).

3. Chest Compressions:

  • If there is no pulse or if the pulse is less than 60 beats per minute with signs of poor perfusion, begin chest compressions.
  • Place the heel of one hand (or two hands if needed for larger children) on the lower half of the sternum.
  • Compress the chest at least one-third the depth of the chest, approximately 2 inches (5 cm).
  • Provide compressions at a rate of 100-120 per minute.
  • Allow complete chest recoil after each compression.

4. Rescue Breaths:

  • After 30 compressions, give 2 breaths (use a barrier device or bag-mask if available).
  • Each breath should last about 1 second, making the chest rise visibly.
  • Minimize interruptions in chest compressions to less than 10 seconds.

5. Continue CPR:

  • Continue the cycle of 30 compressions and 2 breaths until help arrives or the child shows signs of life.

Using an AED in Children

  1. Turn on the AED: Follow the voice prompts.
  2. Attach the Pads:
    • Use paediatric pads if available. If not, use adult pads but ensure they do not touch each other.
    • Place one pad on the center of the child’s chest and the other on the back (anteroposterior placement) for smaller children, or follow the AED’s instructions for larger children.
  3. Analyze the Rhythm: Ensure no one is touching the child during analysis.
  4. Deliver a Shock if Advised: Ensure no one is touching the child, then press the shock button.
  5. Resume CPR Immediately: After the shock, resume CPR starting with chest compressions. Continue following the AED prompts.

Team Dynamics and Communication

  • Clear Roles: Assign specific roles such as airway management, chest compressions, and AED operation.
  • Closed-Loop Communication: Ensure instructions are acknowledged and confirmed.
  • Frequent Switching: Rotate roles every 2 minutes to prevent fatigue and maintain high-quality compressions.
  • Leadership: One team member should take the lead, ensuring coordination and efficient action.

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