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Does the initial approach to childhood resuscitation differ from that for adults?
Historically, the initial approach to adult resuscitation is similar to that for children: A (airway), B (breathing), C (circulation/compression), D (drugs), E (exposure). Attention to proper positioning, oxygenation, and ventilation comes first, and drug therapy comes last. However, in recent years, there has been strong interest in initiating chest compressions earlier, as each minute of delay may result in a 10% decreased chance of survival. The C (compression) A (airway) B (breathing) sequence is generally accepted, especially for adult patients. Because the majority of pediatric arrests are primarily respiratory in nature, adoption of CAB(DE) over ABC(DE) for pediatric patients is not widespread, despite one study showing a statistically significant 24-second advantage to chest compressions in CAB in simulated pediatric cardiac arrests.
Whether one does ABC or CAB, it is always advisable to preassign resuscitation duties to available staff. This preparation eliminates confusion during the heat of the action. Care should always be taken to protect the cervical spine (and spinal cord) during resuscitation, especially during manipulation of the neck and jaw. Some authors suggest that nearly simultaneous initiation of airway alignment and compressions may be the appropriate compromise for pediatric resuscitation.
Sources
Lubrano R, Cecchetti C, Bellelli E, et al: Comparison of times of intervention during pediatric CPR maneuvers using ABC and CAB sequences: A randomized trial. Resuscitation 2012;83(12):1473-1477. Epub 2012 May 8.
