CPR in children a last resort, prevention is key
Cardiac arrest is a dreaded complication of any injury or illness. In children, cardiac arrest is often secondary to respiratory failure and shock, unlike in adults where it is usually sudden and due to a problem in the heart. The majority of children do not survive cardiac arrest, or survive with significant complications. The survival rates vary between 14 and 43 per cent. Therefore, identifying children with these problems early and where possible preventing them all together is essential to increase the survival and recovery of our children from injuries and illnesses. Prevention of cardiac arrest in children is paramount.
In the United States of America, over 60 per cent of deaths in children and adolescents are due to injury-related causes. The leading cause of death related to injuries is motor vehicle crashes, which take the lives of children who are either occupants or other road users, especially pedestrians. Other significant injuries leading to death are drowning and suffocation. Suffocation in this context includes aspiration or obstruction of the airway by a food bolus, vomitus or a foreign body. It also includes suffocation or strangulation due to bed linen, mother’s body, pillows and plastic bags. These injuries are mostly preventable.
So, what can you as an individual do to prevent cardiac arrest in children? Practise and promote injury prevention in your daily life and activities. Here are a few suggestions:
Teach children by example how to use the road safely. This includes using the pedestrian crossing when crossing the road, obeying the traffic lights, using a car seat for infant and children, wearing a seat belt in a moving vehicle, helmets when cycling and no playing on the road.
Do not leave infants and children unattended in or near any body of water. This includes bathtubs, washbasins, pools, beach, river.
Fence around pool and limit access to water hazards, e.g., wells.
Teach children older than five years how to swim.
No one should ever swim alone.
Choking is a leading cause of death in infants and children, with three-year-olds and younger being at greatest risk. The most common items children choke on are food and latex balloons.
If a toy is small enough to fit in a tissue roll or has parts which can, it is a potential hazard and should not be given to young children.
Children tend to choke on food which are small, round or cylindrical like hard candy, peanuts, guineps, grapes and hard vegetables like carrot sticks. These foods must be avoided in young children or cut into bite sizes or prepared in a safe way, like grating carrots, cutting grapes and hot dogs lengthwise.
Teach children not to put non-food items in their mouth, e.g., coin, hair beads, button batteries, marbles, toys, and place them out of their reach.
Keep plastic bags out the their reach, they may put them over their heads;
Parents should avoid sleep in the same bed with infants.
Keep chemical out of the reach of children.
Do not store chemicals in drink bottles, e.g., bleach and kerosene oil.
Keep medications out of the reach of children.
Do not tell children medications are candy or ‘sweetie’ to get them to take it. They will take it when not needed.
Although injury prevention is key, if you are in a setting where a child appears unresponsive, cardiopulmonary resuscitation (CPR) may save his or her life. You need to know what to do until help arrives. Everyone should learn CPR. Life is why! The life you save may be that of someone dearest to you or a stranger.
How to preform CPR in children one year and older? American Heart Association guidelines.
If a child appears unresponsive, the following steps should be performed quickly.
Ensure that the scene is safe before proceeding.
Tap on the child’s shoulder and ask, “Are you okay?” to check if he or she is responsive.
If the child is unresponsive, shout out for help or call for help using a mobile device if possible.
Next, kneel beside the child and check if he or she is breathing and has a pulse.
Check for breathing by looking for the child’s chest moving up and down.
Check for the carotid pulse. The carotid artery runs long either side of the trachea (windpipe).
Run you finger along the windpipe, about halfway down, gently press in the groove between the windpipe and muscles with two fingers on the side of the child’s neck which is closest to you. You should feel the pulse if it is present. If you do not feel a pulse within 10 seconds, start CPR with chest compressions.
If the child is breathing normally and has a pulse, stay with the child and observe until help arrives.
If the child is not breathing or only gasping but has a pulse, provide rescue breathing if it is safe to do so. Using a barrier device like a pocket mask to deliver the rescue breaths is recommended, as without one you will come in contact with the child’s body fluids and put yourself at risk for infection. Many cardiac arrests in children occur at home and in other environments where barrier devices are not available. Family or friends may be present. Being aware of the possible risks, you may choose to provide mouth-to-mouth breathing for your child/family member, which is an effective technique for supplying oxygen to the child.
If the child is not breathing or only gasping and has no pulse, this child is in cardiac arrest.
If you witnessed this and are alone, leave the child to get help or use your phone to call 119/ambulance service/emergency contact of child for help, if you have not already done so. Get the automated external defibrillator (AED), which is a device which provides an electric current to restart the heart if needed, if one is available. Then commence high-quality cardiopulmonary resuscitation (CPR) starting with chest compression.
If you are alone and did not witness the arrest, start with two minutes of CPR before getting help or the AED.
HOW TO GIVE RESCUE BREATHS
Open the child’s airway by pressing firmly with one hand on the child’s forehead and tilting his or her head back while lifting the child’s chin with your other hand (head tilt-chin lift).
Pinch the child’s nose closed with your thumb and index finger.
Take a normal breath, then place your mouth over the child’s mouth and create an airtight seal.
Blow into the child’s mouth over one second. Do not blow fast and hard! Look for the chest moving up as a breath has been delivered. If the chest does not rise, repeat the head tilt-chin lift and give a second breath. You may need to reposition the child’s head to open up the airway.
A breath should be given every three to five seconds until the child’s breathing improves. If the pulse disappears or the heart rate is less than 60 beats per minute start CPR. A pulse check should be done every two minutes.
HOW TO PERFORM HIGH-QUALITY CPR
Chest compression is the foundation of CPR. Chest compressions squeeze the heart between the sternum (breastbone) and spine, thereby pumping blood out of the heart to the rest of the body, especially the brain. Chest compressions can be delivered using one or both hands, depending on the size of the child. The two-hand technique is used for most children and adults.
Prevention of cardiac arrest is the most important step in basic life support in children as the survival rate post-cardiac arrest is low. Get involved, become a champion for injury prevention in your homes and communities.
This will have a great impact on the lives for our nation’s children. All are encouraged to learn CPR, especially if you interact or work with children on a regular basis. This type of emergency response training and certification can be arranged with the Heart Foundation, 28 Beechwood Avenue, as well as at other locations across the island.
Dr Mara Hosang is consultant paediatrician, Bustamante Hospital for Children, advanced emergency training instructor, Heart Foundation of Jamaica.