🫀 Chapter 3: Cardiopulmonary Resuscitation C-A-B · High-Quality CPR · AED · Post-ROSC

High-quality CPR (rate 100-120/min, depth 4-5cm) · C-A-B sequence · AED · Choking · Infant CPR · Post-resuscitation S.T.A.B.L.E.

🫀 High-Quality CPR: The Foundation of Resuscitation

⚡ HIGH-QUALITY CPR COMPONENTS: Adequate rate (100-120/min) · Adequate depth (infant 4cm, child 5cm) · Full chest recoil · Minimize interruptions (<10 sec) · Avoid excessive ventilation

🔴 C-A-B Sequence (Single Rescuer)
Compressions first (30:2 for all ages except newborns). Infant: 2-finger technique, depth 4cm. Child: heel of hand, depth 5cm. Rate 100-120/min.

👥 Two-Rescuer CPR
Infant/child: 15:2 ratio. After advanced airway: continuous compressions + 1 breath every 6-8 sec (8-10 breaths/min). Rotate compressor every 2 min.

⚡ AED Application
Apply as soon as available. Shockable rhythms (VF/pVT) → shock + immediate CPR. Non-shockable (PEA/asystole) → CPR + epinephrine.

🫁 Choking (Foreign Body Airway Obstruction)
Conscious: back blows (infant) / abdominal thrusts (child >1yr). Unconscious: CPR + look for object before breaths.

💊 Drugs in Cardiac Arrest
Epinephrine 0.01 mg/kg (0.1 ml/kg of 1:10,000) IV/IO q3-5 min. Amiodarone 5 mg/kg for shockable rhythms refractory to shocks.

🔄 Post-ROSC (Return of Spontaneous Circulation)
Apply S.T.A.B.L.E.: maintain BP, oxygenation (SpO2 94-99%), avoid hyperoxia, targeted temperature management if comatose.

⚕️ S.T.A.B.L.E. Technique — Post-Resuscitation (After ROSC)

Once ROSC is achieved, the S.T.A.B.L.E. mnemonic guides stabilization to prevent re-arrest and optimize neurological outcome.

🩸 S - Sugar (Glucose)

Maintain normoglycemia (80–150 mg/dL).
• Hypoglycemia after arrest worsens brain injury → D10W 2-5 mL/kg IV.
• Hyperglycemia (>180) associated with poor outcomes; treat underlying stress.

🌡️ T - Temperature

Targeted Temperature Management (TTM).
• If comatose post-ROSC, maintain 36-37.5°C (normothermia) or consider 32-36°C for select patients.
• Avoid hyperthermia (>38°C) → antipyretics, cooling devices.

🫁 A - Airway & Breathing

Secure airway, optimize ventilation.
• Confirm ETT position (EtCO2, CXR). Target EtCO2 35-40 mmHg.
• Avoid hyperventilation (cerebral ischemia) and hypoventilation.
• SpO2 94-99% — avoid hyperoxia (increases mortality).

❤️ B - Blood Pressure & Perfusion

Maintain age-appropriate MAP.
• Treat hypotension with fluid boluses (20 mL/kg) and vasoactive infusions (dopamine, epinephrine, norepinephrine).
• Target MAP > 5th percentile for age. ScvO2 >70% indicates adequate delivery.

🧪 L - Lab Work & Diagnostics

Post-arrest labs guide management.
• ABG/VBG: pH, pCO2, pO2, lactate, HCO3.
• Electrolytes, iCal, Mg, Phos, glucose, CBC, coagulation, troponin.
• Consider ECG, echocardiogram, EEG (seizure detection).

💞 E - Emotional Support

Family & team debriefing.
• Communicate clearly with family about prognosis and next steps.
• Debrief the resuscitation team to improve future performance and reduce moral distress.

📌 Post-ROSC Pearl: Avoid hyperoxia (FiO2 1.0 → titrate to SpO2 94-99%). Hyperventilation (low PaCO2) causes cerebral vasoconstriction. Maintain normocapnia (PaCO2 35-45) unless specific indication (e.g., herniation).

🩺 Step-by-Step: Cardiopulmonary Resuscitation (PALS)

Assess responsiveness & breathing
Tap child, shout. If unresponsive and not breathing or only gasping → activate emergency response, get AED. Check pulse (carotid for child, brachial for infant) for ≤10 sec.

Start CPR (C-A-B sequence)
Compressions: 30:2 (single rescuer), 15:2 (two rescuer for infant/child). Rate 100-120/min. Depth: infant 4cm (1/3 AP), child 5cm. Allow full recoil.

Apply AED as soon as available
Analyze rhythm. Shockable (VF/pVT) → deliver shock, resume CPR immediately x2 min. Non-shockable (PEA/asystole) → continue CPR, give epinephrine.

Advanced airway & drug therapy
• If advanced airway placed: continuous compressions + 1 breath q6-8 sec (8-10/min).
• Epinephrine 0.01 mg/kg IV/IO q3-5 min. Amiodarone 5 mg/kg for shockable refractory rhythms.

Reversible causes (H's & T's)
Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/hyperkalemia, Hypothermia. Tension pneumothorax, Tamponade, Toxins, Thrombosis (pulmonary/coronary).

Post-ROSC (Return of Spontaneous Circulation)
Apply S.T.A.B.L.E.: optimize BP, SpO2 94-99%, EtCO2 35-40, normothermia, glucose control, targeted temperature management if comatose. Transport to ICU.