What is the maximum time to simultaneously check for breathing and palpate the infant pulse before starting Cardiopulmonary Resuscitation (CPR) in pediatric advanced life support?

From the Guidelines

In pediatric advanced life support, healthcare providers should simultaneously check for breathing and palpate the infant pulse for a maximum of 10 seconds before initiating CPR if no signs of life are detected. For infants (under 1 year), the brachial pulse should be checked, while for children, the carotid or femoral pulse is assessed 1. This brief assessment period is critical because delays in starting chest compressions can significantly reduce survival chances. The 10-second limit balances the need for accurate assessment with the urgency of beginning resuscitation efforts quickly. If after 10 seconds you cannot definitely feel a pulse or the pulse is less than 60 beats per minute with signs of poor perfusion, CPR should be started immediately, beginning with chest compressions. This approach prioritizes early intervention, as hypoxic cardiac arrest is the most common cause of pediatric cardiac arrest, and prompt restoration of oxygenation and circulation is essential for neurological outcomes.

Some key points to consider in pediatric advanced life support include:

• The importance of quickly assessing the need for CPR and initiating it promptly if necessary
• The use of the brachial pulse in infants and the carotid or femoral pulse in children for pulse assessment
• The recommendation to start CPR if a pulse is not definitely felt within 10 seconds or if the pulse is less than 60 beats per minute with signs of poor perfusion
• The emphasis on early intervention and prompt restoration of oxygenation and circulation to improve neurological outcomes

It's worth noting that the American Heart Association guidelines provide a framework for pediatric advanced life support, and healthcare providers should be familiar with these guidelines and stay up-to-date with the latest recommendations 1. However, the most recent and highest-quality study, which is the 2020 American Heart Association guidelines, should be prioritized when making decisions about pediatric advanced life support 1.

From the Research

Pediatric Advanced Life Support

The maximum time to simultaneously check for breathing and palpate the infant pulse before starting Cardiopulmonary Resuscitation (CPR) is not explicitly stated in the provided studies. However, some studies provide guidance on the pulse check and its reliability:

• A study from 2008 2 mentions that the pulse check in children has been shown to be unreliable, not only for laypersons but also for healthcare providers.
• A study from 2012 3 states that the "look, listen and feel" approach and the use of the pulse check by healthcare providers to diagnose cardiac arrest have been removed or de-emphasized.
• A study from 2019 4 analyzed pauses in chest compressions during pediatric CPR and found that pulse checks occurred in 23% of pauses, with 62% of these pauses being prolonged.

Pulse Check and CPR

The American Heart Association (AHA) guidelines for pediatric advanced life support emphasize the importance of minimizing pauses in chest compressions during CPR. Some key points related to pulse checks and CPR include:

• Checking a single pulse site with fingers ready on the pulse site pre-pause can decrease pause duration and improve CPR quality 4.
• Coordinated pauses (pulse check, rhythm check, and compressor change) are rare and long in duration 4.
• The AHA recommends a chest compression fraction of at least 80% to improve patient outcomes 4.

Pediatric Perioperative Life Support

A study from 2013 5 provides guidance on pediatric perioperative life support, including preresuscitation preparation, resuscitation techniques, and postresuscitation management. However, this study does not specifically address the maximum time for simultaneously checking for breathing and palpating the infant pulse before starting CPR.

Key Considerations

Some key considerations for pediatric advanced life support include:

• Minimizing pauses in chest compressions during CPR to improve patient outcomes 4.
• Using focused point-of-care echocardiography to correlate with the pulse check during resuscitation 2.
• Following the AHA guidelines for pediatric advanced life support, which emphasize the importance of high-quality CPR and minimizing pauses in chest compressions 6, 3.