What is the immediate management for respiratory arrest in a child?

Immediate Management of Respiratory Arrest in a Child

The immediate management of respiratory arrest in a child requires establishing a patent airway, providing rescue breaths, and assessing circulation, with chest compressions initiated if pulse is absent or <60 beats per minute with signs of poor perfusion. 1, 2

Initial Assessment and Airway Management

1. Assess responsiveness

   • Shake gently or pinch the child
   • Shout for help if unresponsive 1, 2

2. Open the airway

   • Use head tilt-chin lift maneuver
   • For suspected cervical spine injury, use jaw thrust without head tilt 1
   • Remove visible foreign bodies that can be easily grasped (no blind finger sweeps) 1

3. Assess breathing (look, listen, feel for 10 seconds)

   • Look for chest and abdominal movement
   • Listen at mouth and nose for breath sounds
   • Feel for expired air with your cheek 1, 2

Rescue Breathing

If no breathing or only gasping:

1. Deliver 5 initial rescue breaths

   • Each breath should last 1-1.5 seconds
   • For infants: cover mouth and nose
   • For children: cover mouth only 1
   • Ensure visible chest rise with each breath

2. Check pulse (no more than 10 seconds)

   • Infants: brachial pulse (inside of upper arm)
   • Children: carotid or femoral pulse 1

Subsequent Actions Based on Pulse Check

If pulse present (≥60/min):

• Continue rescue breathing at 12-20 breaths per minute (1 breath every 3-5 seconds)
• Reassess pulse approximately every 2 minutes 1

If pulse absent OR <60/min with poor perfusion:

• Begin chest compressions immediately
• For single rescuer: 30 compressions to 2 ventilations
• For two rescuers: 15 compressions to 2 ventilations 1
• Compression depth:
  • Infants: approximately 4 cm (1.5 inches)
  • Children: approximately 5 cm (2 inches) 1, 2
• Compression rate: 100-120/minute for all ages 1, 2

Activation of Emergency Response System

• Two rescuers present: One starts CPR immediately while the other activates emergency response and obtains AED if available
• Lone rescuer: Perform 2 minutes of CPR first, then activate emergency response system, as most pediatric arrests are asphyxial rather than cardiac 1

Advanced Management

1. Oxygen administration

   • Provide high-flow oxygen via face mask as soon as available 1

2. Consider advanced airway management if trained and equipped

   • Bag-mask ventilation is the preferred method for healthcare providers 1
   • Avoid excessive ventilation (8-10 breaths/minute if advanced airway in place) 1

3. Vascular access and medications (for healthcare providers)

   • Establish IV/IO access if arrest continues
   • Epinephrine 0.01 mg/kg (0.1 mL/kg of 1:10,000 solution) IV/IO 2

Monitoring and Reassessment

• Continuously assess effectiveness of ventilations (chest rise)
• Monitor pulse and breathing status
• If available, use pulse oximetry to maintain SpO₂ >92% 1
• Minimize interruptions in chest compressions (<10 seconds) 1, 2

Common Pitfalls to Avoid

• Delay in starting rescue breathing: Respiratory arrest in children often leads to cardiac arrest if not promptly treated 3, 4
• Inadequate airway positioning: Improper head position can obstruct the airway
• Excessive ventilation: Can increase intrathoracic pressure and decrease venous return
• Shallow compressions: Ensure adequate depth for effective circulation
• Prolonged interruptions: Minimize pauses in compressions to maintain coronary perfusion 1

Remember that respiratory arrest in children is commonly caused by respiratory diseases, injuries, or foreign body obstruction, and prompt recognition and management are critical for preventing progression to cardiac arrest 5, 4.