PEDIATRIC LIFE SUPPORT- CHAIN OF SURVIVAL.docx

Pediatric Life Support (PLS) refers to the specialized medical care and interventions designed to address life-threatening situations in infants, children, and adolescents, recognizing the unique physiological needs of pediatric patients. In October 2020, the American Heart Association (AHA) introduced significant updates to their guidelines for pediatric life support. PLS is distinguished as Pediatric Basic Life Support (PBLS) & Pediatric Advanced Life Support (PALS)
CHAIN OF SURVIVAL
The AHA's 2020 guidelines for pediatric life support emphasize the importance of the Chain of Survival, a series of critical steps that, when followed sequentially, can significantly improve survival rates. The chain consists of six key links:
1. Early Recognition of the Emergency & Prevention
2. Activation of The Emergency Response System.
3. High Quality Cardiopulmonary Resuscitation (CPR).
4. Advanced Resuscitation.
5. Post-Cardiac Arrest Care.
6. Recovery

1. PEDIATRIC LIFE SUPPORT (PLS)/ CARDIOPULMONARY RESUSCITATION IN CHILDREN
INTRODUCTION
Pediatric Life Support (PLS) refers to the specialized medical care and interventions designed
to address life-threatening situations in infants, children, and adolescents, recognizing the unique
physiological needs of pediatric patients. In October 2020, the American Heart Association (AHA)
introduced significant updates to their guidelines for pediatric life support. PLS is distinguished as
Pediatric Basic Life Support (PBLS) & Pediatric Advanced Life Support (PALS)
CHAIN OF SURVIVAL
The AHA's 2020 guidelines for pediatric life support emphasize the importance of the Chain
of Survival, a series of critical steps that, when followed sequentially, can significantly improve
survival rates. The chain consists of six key links:
1.Early Recognition of the Emergency & Prevention
2.Activation of The Emergency Response System.
3.High Quality Cardiopulmonary Resuscitation (CPR).
4.Advanced Resuscitation.
5.Post-Cardiac Arrest Care.
6.Recovery
1. Early Recognition of the Emergency & Prevention:
The first link in the Chain of Survival is the early recognition of a pediatric emergency. This
involves recognizing the signs of cardiac arrest or other life-threatening situations in
children.
Efforts should be made to prevent cardiac arrest through injury prevention, promotion of
pediatric safety measures, and early identification of children at risk.

2. 2. Activation of the Emergency Response System:
Once a pediatric emergency is recognized, the next step is to activate the emergency
response system, such as local emergency number.
Prompt activation ensures that professional help is on the way and can be at the scene as
quickly as possible.
3. High-Quality Cardiopulmonary Resuscitation (CPR):
High-quality CPR is the third link in the Chain of Survival and is crucial in saving the lives of
children in cardiac arrest.
Chest Compressions
For Infants (less than 1-year-old):
Use two fingers (middle and ring fingers) for chest compressions.
Place fingers on the lower half of the breastbone (sternum).
Compress the chest to a depth of about 1.5 inches (approximately 4 cm).
Compress at a rate of 100-120 compressions per minute.
For Children (1 year and older):
Use the heel of one or both hands for chest compressions.
Place the heel of your hand on the center of the chest, just below the nipple line.
Compress the chest at a rate of 100-120 compressions per minute.
Aim for a depth of at least one-third the depth of the chest (approximately 2 inches or about
5 cm).
Allow the chest to fully recoil between compressions.
Minimize interruptions in chest compressions to maintain circulation.
Fig 1: A. Two Finger Technique, B. One Hand Technique, C. Head Tilt- Chin Lift Method
Ventilations:

3. Open the airway using the appropriate technique, use the head tilt - chin lift maneuver.
Gently tilt the child's head backward while lifting the chin to open the airway.
For children with suspected spinal injury, use the jaw thrust technique to minimize
movement of the neck and spine while opening the airway.
Mouth to mouth ventilation may be given in case of single rescuer. When two rescuers are
available can provide bag and mask ventilation.
Create an airtight seal when delivering rescue breaths.
Maintain a compression-to-ventilation ratio of 30:2 (for a single rescuer) or 15:2 (for two
rescuers) for children.
4. Advanced Resuscitation:
This is the fourth link in the Chain of Survival and involves advanced medical interventions.
Defibrillation: In this step, medical professionals may use an automated external
defibrillator (AED) or manual defibrillator to analyze the child's heart rhythm. If a shockable
rhythm (ventricular fibrillation or pulseless ventricular tachycardia) is detected, an electric
shock is delivered to attempt to restore a normal heart rhythm.
Medications: Medical personnel may administer medications as part of advanced
resuscitation. These medications can include epinephrine, antiarrhythmic drugs, and other
medications to address specific issues and stabilize the child's condition.
5. Post- Cardiac Arrest Care:
Post-cardiac arrest care for pediatric patients focuses on continuous monitoring of vital
signs, cardiac and neurological status.
It includes identifying and treating underlying causes, maintaining oxygenation, and
administering tailored medications to stabilize heart rhythm and manage blood pressure, all
aimed at enhancing recovery and preventing further cardiac events.
6. Recovery:
The sixth and final link in the Chain of Survival is the recovery phase.
This phase focuses on providing appropriate care and support to pediatric patients who have
survived a cardiac arrest.
Key components of this phase include: Rehabilitation, Psychological Support, Long-Term
Care, Education and Prevention.

4. Fig 2: Paediatric Life Support as Per Aha Guidelines 2020