Circulation
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Artificial ventilation is a cornerstone of basic life support-cardiopulmonary resuscitation (BLS-CPR). Recent data corroborate clinical studies performed in the 1950s and 1960s, suggesting a need to change the present American Heart Association standards for artificial ventilation. These studies show that gastric insufflation followed by regurgitation and pulmonary aspiration are a major hazard of artificial ventilation with an unprotected airway. ⋯ These methods of ventilation predispose the victim to gastric insufflation. Alternative methods of ventilation with longer inspiratory time and thus lower flow rate and peak inspiratory pressure are suggested. Additionally, rescue personnel, particularly EMTs and paramedics, should be taught how to apply cricoid pressure to prevent gastric insufflation in victims with an unprotected airway.
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The outcome from cardiopulmonary arrest in children in the prehospital and hospital setting is generally poor. The event that compromises the cardiac status is often respiratory embarrassment, and the presenting rhythms are often bradyarrhythmias and asystole. Emergency medical services (EMS) systems have primarily an adult focus and may not be organized to manage optimally the critically ill and injured child. ⋯ There are two levels of receiving facilities: Emergency Departments Approved for Pediatrics and Pediatric Critical Care Centers. The system is voluntary and has 85% of the hospitals in compliance with the guidelines. Early recognition of the prearrest state, improved training, and equipping of prehospital care personnel, development of EMS services for children, dissemination of an advanced pediatric life support course, as well as research in pediatric CPR may improve the outcome of resuscitation in the pediatric population.