European Resuscitation Council Guidelines for Resuscitation 2010 ...

1378 D. Biarent et al. / Resuscitation 81 (2010) 1364–1388
Fig. 6.10. Paediatric algorithm for non-shockable rhythm.
Fig. 6.11. Paediatric algorithm for shockable rhythm.
Bystander CPR is associated with a better neurological outcome
in adults and children. 277–279 The most common ECG
patterns in infants, children and adolescents with cardiopulmonary
arrest are asystole and PEA. PEA is characterised by
organised, wide or narrow complex electrical activity, usually
(but not always) at a slow rate, and absent pulses. It commonly
follows a period of hypoxia or myocardial ischaemia,
but occasionally can have a reversible cause (i.e., one of the 4
Hs and 4 Ts) that led to a sudden impairment of cardiac output.
Shockable rhythms
Primary VF occurs in 3.8–19% of cardiopulmonary arrests
in children. 13,41–43,60,274,275,277 The incidence of VF/pulseless VT
increases with age. 267,280 The primary determinant of survival from
VT/pulseless VT cardiopulmonary arrest is the time to defibrillation.
Prehospital defibrillation within the first 3 min of witnessed adult
VF arrest results in >50% survival. However, the success of defibrillation
decreases dramatically the longer the time until defibrillation:
for every minute delay in defibrillation (without any CPR), survival
decreases by 7–10%. Survival after more than 12 min of VF in adult
victims is