https://genoplivning.dk/wp-content/uploads/2013/07/european-resuscitation-council-guidelines-for-resuscitation-2010-section-4-adult-advanced-life-support.pdf

European Resuscitation Council Guidelines for Resuscitation 2010 Section 4 Adult advanced life support

In contrast to adults, cardiac arrest in infants and children does not usually result from a primary cardiac cause. More often it is the terminal result of progressive respiratory failure or shock, also called an asphyxial arrest. Asphyxia begins with a variable period of systemic hypoxemia, hypercapnea, and acidosis, progresses to bradycardia and hypotension, and culminates with cardiac arrest.1

Another mechanism of cardiac arrest, ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT), is the initial cardiac rhythm in approximately 5% to 15% of pediatric in-hospital and out-of-hospital cardiac arrests;2,–,9 it is reported in up to 27% of pediatric in-hospital arrests at some point during the resuscitation.6 The incidence of VF/pulseless VT cardiac arrest rises with age.2,4 Increasing evidence suggests that sudden unexpected death in young people can be associated with genetic abnormalities in myocyte ion channels resulting in abnormalities in ion flow (see “Sudden Unexplained Deaths,” below).

Since 2010 marks the 50th anniversary of the introduction of cardiopulmonary resuscitation (CPR),10 it seems appropriate to review the progressive improvement in outcome of pediatric resuscitation from cardiac arrest. Survival from in-hospital cardiac arrest in infants and children in the 1980s was around 9%.11,12 Approximately 20 years later, that figure had increased to 17%,13,14 and by 2006, to 27%.15,–,17 In contrast to those favorable results from in-hospital cardiac arrest, overall survival to discharge from out-of-hospital cardiac arrest in infants and children has not changed substantially in 20 years and remains at about 6% (3% for infants and 9% for children and adolescents).7,9

It is unclear why the improvement in outcome from in-hospital cardiac arrest has occurred, although earlier recognition and management of at-risk patients on general inpatient units …

https://www.ahajournals.org/doi/pdf/10.1161/CIRCULATIONAHA.110.971101

Part 14: Pediatric Advanced Life Support 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

https://nrr.org/wp-content/uploads/0000/10/02_ERC_Guidelines_2005_Section2.pdf

European Resuscitation Council Guidelines for Resuscitation 2010 Section 2. Adult basic life support and use of automated external defibrillators.

https://www.ilcor.org/data/Post-cardiac_arrest_syndrome.pdf

Post-cardiac arrest syndrome: Epidemiology, pathophysiology, treatment, and prognostication ☆ ☆☆ ★: A Scientific Statement from the International Liaison Committee on Resuscitation; the American Heart Association Emergency Cardiovascular Care Committee; the Council on Cardiovascular Surgery and Anesthesia; the Council on Cardiopulmonary, Perioperative, and Critical Care; the Council on Clinical Cardiology; the Council on Stroke

The contributors to this statement were selected to ensure expertise in all the disciplines relevant to post–cardiac arrest care. In an attempt to make this document universally applicable and generalizable, the authorship comprised clinicians and scientists who represent many specialties in many regions of the world. Several major professional groups whose practice is relevant to post–cardiac arrest care were asked and agreed to provide representative contributors. Planning and invitations took place initially by e-mail, followed a series of telephone conferences and face-to-face meetings of the cochairs and writing group members. International writing teams were formed to generate the content of each section, which corresponded to the major subheadings of the final document. Two team leaders from different countries led each writing team. Individual contributors were assigned by the writing group cochairs to work on 1 or more writing teams, which generally reflected their areas of expertise. Relevant articles were identified with PubMed, EMBASE, and an American Heart Association EndNote master resuscitation reference library, supplemented by hand searches of key papers. Drafts of each section were written and agreed on by the writing team authors and then sent to the cochairs for editing and amalgamation into a single document. The first draft of the complete document was circulated among writing team leaders for initial comment and editing. A revised version of the document was circulated among all contributors, and consensus was achieved before submission of the final version for independent peer review and approval for publication.

This scientific statement outlines current understanding and identifies knowledge gaps in the pathophysiology, treatment, and prognosis of patients who regain spontaneous circulation after cardiac arrest. The purpose is to provide a resource for optimization of post–cardiac arrest care and to pinpoint the need for research focused on gaps in knowledge that would potentially improve outcomes …

Post–Cardiac Arrest Syndrome

ContextCardiopulmonary resuscitation (CPR) guidelines recommend target values
for compressions, ventilations, and CPR-free intervals allowed for rhythm
analysis and defibrillation. There is little information on adherence to these
guidelines during advanced cardiac life support in the field.ObjectiveTo measure the quality of out-of-hospital CPR performed by ambulance
personnel, as measured by adherence to CPR guidelines.Design and SettingCase series of 176 adult patients with out-of-hospital cardiac arrest
treated by paramedics and nurse anesthetists in Stockholm, Sweden, London,
England, and Akershus, Norway, between March 2002 and October 2003. The defibrillators
recorded chest compressions via a sternal pad fitted with an accelerometer
and ventilations by changes in thoracic impedance between the defibrillator
pads, in addition to standard event and electrocardiographic recordings.Main Outcome MeasureAdherence to international guidelines for CPR.ResultsChest compressions were not given 48% (95% CI, 45%-51%) of the time
without spontaneous circulation; this percentage was 38% (95% CI, 36%-41%)
when subtracting the time necessary for electrocardiographic analysis and
defibrillation. Combining these data with a mean compression rate of 121/min
(95% CI, 118-124/min) when compressions were given resulted in a mean compression
rate of 64/min (95% CI, 61-67/min). Mean compression depth was 34 mm (95%
CI, 33-35 mm), 28% (95% CI, 24%-32%) of the compressions had a depth of 38
mm to 51 mm (guidelines recommendation), and the compression part of the duty
cycle was 42% (95% CI, 41%-42%). A mean of 11 (95% CI, 11-12) ventilations
were given per minute. Sixty-one patients (35%) had return of spontaneous
circulation, and 5 of 6 patients discharged alive from the hospital had normal
neurological outcomes.ConclusionsIn this study of CPR during out-of-hospital cardiac arrest, chest compressions
were not delivered half of the time, and most compressions were too shallow.
Electrocardiographic analysis and defibrillation accounted for only small
parts of intervals without chest compressions.

https://jamanetwork.com/journals/jama/articlepdf/200195/joc42116.pdf

Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest

http://degreesofclarity.com/emsbasics/library/kramer-johansen%20-%20Quality%20of%20out-of-hospital%20cardiopulmonary%20resuscitation%20with%20real%20time%20automated%20feedback-%20a%20prospective%20interventional%20study.pdf

Bob Fellows

Papers

Quality of cardiopulmonary resuscitation during out-of-hospital cardiac arrest

Quality of out-of-hospital cardiopulmonary resuscitation with real time automated feedback: a prospective interventional study.