The new American Heart Association cardiopulmonary resuscitation guidelines: should children and adults have to share?
OBJECTIVE
The latest American Heart Association guidelines for pediatric cardiopulmonary resuscitation (CPR) were published in December 2005. Changes from the 2000 guidelines were directed toward simplifying CPR. Infants, children, and adults now share the same recommendation for the initial compression:ventilation ratio. This is a significant change for pediatricians trained in the importance of a respiratory etiology of pediatric cardiopulmonary arrest. The present review will focus on the rationale behind these guideline changes.


RESULTS
The new guidelines for single rescuer CPR include a compression:ventilation ratio of 30: 2 for both adult and pediatric victims. The impetus for this recommendation is based on recent appreciation for the deleterious effects of hyperventilation as well as an attempt to increase bystander delivery of CPR. The physiologic results of hyperventilation are discussed. The new pediatric basic life support guideline changes are underscored. Research representing the spectrum of opinions on the optimal compression:ventilation ratio, including compression-only CPR, is presented.


CONCLUSIONS
Although based primarily on adult, animal, and computational models, the new compression:ventilation ratio, recommended for both initial pediatric and adult CPR, is a reasonable recommendation. The simplified CPR guidelines released in 2005 will hopefully contribute to improved bystander delivery of CPR and improved outcome.
Sherman
Mindy
M
Pediatric Emergency Medicine Unit, Ellison One, Massachusetts General Hospital, Fruit Street, Boston, MA 02138, USA. msherman1@partners.org
D000328:Adult; D000572:American Heart Association; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D002648:Child; D006323:Heart Arrest / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D007223:Infant; D017410:Practice Guidelines as Topic