Our aim is to summarize the new European Resuscitation Council (ERC) 2021 guidelines
on paediatric life support. In children, exhaustion of compensatory mechanisms in
respiratory or circulatory failure leads to cardiac arrest. Recog-nition and treatment
of children in critical condition are the most important element of its prevention.
With the ABCDE approach, life-threatening problems can be identified and treated using
simple interventions (bag-mask venti-lation, intraosseous access, fluid bolus, etc.).
Important new recommendations: 4-hand ventilation during bag-mask ventilation, target
saturation of 94-98% during oxygen therapy, and fluid bolus of 10 ml/kg. In pediatric
basic life support, if there is no normal breathing after 5 initial rescue breaths
in absence of signs of life, chest compression should be initiated immediately using
primarily two-thumb encircling method for infants. Recommended rate is 100-120/ min,
ratio of compression to ventilation is 15 : 2. Pediatric advanced life support is
a teamwork. The structure of the algorithm is unchanged, high-quality chest compression
is still a paramount. Recognition and treatment of potential reversible causes (4H-4T)
and the decisive role of focused ultrasound are emphasized. New features: recommendation
of 4-hand technique bag-mask ventilation, role of capnography, and age-dependent ventilatory
rate in the case of con-tinuous chest compression after endotracheal intubation. Drug
therapy is unchanged, the fastest way to administer adrenaline during resuscitation
is via intraosseous access. Treatment after return of spontaneous circulation decisively
influences neurological outcome. Patient care is further based on the ABCDE scheme.
Important goals are maintaining normoxia, normocapnia, avoiding hypotension, hypoglycemia,
fever and use of targeted temperature management.
