Pediatric Life Support Clinical Practice Guidelines (ESC, 2021)

European Resuscitation Council

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

April 29, 2021

Clinical practice guidelines on pediatric life support were published in April 2021 by the European Resuscitation Council (ERC) inResuscitation.[1]

The ERC guidelines apply to children aged 0-18 years, with the exception of newborn infants. Adolescents who appear to be adults can be treated according to adult life support guidelines.

Oxygen therapy should be started if the peripheral capillary oxygen saturation (SpO2) level is <94%. Titrate to an SpO2 of 94-98%. Avoid sustained SpO2 levels of 100%, unless the patient has pulmonary hypertension or carbon monoxide poisoning. If the SpO2 or partial oxygen pressure cannot be measured and the patient has signs of circulatory and/or respiratory failure, high-flow oxygen should be started.

Administration of one or more boluses of fluid (10 mL/kg) is recommended for children with circulatory failure. Balanced crystalloids are preferred for the fluid bolus, with normal saline as an alternative. To avoid fluid overload, reevaluate the patient’s status after each bolus. For children who require repeated fluid boluses, early use of vasoactive drugs is recommended. For patients with hemorrhagic shock, blood products should be administered as soon as they are available.

The recommended sequence for pediatric basic life support is the ABC (airway, breathing, circulation) approach. Chest compressions should be started immediately after five rescue breaths, unless clear signs of circulation are present. For infant chest compression by a single rescuer, a two-thumb encircling technique is preferred.

For pediatric advanced life support, any reversible causes of the patient’s condition should be actively sought and treated. The first-line method to support ventilation during cardiopulmonary resuscitation is two-person bag-mask ventilation. If the patient is intubated, asynchronous ventilation at an age-appropriate rate is recommended.

For more information, please go to Pediatric Resuscitation.

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