Dr. Peter Antevy explains pediatric airway management in cardiac arrest: two quick BVM breaths, then a supraglottic airway like the iGel, then one breath every six seconds. Most providers hyperventilate kids at 20-30 breaths per minute, which cuts blood flow to the heart and brain. Keep end-tidal CO2 above 35 mmHg, ideally around 50-55.
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Hey, everyone, this is Dr. Peter Henteve. Another edition of the HENT Heavy Minute. I want to continue talking here about cardiac arrest. Pediatric resuscitation. One of the mainstays in pediatrics is the respirations. Right. Ventilation. So we get to the scene, we start to actually address the pediatric airway. But there's some important things to know about the pediatric airway that are very, very critical to the outcomes for these patients. So what do I mean? When you get to the patient, what you want to do is you want to bag that patient so you open up that lung. What we recommend is two large BVM breaths and then go right to a supraglottic airway. In my systems, we use the Igel. Once you have that asynchronous ventilation going, the recommendations are one breath every six seconds. Now, it turns out that that's pretty hard to do. A study just came out from an icu and they noticed that even in the ICU with pediatric cardiac arrest, they were bagging with rates in the twenties and thirties. Not one child out of the hundreds of children had a rate that was according to pal's guidelines. What does that mean? It means that most of us, when we're in the scene or even in the emergency department, we tend to just hyperventilate the child. Why is that bad? Every time you provide a positive pressure breath to these children, you're squeezing down the heart. The RV's not filling, and therefore they're not getting any output during your chest compression. This is dangerous for the patient. That's number one. Number two, hyperventilation brings on your PCO2 or your end tidal CO2, and that causes vasoconstriction of the brain. So the one organ that's really the most important in cardiac arrest, which is the brain, is not getting blood supply because of the hyperventilation. Now, I would really highly recommend that everyone be using an end tidal CO2, not just after ROSC, but intra arrest. As the patient is in arrest, get an end tidal on there. So then you can see if the patient's end Tidal is at 100, then, yes, you have to ventilate faster, but you should never be bringing that end tidal down below 35. If you have a 50 or 55, that's probably okay. So pediatric ventilation and oxygenation is very, very important. Learn how to bvm. Learn how to use your adjuncts. Opa, npa. Learn how to have a supraglottic airway, whether it be the King or the Igel or the air Q Any one of those. But once you have that airway in, understand the mechanism of what you're doing, understand the physiology. This is going to get more kids back to life. It's very, very important. Thanks for your time. This has been Dr. Peter Hentevi with another edition of the Entevi Minute.
