PBLS: Pediatric Basic Life Support

PBLS: Year 2000 Guidelines Analysis

This report is based on final published PBLS changes reported in 
Circulation Supplement for August 22, 2000. All readers are 
encouraged to read the findings for themselves-this review is not 
meant to be comprehensive nor should it substitute for an PBLS 
provider's own inquiry into these subjects, issues and 
recommendations. This material in Circulation represents a process 
of intensive review and consensus begun well over 18 months ago. 
A "roll out" is scheduled for September 21-24 in San Diego where 
this information will be further explained and how it will be 
incorporated in future PBLS will be presented. This, then represents 
the content that the San Diego conference will be based upon..

Chris Perrin, ACUTE CARE, INC. Director of Education

See also: ACLS (Advanced Cardiac Life Support),
Adult BLS (Basic Life Support),
Post-Resuscitation, Acute Coronary Syndromes and CVA,
Ethical Aspects of CPR and ECC, and
PALS (Pediatric Advanced Life Support)

CONTENTS

Major Changes

Core Objectives

Similarity to 1992 Guidelines

Current Research: Circulatory Adjuncts and Mechanical Devices

Definition of classes

PBLS: Pediatric Basic Life Support 
Major Changes

1.     There is a significant and important divergence in PBLS as taught to Lay Rescuers and Healthcare Providers

• Healthcare Provider: Pulse Check versus Lay Rescuer: “Signs of Circulation” (“normal breathing, coughing or movement”)

• Decrease in complexity for Lay Rescuer in Unresponsive FBAO technique (no abdominal compression, back blows, check mouth, or finger sweep)

• “Effective Breaths” for the Lay Rescuer, Bag Valve Mask for the Healthcare Provider  - both “use only the force and tidal volume necessary to cause the chest to rise visibly”

• Healthcare Provider only: use of an AED for children older than 8

2.      Emphasis on teaching Core Objectives: 
Minimize Lecture – Maximize Practice

Core Objectives

• Recognize a resuscitation situation

• Activate EMS

• Use an AED for children older than 8 (Healthcare Provider)

• Effective ventilations (cause the chest to rise)

• Effective chest compressions (cause a palpable pulse)

• Ensure rescuer and bystander safety

3.      Discussion of “phone first” – typically children older than 8 (early arrival of an AED, suspected cardiac etiology) and “phone fast” – typically children younger than 8 (suspected respiratory etiology – need for ventilations). Exceptions: Sudden collapse of a child younger than 8 – suspected cardiac causation – phone first. Submersion / drowning of a child older than 8 – suspected respiratory causation – phone fast. 

Similarity to 1992 Guidelines

• Compression / Ventilation ratio stays at 5:1 for infants and children

• Healthcare Provider Performance Objectives very similar to 1992 Guidelines

•  Emphasis on safety and prevention: SIDS, motor vehicle injuries, pedestrian injuries, bicycle injuries, submersion/drowning, burns, firearm injuries

Current Research: Circulatory Adjuncts and Mechanical Devices for Chest Compression

•  “No Ventilation CPR”: Better than no CPR, not as good as ventilation and compression.

• Active Compression / Decompression CPR: Not tested in children – not recommended

• Interposed Abdominal CPR : Not tested in children – not recommended

Throughout the Guidelines, the following definitions of classes of  recommendations are used:

Class I recommendations are always acceptable. They are proven 
safe and definitely useful, and they are supported by excellent 
evidence from at least one prospective, randomized controlled 
clinical trial

Class IIa recommendations are considered acceptable and useful 
with good to very good evidence providing support. The weight of 
evidence and expert opinions strongly favor these interventions.

Class IIb recommendations are considered acceptable and useful with 
weak or only fair evidence providing support. The weight of evidence 
and expert opinion are not strongly in favor of the intervention.

Class III refers to interventions that are unacceptable. These 
interventions lack any evidence of benefit, and often the evidence 
suggests or confirms harm.

Class Indeterminate refers to an intervention that is promising, but 
the evidence is insufficient in quantity and/or quality to support a 
definitive class of recommendation. The Indeterminate Class was 
added to indicate interventions that are considered safe and perhaps 
effective and are recommended by expert consensus. However, the 
available evidence supporting the recommendation is either too weak 
or too limited at present to make a definitive recommendation based 
on the published data.

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