Ventilation During Pediatric CPR

In children, ventilation management is essential before, during, and after cardiopulmonary resuscitation (CPR). In the pre-arrest phase, interventions must focus on the prevention of cardiopulmonary arrest. During CPR, the objective is to match ventilation with perfusion, because much less ventilation is necessary for adequate gas exchange and evidences indicate that overventilation is common and can compromise venous return, cardiac output and outcome. Hypoventilation, hypoxemia and hyperoxemia must be also avoided. Self-inflating bags connected to a face mask or an endotracheal tube are the preferred devices to deliver oxygen and positive pressure ventilation during respiratory or cardiac arrest in children. Following return of spontaneous circulation (ROSC) a complex and global process of reperfusion injury occurs; therefore, intensive monitoring and goal directed respiratory therapy should be the standard of care. New studies and evidences are needed to define the optimal ventilation procedures and strategies in pediatric CPR.