Neonatal vs. Pediatric Resuscitation Standards

CPR ratios for paediatrics Neonatal resuscitation is 3:1 ratio. Paediatric resuscitation is 15:2 (2 rescuers) and 30:2 (1 rescuer) I know the directives have changed but is there still a >24 HOURS to 28 DAYS a CPR ration of 3:1 and selected j/kg as per ALS PCS. The BLS states follow the heart & stroke guidelines. BLS H&S Guidelines state infants (age less than 1 year, excluding newborns AND paediatrics (age 1 to puberty): non-intubated: ratio 15:2 as above. Intubated: Gave 1 breath every 2 to 3 seconds Neonate: both non-intubated AND intubated 3:1 ratio as above.

Great question regarding neonatal and pediatric resuscitation standards, particularly the transition in CPR ratios and defibrillation energy requirements during the first 28 days of life. Under the current Ontario ALS PCS and BLS PCS standards, aligned with Heart & Stroke Canada and American Heart Association (AHA) guidelines, the 3:1 compression-to-ventilation ratio no longer applies to patients older than 24 hours of age, including those younger than 28–30 days. The transition from neonatal to pediatric resuscitation standards occurs at 24 hours of age. Once a patient is older than 24 hours, pediatric/infant CPR standards apply: Two-rescuer CPR: 15:2 compression-to-ventilation ratio. Single-rescuer CPR: 30:2 compression-to-ventilation ratio. In response to your question regarding whether the 3:1 CPR ratio and weight-based defibrillation energy selection still apply to patients aged >24 hours to 28 days: Patients >24 Hours to 30 Days Medical Advisory Committee (MAC) clarifications and updated medical directives have established that patients older than 24 hours are managed under pediatric resuscitation standards rather than neonatal CPR ratios. Accordingly, the compression-to-ventilation ratio is 15:2 for two rescuers or 30:2 for a single rescuer. When manual defibrillation is indicated under the pediatric medical directives (patients >24 hours to 8 years of age, or as otherwise specified by the applicable directive), weight-based energy selectionremains: Initial defibrillation: 2 J/kg Subsequent defibrillation: 4 J/kg (or as specified by the applicable ALS PCS Medical Directive). Advanced Airway Considerations If an advanced airway (ETT or SGA) is placed in a pediatric patient older than 24 hours and up to puberty, chest compressions should be delivered continuously at 100 - 120 compressions/min, with asynchronous ventilations provided at 1 breath every 2–3 seconds (20–30 breaths/min), consistent with Heart & Stroke Canada and AHA guidelines. In summary: The 3:1 compression-to-ventilation ratio applies to neonatal resuscitation within the first 24 hours of life. Beyond 24 hours, pediatric CPR ratios apply, with weight-based defibrillation energy selection and ventilation strategies guided by the applicable ALS PCS/BLS PCS standards. img src="https://nwrpcp.myobh.ca/images/MedicASK_CPR_ratios.png" alt="MedicASK CPR ratios" style="display: block; margin-left: auto; margin-right: auto;">