2025 Korean Guidelines for Cardiopulmonary Resuscitation: Part 7. Pediatric basic life support

Abstract

Pediatric cardiac arrest primarily arises from asphyxia in infants and trauma in older children, contrasting with adult etiologies dominated by cardiac events. This underscores prevention as the cornerstone of pediatric basic life support, through injury mitigation like child restraint systems and water supervision, safe sleep practices including supine positioning on firm surfaces with caregiver smoking cessation to reduce sudden infant death syndrome, plus awareness of child abuse and adolescent suicide prevention. In hospitals, pediatric early warning systems (PEWS) enable early deterioration detection via vital sign scoring for timely intervention. Major updates in the 2025 pediatric basic life support guidelines reflect evidence-driven refinements. First, hospitals should implement PEWS to prompt rapid response teams for at-risk inpatients. Second, all rescuers (lay and healthcare providers) should employ the two-thumb encircling hands technique for infant chest compressions for optimal depth (about 4 cm), rate (100-120/min), and recoil; one-hand heel compression serves as backup if infeasible. Third, lay rescuers may apply automated external defibrillators for nontraumatic out-of-hospital cardiac arrest in children aged 1 year or older, prioritizing prompt attachment after initial cardiopulmonary resuscitation (CPR) cycles to address potential shockable rhythms. Fourth, for infant foreign body airway obstruction, alternate five back blows (over the spine between scapulae) with five chest thrusts (using heel-of-hand on sternum) until cleared or unresponsive, then transition to CPR. These updates aim to enhance bystander intervention, CPR quality, and survival with favorable neurologic outcomes in pediatric cardiac arrest.