Базовая и расширенная сердечно-легочная реанимация у детей – рекомендации 2025

Современные международные рекомендации по сердечно-легочной реанимации (СЛР) все более акцентируют внимание на индивидуализированном, физиологически ориентированном подходе к ведению пациентов после остановки сердца. В обновленных протоколах расширенной поддержки жизни у детей Европейского совета по реанимации (ERC PALS, 2025) подтверждена ключевая роль качественной СЛР как основы успешного исхода. Подчеркивается необходимость поддержания оптимальной частоты и глубины компрессий грудной клетки, минимизации перерывов между ними и предотвращения гипервентиляции. При этом внимание смещается на достижение целевых физиологических параметров – прежде всего диастолического давления (≥25 мм рт. ст. у младенцев и ≥30 мм рт. ст. у детей старше года) и концентрации углекислого газа в конце выдоха (ETCO2) как маркеров эффективности СЛР. Ряд нововведений касается сроков и последовательности введения адреналина, приоритетности быстрой дефибрилляции при шоковых ритмах, а также ведения постреанимационного периода, где основным направлением стало активное предотвращение гипертермии (поддержание температуры ≤37,5 °C) и поддержание артериального давления выше 10-го перцентиля для возраста. Новые данные подчеркивают необходимость многофакторного неврологического прогнозирования, исключающего зависимость от одного изолированного теста. Таким образом, новые руководства Американской ассоциации сердца и Американской академии педиатрии (AHA/AAP) направлены на повышение эффективности СЛР, персонализацию постреанимационного ухода и улучшение долгосрочных неврологических исходов у педиатрических пациентов.

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