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Updated: May 22, 2026
Ultrasonographic Assessment During Cardiopulmonary Resuscitation
Published on: October 24, 2020
Comparison of times of intervention during pediatric CPR maneuvers using ABC and CAB sequences: a randomized trial
R Lubrano1, C Cecchetti, E Bellelli
1Dipartimento di Pediatria, CEQUAM, Sapienza Università di Roma, Italy. riccardo.lubrano@uniroma1.it
Insights
The Circulation, Airway, Breathing (CAB) sequence in pediatric cardiopulmonary resuscitation leads to faster recognition of arrest and quicker initiation of interventions compared to the Airway, Breathing, Circulation (ABC) sequence.
Area of Science:
- Pediatric Emergency Medicine
- Cardiopulmonary Resuscitation Research
- Clinical Trial Methodology
Background:
- The pediatric resuscitation community has expressed uncertainty regarding the proposed shift from the Airway, Breathing, Circulation (ABC) to the Circulation, Airway, Breathing (CAB) sequence.
- A randomized trial was conducted to evaluate the impact of the CAB sequence on the timing of interventions in pediatric cardiopulmonary resuscitation.
Purpose of the Study:
- To compare the timing of critical interventions in pediatric cardiopulmonary resuscitation using the CAB sequence versus the traditional ABC sequence.
- To assess whether the CAB sequence influences the speed of arrest recognition and the initiation of key resuscitation steps.
Main Methods:
- A randomized trial involving 340 volunteers, organized into 170 two-person teams.
- Participants performed two-rescuer basic life support (BLS) using both CAB and ABC sequences.
- Intervention times for respiratory and cardiac arrest scenarios were audio-video recorded and monitored.
Main Results:
- The CAB sequence resulted in significantly quicker recognition of respiratory arrest (17.48s vs. 19.17s) and cardiac arrest (17.48s vs. 41.67s) compared to ABC.
- Initiation of ventilatory maneuvers was faster with CAB (19.13s vs. 22.66s), as was the start of chest compressions (19.27s vs. 43.40s).
Conclusions:
- The CAB sequence demonstrates a time advantage in both diagnosing arrest and initiating critical interventions like ventilation and chest compressions in pediatric resuscitation.
- Further research is necessary to determine if these time improvements translate to better outcomes, such as earlier return of spontaneous circulation and reduced neurological deficits.
Background:
The proposed introduction of the CAB (circulation, airway, breathing) sequence for cardiopulmonary resuscitation has raised some perplexity within the pediatric community. We designed a randomized trial intended to verify if and how much timing of intervention in pediatric cardiopulmonary resuscitation is affected by the use of the CAB vs. the ABC (airway, breathing, circulation) sequence.
Patients And Methods:
340 volunteers, paired into 170 two-person teams, performed 2-rescuer healthcare provider BLS with both a CAB and ABC sequence. Their performances were audio-video recorded and times of intervention in the two scenarios, cardiac and respiratory arrest, were monitored.
Results:
The CAB sequence compared to ABC prompts quicker recognition of respiratory (CAB vs. ABC=17.48 ± 2.19 vs. 19.17 ± 2.38s; p<0.05) or cardiac arrest (CAB vs. ABC=17.48 ± 2.19 vs. 41.67 ± 4.95; p<0.05) and faster start of ventilatory maneuvers (CAB vs. ABC=19.13 ± 1.47s vs. 22.66 ± 3.07; p<0.05) or chest compressions (CAB vs. ABC=19.27 ± 2.64 vs. 43.40 ± 5.036; p<0.05).
Conclusions:
Compared to ABC the CAB sequence prompts shorter time of intervention both in diagnosing respiratory or cardiac arrest and in starting ventilation or chest compression. However, this does not necessarily entail prompter resumption of spontaneous circulation and significant reduction of neurological sequelae, an issue that requires further studies.
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