Part 10: Pediatric Basic and Advanced Life Support

Kleinman, Monica E.; Caen, Allan R. de; Chameides, Leon; Atkins, Dianne L.; Berg, Robert A.; Berg, Marc D.; Bhanji, Farhan; Biarent, Dominique; Bingham, Robert; Coovadia, Ashraf; Hazinski, Mary Fran; Hickey, Robert W.; Nadkarni, Vinay; Reis, Amélia G.; Núñez, Antonio Rodríguez; Tibballs, James; Zaritsky, Arno; Zideman, David

doi:10.1161/circulationaha.110.971093

Cited by 183 publications

(188 citation statements)

References 697 publications

(596 reference statements)

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“…In the 2015 guidelines, the ERC recommends 4 J/kg, while the AHA recommends 2 J/kg for the fi rst shock and 4 J/kg for subsequent shocks. (59)(60)(61)(62) (a) Energy dose Two small case series demonstrated termination of VF/pVT with either 2 J/kg or 2-4 J/kg. In an observational study on IHCA, Meaney et al (63) reported that a higher initial energy dose of > 3-5 J/kg was less effective than a dose of 1-3 J/kg in achieving ROSC.…”

Section: Shockable Rhythms In Paediatric Cardiac Arrest: Vf and Pvt Dmentioning

confidence: 99%

“…The 2010 AHA Pediatric Advanced Life Support (PALS) guidelines suggested that ECPR be considered when dealing with paediatric cardiac arrest refractory to conventional interventions and when the underlying disease process is deemed to be reversible in nature. (60) The 2015 ILCOR systematic review looked at the clinically signifi cant outcomes of survival at 180 days with favourable neurological outcome and survival to hospital discharge.…”

Section: Ecmo In Cpr and Paediatric Ihcamentioning

confidence: 99%

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Singapore Paediatric Resuscitation Guidelines 2016

Ong

Chan

et al. 2017

smedj

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Section: Shockable Rhythms In Paediatric Cardiac Arrest: Vf and Pvt Dmentioning

confidence: 99%

Section: Ecmo In Cpr and Paediatric Ihcamentioning

confidence: 99%

Singapore Paediatric Resuscitation Guidelines 2016

Ong

Chan

et al. 2017

smedj

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“…176,193 Optimal compression:ventilation ratios have not been determined, but recent guidelines trended toward a greater emphasis on chest compression. 194 Pharmacologic agents: Vasopressive and antiarrhythmic agents are widely used in resuscitation, but no drug has been shown in prospective trial to improve long-term survival from cardiac arrest. 195 Administration of epinephrine during cardiac arrest has been accepted as a standard of care, but its use remains controversial; although epinephrine has been shown to improve ROSC, no improvement in long-term survival has yet been demonstrated.…”

Section: Defibrillationmentioning

confidence: 99%

“…196 Vasopressin has been used as an alternative, but trials comparing epinephrine to either vasopressin or placebo have failed to show superiority to hospital discharge or long-term survival. 194,197,198 Further clinical trials are needed on this topic, as all studies to date have been underpowered to draw conclusions with respect to survival outcomes. 199 Similarly, limited evidence is available to guide the use of antiarrhythmics agents during cardiac arrest.…”

Section: Defibrillationmentioning

confidence: 99%

“…Thus, the AHA guidelines recommend different compression-ventilation ratios and less compression depth for infants . 3,194 Current guidelines also do not recommend chest compression only CPR for young children, based on two Japanese studies in which children who received chest compression-only had worse neurologic outcomes. However, chest compression-only CPR was as effective as conventional CPR in children presumed to have arrest from a cardiac etiology.…”

Section: Defibrillationmentioning

confidence: 99%

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Sudden cardiac death in the young

2017

Progress in Pediatric Cardiology

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Although the occurrence of sudden cardiac death (SCD) in a young person is a rare event, it is traumatic and often widely publicized. In recent years, SCD in this population has been increasingly seen as a public health and safety issue. This review presents current knowledge relevant to the epidemiology of SCD and to strategies for prevention, resuscitation and identification of those at greatest risk. Areas of active research and controversy include the development of best practices in screening, risk stratification approaches and post-mortem evaluation, and identification of modifiable barriers to providing better outcomes after resuscitation of young SCD victims. Institution of a national registry of SCD in the young will provide data that will help to answer these questions.

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Time to Epinephrine and Survival After Pediatric In-Hospital Cardiac Arrest

Andersen

Berg

Saindon

et al. 2015

JAMA

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171

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IMPORTANCE Delay in administration of the first epinephrine dose is associated with decreased survival among adults after in-hospital, nonshockable cardiac arrest. Whether this association is true in the pediatric in-hospital cardiac arrest population remains unknown.OBJECTIVE To determine whether time to first epinephrine dose is associated with outcomes in pediatric in-hospital cardiac arrest. DESIGN, SETTING. AND PARTICIPANTSWe performed an analysis of data from the Get With the Guidelines-Resuscitation registry. We included US pediatric patients (age <18 years) with an in-hospital cardiac arrest and an initial nonshockable rhythm who received at least 1 dose of epinephrine. A total of 1558 patients (median age, 9 months [interquartile range [IQR], 13 days-5 years]) were included in the final cohort. EXPOSURE Time to epinephrine, defined as time in minutes from recognition of loss of pulse to the first dose of epinephrine. MAIN OUTCOMES AND MEASURESThe primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation (ROSC), survival at 24 hours, and neurological outcome. A favorable neurological outcome was defined as a score of 1 to 2 on the Pediatric Cerebral Performance Category scale. RESULTS Among the 1558 patients, 487 (31.3%) survived to hospital discharge. The median time to first epinephrine dose was 1 minute (IQR, 0-4; range, 0-20; mean [SD], 2.6 [3.4] minutes). Longer time to epinephrine administration was associated with lower risk of survival to discharge in multivariable analysis (multivariable-adjusted risk ratio [RR] per minute delay, 0.95 [95% CI, 0.93-0.98]). Longer time to epinephrine administration was also associated with decreased risk of ROSC (multivariable-adjusted RR per minute delay, 0.97 [95% CI, 0.96-0.99]), decreased risk of survival at 24 hours (multivariable-adjusted RR per minute delay, 0.97 [95% CI, 0.95-0.99]), and decreased risk of survival with favorable neurological outcome (multivariable-adjusted RR per minute delay, 0.95 [95% CI, 0.91-0.99]). Patients with time to epinephrine administration of longer than 5 minutes (233/1558) compared with those with time to epinephrine of 5 minutes or less (1325/1558) had lower risk of in-hospital survival to discharge (21.0% [49/233] vs 33.1% [438/1325]; multivariable-adjusted RR, 0.75 [95% CI, 0.60-0.93]; P = .01).CONCLUSIONS AND RELEVANCE Among children with in-hospital cardiac arrest with an initial nonshockable rhythm who received epinephrine, delay in administration of epinephrine was associated with decreased chance of survival to hospital discharge, ROSC, 24-hour survival, and survival to hospital discharge with a favorable neurological outcome.

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Part 10: Pediatric Basic and Advanced Life Support

Cited by 183 publications

References 697 publications

Singapore Paediatric Resuscitation Guidelines 2016

Singapore Paediatric Resuscitation Guidelines 2016

Sudden cardiac death in the young

Time to Epinephrine and Survival After Pediatric In-Hospital Cardiac Arrest

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