Part 12: Pediatric Advanced Life Support

Caen, Allan R. de; Berg, Marc D.; Chameides, Leon; Gooden, Cheryl K.; Hickey, Robert W.; Scott, Halden F.; Sutton, Robert M.; Tijssen, Janice A.; Topjian, Alexis; Jagt, Élise W. van der; Schexnayder, Stephen M.; Samson, Ricardo A.

doi:10.1161/cir.0000000000000266

Cited by 427 publications

(193 citation statements)

References 103 publications

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“…These data support the American Heart Association recommendations 22 that parenteral fluids and/or inotropes or vasoactive drugs be used to maintain an SBP greater than the fifth percentile for age. In our study, 163 of 292 participants (55.8%) were treated with at least 1 vasoactive infusion in the first 6 hours after temperature intervention, including 60 of 78 with early hypotension (76.9%) and 103 of 214 without early hypotension (48.1%).…”

Section: Discussionsupporting

confidence: 78%

Association of Early Postresuscitation Hypotension With Survival to Discharge After Targeted Temperature Management for Pediatric Out-of-Hospital Cardiac Arrest

et al. 2018

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IMPORTANCE-Out-of-hospital cardiac arrest (OHCA) occurs in more than 6000 children each year in the United States, with survival rates of less than 10% and severe neurologic morbidity in many survivors. Post-cardiac arrest hypotension can occur, but its frequency and association with survival have not been well described during targeted temperature management.OBJECTIVE-To determine whether hypotension is associated with survival to discharge in children and adolescents after resuscitation from OHCA. DESIGN, SETTING, AND PARTICIPANTS-This post hoc secondary analysis of the Therapeutic Hypothermia After Pediatric Cardiac Arrest (THAPCA) trial included 292 pediatric patients older than 48 hours and younger than 18 years treated in 36 pediatric intensive care units from September 1, 2009, through December 31, 2012. Participants underwent therapeutic hypothermia (33.0°C) vs therapeutic normothermia (36.8°C) for 48 hours. All participants had hourly systolic blood pressure measurements documented during the initial 6 hours of temperature intervention. Hourly blood pressures beginning at the time of temperature intervention (time 0) were normalized for age, sex, and height. Early hypotension was defined as a systolic blood pressure less than the fifth percentile during the first 6 hours after temperature intervention. With use of forward stepwise logistic regression, covariates of interest (age, sex, initial cardiac rhythm, any preexisting condition, estimated duration of cardiopulmonary resuscitation [CPR], primary cause of cardiac arrest, temperature intervention group, night or weekend cardiac arrest, witnessed status, and bystander CPR) were evaluated in the final model. Data were analyzed from February 5, 2016, through June 13, 2017. EXPOSURES-Hypotension. MAIN OUTCOMES AND MEASURE-Survival to hospital discharge. RESULTS-Of 292 children (194 boys [66.4%] and 98 girls [33.6%]; median age, 23.0 months [interquartile range, 5.0-105.0 months]), 78 (26.7%) had at least 1 episode of early hypotension. No difference was observed between the therapeutic hypothermia and therapeutic normothermia groups in the prevalence of hypotension during induction and maintenance (73 of 153 [47.7%] vs 72 of 139 [51.8%]; P = .50) or rewarming (35 of 118 [29.7%] vs 19 of 95 [20.0%]; P = .10) during the first 72 hours. Participants who had early hypotension were less likely to survive to hospital discharge (20 of 78 [25.6%] vs 93 of 214 [43.5%]; adjusted odds ratio, 0.39; 95% CI, 0.20-0.74).CONCLUSIONS AND RELEVANCE-In this post hoc secondary analysis of the THAPCA trial, 26.7% of participants had hypotension within 6 hours after temperature intervention. Early post-cardiac arrest hypotension was associated with lower odds of discharge survival, even after adjusting for covariates of interest.Out-of-hospital cardiac arrest (OHCA) occurs in more than 6000 children each year in the United States, with survival rates of less than 10%. 1,2 After initial resuscitation from OHCA and admission to a pediatric intensive care unit, many children die ...

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Section: Discussionsupporting

confidence: 78%

Association of Early Postresuscitation Hypotension With Survival to Discharge After Targeted Temperature Management for Pediatric Out-of-Hospital Cardiac Arrest

et al. 2018

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“…The use of epinephrine during CPR has been considered an essential element of pediatric resuscitation for over 50 years (22, 23). Recommendations by the American Heart Association and International Liaison Committee on Resuscitation (20, 21) with regards to use of epinephrine and additional vasoactive medications have been challenged recently as several reports have demonstrated poorer hospital survival and neurologic outcomes in the adult out-of-hospital cardiac arrest population receiving epinephrine (24–28). Contrary to the recommended dosing of epinephrine until return of spontaneous circulation (every 3–5 min intervals), nearly one third of respondents in our survey reported limiting epinephrine doses, regardless of CPR duration (Fig.…”

Section: Discussionmentioning

confidence: 99%

Extracorporeal Cardiopulmonary Resuscitation in the Pediatric Cardiac Population: In Search of a Standard of Care*

Lasa¹,

Jain²,

Raymond

et al. 2018

Pediatric Critical Care Medicine

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Objectives: Although clinical and pharmacologic guidelines exist for the practice of cardiopulmonary resuscitation in children (Pediatric Advanced Life Support), the practice of extracorpo-real cardiopulmonary resuscitation in pediatric cardiac patients remains without universally accepted standards. We aim to explore variation in extracorporeal cardiopulmonary resuscitation procedures by surveying clinicians who care for this high-risk patient population. Design: A 28-item cross-sectional survey was distributed via a web-based platform to clinicians focusing on cardiopulmonary resuscitation practices and extracorporeal membrane oxygenation team dynamics immediately prior to extracorporeal membrane oxygenation cannulation. Settings: Pediatric hospitals providing extracorporeal mechanical support services to patients with congenital and/or acquired heart disease. Subjects: Critical care/cardiology specialist physicians, cardiothoracic surgeons, advanced practice nurse practitioners, respiratory therapists, and extracorporeal membrane oxygenation specialists. Interventions: None. Measurements and Main Results: Survey web links were distributed over a 2-month period with critical care and/or cardiology physicians comprising the majority of respondents (75%). Nearly all respondents practice at academic/teaching institutions (97%), 89% were from U.S./Canadian institutions and 56% reported less than 10 years of clinical experience. During extracorporeal cardiopulmonary resuscitation, a majority of respondents reported adherence to guideline recommendations for epinephrine bolus dosing (64%). Conversely, 19% reported using only one to three epinephrine bolus doses regardless of extracorporeal cardiopulmonary resuscitation duration. Inotropic support is held after extra-corporeal membrane oxygenation cannulation “most of the time” by 58% of respondents and 94% report using afterload reducing/antihypertensive agents “some” to “most of the time” after achieving full extracorporeal membrane oxygenation support. Interruptions in chest compressions are common during active cannulation according to 77% of respondents. Conclusions: The results of this survey identify wide variability in resuscitative practices during extracorporeal cardiopulmonary resuscitation in the pediatric cardiac population. The deviations from established Pediatric Advanced Life Support CPR guidelines support a call for further inquiry into the pharmacologic and logistical care surrounding extracorporeal cardiopulmonary resuscitation. (Pediatr Crit Care Med 2018; 19:125–130)

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“…201 An study in hospitalized young patients showed that survival to hospital discharge is improved with lidocaine compared to amiodarone 202 and guided the 2015 AHA recommendations to downgrade amiodarone during cardiac arrest in children. 4 The Resuscitation Outcomes Consortium is currently conducting a study of antiarrhythmic use during CPR. 203 …”

Section: Prophylaxis and Secondary Therapy Of Scd In The Youngmentioning

confidence: 99%

Sudden Cardiac Death in the Young

2016

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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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Part 12: Pediatric Advanced Life Support

Cited by 427 publications

References 103 publications

Association of Early Postresuscitation Hypotension With Survival to Discharge After Targeted Temperature Management for Pediatric Out-of-Hospital Cardiac Arrest

Association of Early Postresuscitation Hypotension With Survival to Discharge After Targeted Temperature Management for Pediatric Out-of-Hospital Cardiac Arrest

Extracorporeal Cardiopulmonary Resuscitation in the Pediatric Cardiac Population: In Search of a Standard of Care*

Sudden Cardiac Death in the Young

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