Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support

Caen, Allan R. de; Maconochie, Ian; Aickin, Richard; Atkins, Dianne L.; Biarent, Dominique; Guerguerian, Anne‐Marie; Kleinman, Monica E.; Kloeck, David; Meaney, Peter A.; Ng, Kee-Chong; Nuthall, Gabrielle; Reis, Amélia G.; Shimizu, Naoki; Tibballs, James; Pintos, Remigio Véliz

doi:10.1542/peds.2015-3373c

Cited by 44 publications

(74 citation statements)

References 98 publications

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“…We also suggest that in the absence of evidence, a reasonable approach would be to use the Task Force derived 5 th centile SBP for males by age (and assumption of 50 th centile height) as a cut-off for hypotension and as a target for therapy (8). This is also the recent conclusion of the Paediatric Task Force of the International Liaison Committee on Resuscitation (ILCOR) in regard to children post cardiac arrest (15). Such an approach would standardise treatment.…”

Section: Resultsmentioning

confidence: 86%

Ten concerns about blood pressure measurement and targets in paediatric sepsis

2016

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Section: Resultsmentioning

confidence: 86%

Ten concerns about blood pressure measurement and targets in paediatric sepsis

2016

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“…Use of ECPR is indicated in only 1 situation after out-of-hospital cardiac arrest, which is in cases of environmentally induced severe hypothermia (< 30°C), again, only if the appropriate equipment and expertise are available. 36 Medical institutions providing ECPR should have established protocols for its implementation and use. Often centers lacking these resources are unable to offer ECPR at all.…”

Section: When To Initiate Therapy?mentioning

confidence: 99%

“…36 A substantial amount of debate can be found in published reports about when ECPR should be initiated and when further intervention would be futile. Several pediatric studies have shown increased mortality rates for patients cannulated after 30 minutes of conventional CPR.…”

Section: Population Of Patientsmentioning

confidence: 99%

Extracorporeal Membrane Oxygenation for Pediatric Cardiac Arrest

Ryan

2015

Critical Care Nurse

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It is only fitting that the first neonate to be supported by extracorporeal membrane oxygenation (ECMO) was named Esperanza, which when translated from Spanish means hope.1 Indeed, to the more than 50 000 patients who have survived because of ECMO, this revolutionary treatment has provided hope where there was none before. 2 In the past 5 decades, the use of artificial oxygenation and perfusion has revolutionized the care of critically ill patients, both in the operating room and in the intensive care unit. Use of artificial oxygenation and perfusion has evolved from bypass during cardiac surgery to advanced life support, to complex extracorporeal cardiopulmonary resuscitation (ECPR). Within the past 20 years, ECPR has been initiated when traditional resuscitation methods have failed and has proven its effectiveness with a survival to discharge rate of approximately 40%.3-13 However, the appropriate use of this therapy and delineated criteria for initiating and withdrawing this therapy have yet to be defined. Furthermore, implementation of this Pediatric CareExtracorporeal cardiopulmonary resuscitation (ECPR) remains a promising treatment for pediatric patients in cardiac arrest unresponsive to traditional cardiopulmonary resuscitation. With veno-arterial extracorporeal support, blood is drained from the right atrium, oxygenated through the extracorporeal circuit, and transfused back to the body, bypassing the heart and lungs. The use of artificial oxygenation and perfusion thus provides the body a period of hemodynamic stability, while allowing resolution of underlying disease processes. Survival rates for ECPR patients are higher than those for traditional cardiopulmonary resuscitation (CPR), although neurological outcomes require further investigation. The impact of duration of CPR and length of treatment with extracorporeal membrane oxygenation vary in published reports. Furthermore, current guidelines for the initiation and use of ECPR are limited and may lead to confusion about appropriate use of this support. Many ethical concerns arise with this advanced form of life support. More often than not, the dilemma is not whether to withhold ECPR, but rather when to withdraw it. Although clinicians must decide if ECPR is appropriate and when further intervention is futile, the ultimate burden of choice is left to the patient's caregivers. Offering support and guidance to the patient's family as well as the patient is essential. (Critical Care Nurse. 2015;35[1]:60-70) This article has been designated for CNE credit. A closed-book, multiple-choice examination follows this article, which tests your knowledge of the following objectives:1. Determine the difference between venovenous and venoarterial extracorporeal membrane oxygenation (ECMO) 2. Describe the benefits of extracorporeal cardiopulmonary resuscitation 3. Discuss the ethical considerations related to management of patients undergoing ECMO CNE Continuing Nursing Education

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“…36 KPR eğitimlerinin basitleştirilmesi amacıyla, çocuklardaki verilerin yetersizliği de göz önüne alınarak, erişkinler için önerilen gö-ğüs bası sayıları olan dakikada 100-120 bası yapılması, bebek ve çocuklar için de önerilmektedir (Sınıf IIa). 22,32 Ayrıca KPR yapan kurtarıcının göğüs bası sayısı ve derinliğinin iyileştirilmesi bakımından bilgi verebilen geri bildirim gereçlerinin (akıllı telefonlardaki programlar ve özel yapılmış, giyilebilir veya taşınabilir cihazlar) de KPR yeterliliğini ölçmek için olası ise kullanılabileceği belirtilmiştir (Sınıf IIb). Doğumdan ergenlik başlangı-cına dek olan çocukluk yaş grubunda bası derinliğinin göğüs ön-arka çapının en az üçte biri kadar olması sağ-lanmalıdır.…”

Section: Canlandırmaya Başlamadan öNce Yardım çAğırmaunclassified

“…Canlandırmada basılara solutma için daha az ara verilmesiyle koroner arter basınçlarının ve nörolojik prognozun daha iyi olduğu gösterilmiş ve son akış çizelgelerinde göğüs basılarının solutmaya oranı kalp basılarına daha az ara verilmesi yönünde deği-şiklik göstermiştir. 9,22,32,37 Ventriküler fibrilasyon gelişti-rilerek arrest oluşturulan deneysel hayvan çalışmasında 24. saatin sonundaki en iyi nörolojik prognozun 100 göğüs basısına karşılık 2 solutma uygulanan grupta elde edildiği, 15 göğüs basısına karşılık 2 solutma uygulanan gruba göre ve sadece göğüs basısı uygulanan ve solutma yapılmayan gruba göre nörolojik prognozun daha gereksinim bulunmaktadır. İlk olarak göğüs basılarıyla başlanmasının A-B-C ile canlandırmaya başlanmasına göre etkisi halen değerlendirilmektedir.…”

Section: Canlandırmada Sadece Göğüs Basısının Kullanılması-sadece Göğunclassified