Part 6: Pediatric basic life support and pediatric advanced life support

Maconochie, Ian; Caen, Allan R. de; Aickin, Richard; Atkins, Dianne L.; Biarent, Dominique; Guerguerian, Anne‐Marie; Kleinman, Monica E.; Kloeck, David; Meaney, Peter A.; Nadkarni, Vinay; Ng, Kee-Chong; Nuthall, Gabrielle; Reis, Ameila G.; Shimizu, Naoki; Tibballs, James; Pintos, Remigio Véliz; Argent, Andrew C.; Berg, Marc D.; Bingham, Robert; Bruinenberg, Jos; Chameides, Leon; Coulthard, Mark G.; Couto, Thomaz Bittencourt; Dalziel, Stuart R; Duff, Jonathan P.; Egan, Jonathan R.; Eich, Christoph; Gene, Ong Yong-Kwang; Fink, Ericka L.; Friess, Stuart H.; Fuchs, Susan; Hickey, Robert W.; Hunt, Elizabeth A.; Ikeyama, Takanari; Kissoon, Niranjan; MacLaren, Graeme; Marino, Bradley S.; McBride, Mary E.; Parker, Melissa; Raymond, Tia; Rey, Corsino; Núñez, Antonio Rodríguez; Sá, Fernanda V.M. de; Schexnayder, Stephen M.; Shibata, Audrey Rie Ogawa; Singhi, Sunit; Thiagarajan, Ravi R.; Tijssen, Janice A.; Topjian, Alexis; Urbano, Javier; Were, Wilson

doi:10.1016/j.resuscitation.2015.07.044

Cited by 93 publications

(70 citation statements)

References 91 publications

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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%

“…Of particular interest to the authors is the use of vasoactive medications, a key component of conventional CPR. Although data are lacking on drug choice, timing, and overall efficacy during CPR, the American Heart Association’s Pediatric Advanced Life Support (PALS) guidelines recommend administering epinephrine (1:10,000 concentration) IV/intraosseously every 3–5 minutes for the treatment of asystole and pulseless electrical activity (19–21). To date, consensus guidelines have not addressed vasoactive dosing regimens during conventional CPR escalating to E-CPR.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

mentioning

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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“…As noted, race/ethnicity or etiology of OHCA were not consistently available for analysis, but these types of data could be helpful to direct public health advocacy initiatives to prevent OHCA in children. Time to first epinephrine dose, a primary component of pediatric advanced life support, was associated with survival in a study of pediatric IHCA 20,21 . Interestingly, only 65% of children were given epinephrine by EMS in this study.…”

Section: Discussionmentioning

confidence: 99%

“…For children, consideration should be given to modifying the chain of survival to stress preventative measures for respiratory and cardiac arrest events, educational efforts for faster recognition and highest quality treatment performance of the deteriorating child by bystander and first responders, discovery of effective therapeutic interventions, and rehabilitative strategies 21,29 .…”

Section: Discussionmentioning

confidence: 99%

Unchanged pediatric out-of-hospital cardiac arrest incidence and survival rates with regional variation in North America

et al. 2016

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Aim Outcomes for pediatric out-of-hospital cardiac arrest (OHCA) are poor. Our objective was to determine temporal trends in incidence and mortality for pediatric OHCA. Methods Adjusted incidence and hospital mortality rates of pediatric non-traumatic OHCA patients from 2007-2012 were analyzed using the 9 region Resuscitation Outcomes Consortium - Epidemiological Registry (ROC-Epistry) database. Children were divided into 4 age groups: perinatal (< 3 days), infants (3 days - 1 year), children (1 - 11 years), and adolescents (12 - 19 years). ROC regions were analyzed post-hoc. Results We studied 1,738 children with OHCA. The age- and sex-adjusted incidence rate of OHCA was 8.3 per 100,000 person-years (75.3 for infants vs. 3.7 for children and 6.3 for adolescents, per 100,000 person-years, p<0.001). Incidence rates differed by year (p<0.001) without overall linear trend. Annual survival rates ranged from 6.7-10.2%. Survival was highest in the perinatal (25%) and adolescent (17.3%) groups. Stratified by age group, survival rates over time were unchanged (all p>0.05) but there was a non-significant linear trend (1.3% increase) in infants. In the multivariable logistic regression analysis, infants, unwitnessed event, initial rhythm of asystole, and region were associated with worse survival, all p<0.001. Survival by region ranged from 2.6-14.7%. Regions with the highest survival had more cases of EMS-witnessed OHCA, bystander CPR, and increased EMS-defibrillation (all p<0.05). Conclusions Overall incidence and survival of children with OHCA in ROC regions did not significantly change over a recent 5 year period. Regional variation represents an opportunity for further study to improve outcomes.

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“…Epidemiological investigations often report resuscitation efforts of up to two hours [3, 29]. In the absence of a reversible cause and after asystole for more than 20 min despite ongoing ALS, the 2015 ERC-Guidelines recommend to consider withholding CPR [12, 30]. In our study, cumulative CPR-duration (sum of bystander and EMS-CPR) was known for 29 patients.…”

Section: Discussionmentioning

confidence: 89%

Adult “termination-of-resuscitation” (TOR)-criteria may not be suitable for children - a retrospective analysis

Rotering

Trepels-Kottek

Heimann

et al. 2016

Scand J Trauma Resusc Emerg Med

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BackgroundOnly a small number of patients survive out-of-hospital-cardiac-arrest (OHCA). The duration of CPR varies considerably and transportation of patients under CPR is often unsuccessful. Termination-of-resuscitation (TOR)-criteria aim to preclude futile resuscitation efforts.Our goal was to find out to which extent existing TOR-criteria can be transferred to paediatric OHCA-patients with special regard to their prognostic value.MethodsWe performed a retrospective analysis of an eleven-year single centre patient cohort. 43 paediatric patients admitted to our institution after emergency-medical-system (EMS)-confirmed OHCA from 2003 to 2013 were included. Morrison’s BLS- and ALS-TOR-rules as well as the Trauma-TOR-criteria by the American Association of EMS Physicians were evaluated for application in children, by calculating sensitivity, specificity, negative and positive predictive value for death-, as well as survival-prediction in our cohort.Results26 patients achieved ROSC and 14 were discharged alive (n = 7 PCPC 1/2, n = 7 PCPC 5). Sensitivity for BLS-TOR-criteria predicting death was 48.3%, specificity 92.9%, the PPV 93.3% and the NPV 46.4%. ALS-TOR-criteria for death had a sensitivity of 10.3%, specificity of 100%, a PPV of 100% and an NPV of 35%.ConclusionRetrospective application of the BLS-TOR-rule in our patient cohort identified the resuscitation of one later survivor as futile. ALS-TOR-criteria did not give false predictions of death. The proportion of CPRs that could have been abandoned is 48.2% for the BLS-TOR and only 10.3% for the ALS-TOR-rule. Both rules therefore appear not to be transferable to a paediatric population.

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Part 6: Pediatric basic life support and pediatric advanced life support

Cited by 93 publications

References 91 publications

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

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

Unchanged pediatric out-of-hospital cardiac arrest incidence and survival rates with regional variation in North America

Adult “termination-of-resuscitation” (TOR)-criteria may not be suitable for children - a retrospective analysis

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