Pediatric Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Abstract

This 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (CoSTR) for pediatric life support is based on the most extensive evidence evaluation ever performed by the Pediatric Life Support Task Force. Three types of evidence evaluation were used in this review: systematic reviews, scoping reviews, and evidence updates. Per agreement with the evidence evaluation recommendations of the International Liaison Committee on Resuscitation, only systematic reviews could result in a new or revised treatment recommendation. Systematic reviews performed for this 2020 CoSTR for pediatric life support included the topics of sequencing of airway-breaths-compressions versus compressions-airway-breaths in the delivery of pediatric basic life support, the initial timing and dose intervals for epinephrine administration during resuscitation, and the targets for oxygen and carbon dioxide levels in pediatric patients after return of spontaneous circulation. The most controversial topics included the initial timing and dose intervals of epinephrine administration (new treatment recommendations were made) and the administration of fluid for infants and children with septic shock (this latter topic was evaluated by evidence update). All evidence reviews identified the paucity of pediatric data and the need for more research involving resuscitation of infants and children.

European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions

“…The European Resuscitation Council (ERC) ethics writing group acknowledges the ALS and paediatric life support 2020 ILCOR COSTRs that support the use of E-CPR as a rescue therapy for selected cardiac arrest patients when conventional CPR has failed in settings where E-CPR can be implemented (weak recommendation, very-low certainty of evidence). 154,155 To inform our insights, we further identified 6 systematic reviews, 156À161 four narrative reviews 162À165 and 13 observational studies 68,140,160,166À175 on this topic.…”

Non-invasive carbon dioxide monitoring in neonates: methods, benefits, and pitfalls

“… ETT placement: the 2020 AHA and 2016 Neonatal resuscitation Program (NRP) guidelines recommend confirming ETT placement by CCDD or waveform capnography in intubated infants with a perfusing cardiac rhythm (Fig. 5 ) [ 74 , 75 ]. CCDD is more accurate as well as quicker in confirming correct ETT placement when compared to clinical assessment [ 76 , 77 ].…”

Complete atrio-ventricular block with coronary artery spasm due to direct laryngoscopy in a pediatric patient with laryngeal papillomatosis: a case report

“…Pediatric life support algorithm suggests the consideration of atropine administration for bradycardia caused by an increased vagal tone [13]. However, we should have considered epinephrine administration or the use of an external pacemaker because atropine, which acts at the AV node, is rarely effective in patients with a complete AV block.…”