Review article: Paediatric status epilepticus in the pre‐hospital setting: An update

Abstract

Paediatric status epilepticus (SE) is a medical emergency and a common critical condition confronting pre-hospital providers. Management in the pre-hospital environment is challenging but considered extremely important as a potentially modifiable factor on outcome. Recent data from multicentre clinical trials, quality observational studies and consensus documents have influenced management in this area, and is important to both pre-hospital providers and emergency physicians. The objective of this review was to: (i) present an overview of the available evidence relevant to pre-hospital care of paediatric SE; and (ii) assess the current pre-hospital practice guidelines in Australia and New Zealand. The review outlines current definitions and guidelines of SE management, regional variability in pre-hospital protocols within Australasia and aspects of pre-hospital care that could potentially be improved. Contemporary data is required to determine current practice in our setting. It is important that paediatric neurologists, emergency physicians and pre-hospital care providers are all engaged in future endeavours to improve clinical care and knowledge translation efforts for this patient group.

Prehospital benzodiazepine use and need for respiratory support in paediatric seizures

“…Another important aspect of prehospital CSE management, especially in paediatric populations, is dosing. The correct weight-based dose of intramuscular midazolam has been subject to discussion ranging from 0.1 to 0.2 mg/kg4 5 26 and fixed doses of 5 mg for patients weighing from 13 to 40 kg and 10 mg above 40 kg 11 27 28. Incorrect weight-based dosing in the prehospital setting has been an important issue of concern for paramedics29 and in a recent study, a third of treated patients received an incorrect dose 30.…”

“…This has led to a change in clinical practice guidelines 31 32. While many prehospital providers, including Australian emergency medical service systems,26 are still limited to first-line BZD treatment only, levetiracetam and valproate are attractive alternatives to repeated BZD. Levetiracetam requires a 5 min intravenous infusion but has a favourable adverse event profile, while valproate can be given as an intravenous bolus but has some hypothetical concerns regarding use in young infants 33.…”

Status Epilepticus Australasian Registry for Children: A pilot prospective, observational, cohort study of paediatric status epilepticus

“…if >40 kg, and 5 mg if 13–40 kg, 9,17 which simplifies management, but may lead to wide variation in weight‐based dosages. A recent review found wide dosing variation in pre‐hospital services in Australia and New Zealand 18 . The heterogeneity of midazolam dosing and other AEDs could be useful to explore in high quality, adequately powered, prospectively collected observational data, and could provide evidence regarding the effectiveness of various dosages of midazolam for seizure cessation.…”

“…A recent review found wide dosing variation in pre-hospital services in Australia and New Zealand. 18 The heterogeneity of midazolam dosing and other AEDs could be useful to explore in high quality, adequately powered, prospectively collected observational data, and could provide evidence regarding the effectiveness of various dosages of midazolam for seizure cessation. Until recently, there was no highquality evidence on second-line AEDs for children with SE.…”

Akute neurologische Notfälle im Kindesalter

“…Ein bilateral tonisch-klonischer Anfall sollte spätestens nach 5 min Dauer durchbrochen werden. Bei einem fokalen Anfall sollte dies spätestens nach 10 min und bei Absence-Anfällen nach 10-15 min erreicht sein [10,17].…”