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Resuscitation

Volume 81, Issue 1, Supplement, October 2010, Pages e213-e259
Resuscitation

Part 10: Paediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations,☆☆

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Systems

Medical emergency teams (METs) or rapid response teams (RRTs) have been shown to be effective in preventing respiratory and cardiac arrests in selected paediatric inpatient settings.

Family presence during resuscitations has been shown to be beneficial for the grieving process and in general was not found to be disruptive. Thus, family presence is supported if it does not interfere with the resuscitative effort.

Assessment

Many healthcare providers find it difficult to rapidly and accurately determine the presence or absence of a pulse. On the basis of available evidence, the Task Force decided to deemphasise but not eliminate the pulse check as part of the healthcare provider assessment. The Task Force members recognised that healthcare providers who work in specialised settings may have enhanced skills in accurate and rapid pulse checks, although this has not been studied.

There are considerable data regarding

Airway and ventilation

Opening and maintaining a patent airway and providing ventilations are fundamental elements of paediatric CPR, especially because cardiac arrest often results from, or is complicated by, asphyxia. There are no new data to change the 2005 ILCOR recommendation to use manual airway maneuvers (with or without an oropharyngeal airway) and bag-mask ventilation (BMV) for children requiring airway control or positive-pressure ventilation for short periods in the out-of-hospital setting. When airway

Chest compressions

The concept of chest compression-only CPR is appealing because it is easier to teach than conventional CPR, and immediate chest compressions may be beneficial for resuscitation from sudden cardiac arrest caused by VF or pulseless VT. Animal studies showed that conventional CPR, including ventilations and chest compressions, is best for resuscitation from asphyxial cardiac arrest. In a large study of out-of-hospital paediatric cardiac arrest,176 few children with asphyxial arrest received

Compression–ventilation ratio

The ILCOR Neonatal Task Force continues to recommend a compression–ventilation ratio of 3:1 for resuscitation of the newly born in the delivery room, with a pause for ventilation whether or not the infant has an advanced airway. The Paediatric Task Force reaffirmed its recommendation for a 15:2 compression–ventilation ratio for two-rescuer infant CPR, with a pause for ventilation in infants without an advanced airway, and continuous compressions without a pause for ventilation for infants with

Vascular access and drug delivery

There is no new evidence to change the 2005 ILCOR recommendations on vascular access, including the early use of intraosseous (IO) access and de-emphasis of the tracheal route of drug delivery. Epidemiological data, largely from the National Registry of CPR (NRCPR), reported an association between vasopressin, calcium, or sodium bicarbonate administration and an increased likelihood of death. These data, however, cannot be interpreted as a cause-and-effect relationship. The association may be

Defibrillation

The Paediatric Task Force evaluated several issues related to defibrillation, including safe and effective energy dosing, stacked versus single shocks, use of automated external defibrillators (AEDs) in infants ≤1 year of age and paddle/pad type, size, and position. There were a few new human and animal studies on these topics, and the level of evidence (LOE) was generally 3–5. No new data are available to support a change in drug treatment of recurrent or refractory VF/pulseless VT. There were

Arrhythmia therapyPeds-030

.

The evidence on emergency treatment of arrhythmias was reviewed and the only change was the addition of procainamide as possible therapy for refractory supraventricular tachycardia (SVT).

Drugs for supraventricular tachycardiaPeds-031

.

Shock

The Task Force reviewed evidence related to several key questions about the management of shock in children. There is ongoing uncertainty about the indications for using colloid versus crystalloid in shock resuscitation. One large adult trial suggested that normal saline (isotonic crystalloid) is equivalent to albumin, although subgroup analysis suggested harm associated with the use of colloid in patients with traumatic brain injury. There were insufficient data to change the 2005

Medications in cardiac arrest and bradycardia

The Task Force reviewed and updated evidence to support medications used during cardiac arrest and bradycardia, but no new recommendations were made. It was again emphasised that calcium and sodium bicarbonate should not be routinely used in paediatric cardiac arrest (i.e., should not be used without specific indications).

Extracorporeal cardiac life supportPeds-014, Peds-014B

.

.

There is increasing evidence that extracorporeal cardiac life support (ECLS) can act as a bridge to maintain oxygenation and circulation in selected infants and children with cardiac arrest if they are transplant candidates or have a self-limited or treatable illness. When ECLS is initiated for the treatment of cardiac arrest, it is referred to as ECPR (extracorporeal CPR). ECPR can only be employed if the cardiac arrest occurs in a monitored environment with protocols and personnel for rapid

Post-resuscitation care

The Task Force reviewed evidence regarding hypothermia for paediatric patients who remain comatose following resuscitation from cardiac arrest. There is clear benefit for adult patients who remain comatose after VF arrest, but there is little evidence regarding effectiveness for infants (i.e., beyond the neonatal period) and young children who most commonly have asphyxial arrest.

Some patients with sudden death without an obvious cause have a genetic abnormality of myocardial ion channels (i.e.,

Special situations

New topics introduced in this document include resuscitation of infants and children with certain congenital cardiac abnormalities, namely single ventricle following stage I procedure and following the Fontan or bidirectional Glenn procedures (BDGs) as well as resuscitation of infants and children with cardiac arrest and pulmonary hypertension.

Consensus on science

In one LOE 3687 and one LOE 4688 study, survival from in-hospital paediatric cardiac arrest in the 1980 s was approximately 9%. One LOE 1538 and one LOE 3 paediatric study689 showed that survival from in-hospital cardiac arrest in the early 2000 s was 16–18%. Three prognostic LOE 1 prospective observational paediatric studies from 2006537, 690, 691 reported that survival from in-hospital cardiac arrest in 2006 was 26–27%.

One LOE 1 prospective study300 showed that survival from all paediatric

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  • Cited by (0)

    Note from the writing group: Throughout this article, the reader will notice combinations of superscripted letters and numbers (e.g., “Family Presence During ResuscitationPeds-003”). These callouts are hyperlinked to evidence-based worksheets, which were used in the development of this article. An appendix of worksheets, applicable to this article, is located at the end of the text. The worksheets are available in PDF format and are open access.

    ☆☆

    The European Resuscitation Council requests that this document be cited as follows: de Caen AR, Kleinman ME, Chameides L, Atkins DL, Berg RA, Berg MD, Bhanji F, Biarent D, Bingham R, Coovadia AH, Hazinski MF, Hickey RW, Nadkarni VM, Reis AG, Rodriguez-Nunez A, Tibballs J, Zaritsky AL, Zideman D, On behalf of the Paediatric Basic and Advanced Life Support Chapter Collaborators. Part 10: Paediatric basic and advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2010;81:e213–e259.

    We thank the following individuals for their collaborations on the worksheets contained in this chapter: Ian Adatia; Richard P. Aickin; Dianne Atkins; Marc Berg; Robert A. Berg; John Berger; Jeffrey M. Berman; Farhan Bhanji; Dominique Biarent; Robert Bingham; Desmond Bohn; Kate L. Brown; Leon Chameides; Ashraf Coovadia; Mark G. Coulthard; Allan de Caen; Douglas Diekema; Aaron Donoghue; Jonathan Duff; Jonathan R. Egan; Christoph B. Eich; Diana Fendya; Ericka Fink; Loh Tsee Foong; Eugene Freid; Susan Fuchs; Anne-Marie Guerguerian; Bradford D. Harris; Robert Hickey; George M. Hoffman; James S. Hutchison; Sharon B. Kinney; Monica Kleinman; Sasa Kurosawa; Jesús Lopez-Herce; Ian Maconochie; Sharon E. Mace; Duncan Macrae; Mioara D. Manole; Bradley Marino; Felipe Martinez; Reylon A. Meeks; Marilyn Morris; Akira Nishisaki; Masahiko Nitta; Gabrielle Nuthall; Sergio Pesutic; Lester Proctor; Faiqa Qureshi; Amelia Reis; Sergio Rendich; Antonio Rodriguez-Nunez; Ricardo Samson; Kennith Sartorelli; Stephen M. Schexnayder; William Scott; Vijay Srinivasan; Robert Michael Sutton; Mark Terry; James Tibballs; Shane Tibby; Alexis Topjian; Elise van der Jagt; David Wessel; Arno Zaritsky; and David Zideman.

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    Co-chairs and equal first co-authors.

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