Updated International Guidelines for Pediatric Resuscitation
Katherine Bakes, MD
Goals for emergency physicians include focusing on both respiratory and cardiac support, with consideration of targeted temperature management and extracorporeal membrane oxygenation when feasible.
Sponsoring Organization: International Liaison Committee on Resuscitation
Target Audience: Physician who care for critically ill children, including emergency physicians, family medicine physicians, pediatricians, and pediatric intensivists.
Background and Objective: These guidelines update the 2010 International Liaison Committee on Resuscitation guidelines for pediatric resuscitation.
Key Recommendations:
- Because many pediatric arrests involve a respiratory event, rescue breaths should accompany chest compressions for pediatric cardiac arrest.
- Defibrillation doses should start at 2-4 J/kg with monophasic or biphasic waveform devices.
- Either amiodarone or lidocaine may be used for shock resistant ventricular fibrillation or pulseless ventricular tachycardia.
- Based on short-term outcomes, standard-dose epinephrine is a reasonable vasopressor choice.
- When expertise and resources are available,
- Extracorporeal membrane oxygenation (ECMO) should be considered for children with cardiac diagnoses (e.g., fulminant myocarditis) who have in-hospital cardiac arrest.
- Children with out-of-hospital cardiac arrest and return of spontaneous circulation should undergo targeted temperature management (TTM) – either hypothermia (32°C – 34°C) or normothermia (36°C – 37.5°C).
- Positive outcome predictors (e.g., age >1 year, initial shockable rhythm) can be used to assist in prognostic decision-making and to determine futility of further resuscitation efforts.
Owing to lack of evidence for or against, no recommendations could be made for the following in pediatric resuscitation.
- Use of atropine to prevent shock or arrhythmias with intubation.
- Prioritizing chest compressions (C-B-A) versus airway and breathing (A-B-C) in cardiac arrest.
- Use of end tidal CO2 to adjust chest compression technique.
- TTM for children with in-hospital cardiac arrest and return of spontaneous circulation.
Comment:
These recommendations are largely unchanged from the 2010 guidelines, save the new additional recommendations for centers with the ability to provide TTM and ECMO.
Citation(s):
de Caen AR, et al. Part 6: Pediatric basic life support and pediatric advanced life support. 2015 international consensus on cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations. Circulation 2015 Oct 20;132:S177. (http://dx.doi.org/10.1161/CIR.0000000000000275)
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