Part 6: Paediatric basic and advanced life support
Section snippets
Initial steps of CPR
The ECC Guidelines 20001 recommended that lone rescuers of adult victims of cardiac arrest phone the emergency medical services (EMS) system and get an AED (“call first”) before starting CPR. The lone rescuer of an unresponsive infant or child victim was instructed to provide a brief period of CPR before leaving the victim to phone for professional help and an AED (“call fast”). These sequence differences were based on the supposition that cardiac arrest in adults is due primarily to
Disturbances in cardiac rhythm
Evidence evaluation for the treatment of haemodynamically stable arrhythmias focused on vagal manoeuvres, amiodarone, and procainamide. There were no new data to suggest a change in the indications for vagal manoeuvres or procainamide. Several case series described the safe and effective use of amiodarone in children, but these studies involved selected patient populations (often with postoperative arrhythmias) treated by experienced providers in controlled settings. Although there is no change
Airway and ventilation
Maintaining a patent airway and ventilation are fundamental to resuscitation. Adult and animal studies during CPR suggest detrimental effects of hyperventilation and interruption of chest compressions. For children requiring airway control or ventilation for short periods in the out-of-hospital setting, bag-valve-mask (BVM) ventilation produces equivalent survival rates compared with ventilation with tracheal intubation.
The risks of tracheal tube misplacement, displacement, and obstruction are
Vascular access and drugs for cardiac arrest
Vascular access can be difficult to establish during resuscitation of children. Review of the evidence showed increasing experience with IO access and resulted in a de-emphasis of the tracheal route for drug delivery. Evidence evaluation of resuscitation drugs was limited by a lack of reported experience in children. There was little experience with vasopressin in children in cardiac arrest and inconsistent results in adult patients. In contrast, there was a good study in children showing no
Postresuscitation care
Postresuscitation care is critical to a favourable outcome. An evidence-based literature review was performed on the topics of brain preservation and myocardial function after resuscitation from cardiac arrest. It showed the potential benefits of induced hypothermia on brain preservation, the importance of preventing or aggressively treating hyperthermia, the importance of glucose control, and the role of vasoactive drugs in supporting haemodynamic function.
Prognosis
One of the most difficult challenges in CPR is to decide the point at which further resuscitative efforts are futile. Unfortunately, there are no simple guidelines. Certain characteristics suggest that resuscitation should be continued (e.g. ice water drowning, witnessed VF arrest), and others suggest that further resuscitative efforts will be futile (e.g. most cardiac arrests associated with blunt trauma or septic shock).
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