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Erschienen in: Intensive Care Medicine 2/2018

22.09.2017 | What's New in Intensive Care

What works in paediatric CPR?

verfasst von: Sophie Skellett, Dominique Biarent, Vinay Nadkarni

Erschienen in: Intensive Care Medicine | Ausgabe 2/2018

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Excerpt

Over the last 15 years, return of spontaneous circulation (ROSC) following paediatric in-hospital cardiac arrest (IHCA) has improved from less than 50% to more than 80%, and survival to hospital discharge has improved from 14% to more than 40% (Table 1). However, survival after paediatric out-of-hospital CA (OHCA) remains low at 4–13%. Early recognition and rapid response to pre-arrest conditions, high quality first responder cardiopulmonary resuscitation (CPR), goal-directed CPR and post-resuscitative care, and extracorporeal support of circulation for special reversible cardiac arrest conditions offer great promise for further improved survival and quality of life outcomes.
Table 1
Summary table
 
Authors
Year
% Patients with ROSC
% Survival to discharge
Survival after paediatric IHCA is improving
Slonim
1997
Not reported
14%
Meaney
2006
50%
22%
De Moss
2006
82%
25%
Berg
2013
72%
38%
Berg
2016
78%
45%
Bystander CPR
Improves survival after OHCA in children
Dispatch-directed CPR improves bystander CPR rates for children (and adults) [24]
Physiological directed CPR
CPP to target during IHCA with arterial line and CVP line in situ
No absolute level known in children or adults but reasonable to aim for [6]:
CPP > 25 mmHg
(adult guidelines suggest > 20 mmHg)
 
DBP to target during IHCA with arterial line in situ
No absolute level known in children or adults but reasonable to aim for [6]:
DBP > 25–30 mmHg
(adult guidelines suggest > 25 mmHg)
Adrenaline use
Adrenaline for OHCA in children
No evidence in children but best given early
 
Adrenaline timing IHCA in children
Time to first adrenaline dose is important and should be as soon as CA with non-shockable rhythm noted and intravascular access secured; 1 min within start CPR ideal [9]
 
Adrenaline interval dosing in children in IHCA
A recent study appears to indicate that giving adrenaline every 4 min may be too frequently and intervals of 8–10 min may be preferable [11]
ECPR
Use of ECPR in children
Consider for children with IHCA resistant to C-CPR (defined as ≥ 10 min) with a potentially reversible cause for the arrest at centres where expertise and equipment available [13]
TTM post CA
TTM after OHCA in children
Maintenance of controlled normothermia or hypothermia, with strict avoidance of fever is important; the length of time is unclear [15]
 
TTM after IHCA in children
Maintenance of controlled normothermia, with strict avoidance of fever, after IHCA is important; the length of time is unclear [14]
CPP coronary perfusion pressure, CPR cardiopulmonary resuscitation, DBP diastolic blood pressure, ECPR extracorporeal cardiopulmonary resuscitation, IHCA in-hospital cardiac arrest, OHCA out-of-hospital cardiac arrest, ROSC return of spontaneous circulation, TTM targeted temperature management
Literatur
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Metadaten
Titel
What works in paediatric CPR?
verfasst von
Sophie Skellett
Dominique Biarent
Vinay Nadkarni
Publikationsdatum
22.09.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
Intensive Care Medicine / Ausgabe 2/2018
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-017-4946-2

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