What works in paediatric CPR?
- 22.09.2017
- What's New in Intensive Care
Erschienen in:
- Verfasst von
- Sophie Skellett
- Dominique Biarent
- Vinay Nadkarni
- Erschienen in
- Intensive Care Medicine | Ausgabe 2/2018
Auszug
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
|
|||
|
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
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- 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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