2015 CPR Update for Pediatric Advanced Life Support

Authors:
de Caen AR, Berg MD, Chameides L, et al.
Citation:
Part 12: Pediatric Advanced Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015;132:S526-S542.

The following are key points from the 2015 AHA pediatric advanced life support cardiopulmonary resuscitation (CPR) guidelines update (part 12):

  1. Survival from pediatric in-hospital cardiac arrest has improved to approximately 43%.
  2. Prolonged CPR is not futile; 12% of those who received CPR for >35 minutes survived, and 60% had favorable neurologic outcomes.
  3. Pre-arrest care updates:
    • Pediatric rapid response teams and the use of pediatric early warning scores in non–intensive care unit, general in-patient units may reduce mortality, but data are contradictory and inconsistent. Their use may be considered where high-risk children are cared for in general in-patient floors.
    • In septic shock, a fluid bolus of up to 20 cc/kg is reasonable, but further boluses should be guided by individualized evaluation.
    • The routine use of pre-intubation atropine during emergency intubation is not supported by available evidence, but may be considered.
    • Veno-arterial extracorporeal membrane oxygenation (ECMO) may be considered in acute fulminant myocarditis at risk for imminent arrest.
  4. Intra-arrest care updates:
    • ECMO CPR (ECPR) may be considered in those with a surgical cardiac diagnosis. Outcome after ECPR is better for those with underlying cardiac disease than for those without.
    • End-tidal CO2 and invasive hemodynamic monitoring may be considered to evaluate quality of CPR, but specific values have not been established.
    • Defibrillation energy: 2 J/kg, 4 J/kg, >4 J/kg, max of 10 J/kg or adult dose, sequentially.
    • For shock refractory ventricular fibrillation or pulseless ventricular tachycardia, amiodarone OR lidocaine may be used.
  5. Post-arrest updates:
    • Fever (>38°C) should be treated after return of circulation.
    • Aim for normoxemia and normocapnea.
    • Use fluids and vasoactive drugs to maintain a systolic blood pressure of at least 5th percentile for age.
    • Electroencephalograms within 7 days may help prognosticate neurologic outcome.
  6. The update covers only topics that underwent the 2015 systematic review process. For all other topics, the 2010 guidelines remain official.

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