2015 CPR Update for Pediatric Advanced Life Support

de Caen AR, Berg MD, Chameides L, et al.
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.

Keywords: American Heart Association, Arrhythmias, Cardiac, Amiodarone, Atropine, Blood Pressure, Cardiopulmonary Resuscitation, Electric Countershock, Electroencephalography, Emergency Medical Services, Extracorporeal Membrane Oxygenation, Heart Arrest, Intensive Care Units, Intubation, Lidocaine, Myocarditis, Pediatrics, Shock, Septic, Tachycardia, Ventricular, Ventricular Fibrillation, Heart Defects, Congenital

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