UPDATECPR IN PAEDIATRICS

Jirayut Jarutach MD

Division of Pediatric Cardiology

Department of Pediatric, PSU hospital

1

PEDIATRIC RESUSCITATION 2015

PEDIATRIC-BLS: KEY ISSUES & MAJOR CHANGES

• Same C-A-B sequence • Adolescent: CC depth(upper limit 6 cm) • CC rate 100-120/min • Conventional CPR better than hand only CPR • Algorithms: 1 & multiple rescuer,cell phone

era

CIRCULATION 2015

2

PEDIATRIC RESUSCITATION 2015

HIGH QUALITY CPR “5 ”

1. กดแรง: >1/3 ของความหนาของหน้าอก (4 cm ทารก, 5 cm เด็ก และ 5-6 cm วัยรุ่น)

2. กดเร็ว: 100-120 ครั้งต่อนาที 3. รอ 4. กดไปเรื่อยๆ

5. ระวัง hyperventilation

ร 3

2 or more RescuersSingle Rescuer

CIRCULATION 2015

4

CIRCULATION 2015

PBLS: Single Rescuer

5

CIRCULATION 20156

CIRCULATION 2015

PBLS: 2 or more Rescuers

7

CIRCULATION 20158

PEDIATRIC RESUSCITATION 2015

AUTOMATED EXTERNAL DEFIBRILLATOR (AED)

9

PEDIATRIC RESUSCITATION 2015

AUTOMATED EXTERNAL DEFIBRILLATOR (AED)

10

PALS ADDRESSED ISSUES

PEDIATRIC ADVANCE LIFE SUPPORT

11

CIRCULATION 2015

PEDIATRIC RESUSCITATION 2015

PALS ALGORITHM

▸ Pulseless arrest

▸ Tachycardia

▸ Bradycardia

12

PEDIATRIC RESUSCITATION 2015

PULSELESS ARREST

▸ Ventricular fibrillation (VF)

▸ Pulseless ventricular tachycardia (pVT)

▸ Pulseless electrical activity (PEA)

▸ Asystole

13

1.RECOMMENDATIONS OF FLUID RESUSCITATION

2015

Shock : bolus of 20 ml/kg

Febrile illness with limited access to critical care : bolus fluid should be

given with extreme caution

14

2. ATROPINE FOR ENDOTRACHEAL INTUBATION

2015

No routine of atropine to prevent bradycardia.

No minimum dose.

2010

Atropine minimum dose = 0.1 mg

(paradoxical bradycardia)

*Dose Atropine = 0.02 mg/kg

*In symptomatic bradycardia; still has minimum dose

15

3. INVASIVE HEMODYNAMIC MONITORING DURING CPR

2015

Use of invasive hemodynamic

monitoring to guide CPR quality

2010

Use of arterial catheter waveform as a feedback

of compression effectiveness

16

4. ANTIARRHYTHMIC MEDICATIONS FOR SHOCK-REFRACTORY VF OR PULSELESS VT

2015

Amiodarone or Lidocaine

2010

Amiodarone

17

2015

Reasonable to give Epinephrine during

cardiac arrest

2010

Epinephrine should be given for pulseless arrest

5. VASOPRESSORS FOR RESUSCITATION

18

6. ECPR COMPARED WITH STANDARD RESUSCITATION

2015

ECPR may be considered in cardiac patients with IHCA (available set up)

2010

ECPR may be considered in IHCA refractory to standard

resuscitation and with reversible cause (available

set up)

*IHCA: intra-hospital cardiac arrest

*ECPR: ECMO-CPR

19

20

7. TARGETED TEMPERATURE MANAGEMENT

2015

Comatosed IHCA:continuous temperature monitoring, fever treated aggressively

Comatosed OHCA:

5 days of normothermia (36-37.5 C)

2 days of hypothermia (32-34 C) then 3 days of normothermia

*2010 Therapeutic hypothermia may be considered in children who remain comatose after resuscitation

21

8. INTRA-ARREST AND POST-ARREST PROGNOSTIC FACTORS

2015

Consider multiple factors to continue or terminate

resuscitation or estimate recovery

2010

Consider multiple variable to prognosticate outcomes

22

9. POST–CARDIAC ARREST FLUIDS AND INOTROPES

2015

After ROSC Fluids/Inotropes/Vasopressor should be used

Use of intra-arterial monitoring, target SBP >5th

for age

2010

No recommendation

23

10. TARGET OF OXYGENATION AND CO2 LEVEL AFTER ROSC

2015

After ROSC, Keep SpO2 94-99% and target PaCO2

for avoid hyper or hypocarbia

2010

After ROSC, titrate FiO2 keep SpO2 94-99%

24

PULSELESS ARREST ALGORITHM2010 2015

25

TACHYCARDIA ALGORITHM (SAME)2010 2015

26

BRADYCARDIA ALGORITHM (SAME)2010 2015

27