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UPDATECPR IN PAEDIATRICS
Jirayut Jarutach MD
Division of Pediatric Cardiology
Department of Pediatric, PSU hospital
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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
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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
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2 or more RescuersSingle Rescuer
CIRCULATION 2015
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CIRCULATION 2015
PBLS: Single Rescuer
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CIRCULATION 20156
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CIRCULATION 2015
PBLS: 2 or more Rescuers
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CIRCULATION 20158
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PEDIATRIC RESUSCITATION 2015
AUTOMATED EXTERNAL DEFIBRILLATOR (AED)
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PEDIATRIC RESUSCITATION 2015
AUTOMATED EXTERNAL DEFIBRILLATOR (AED)
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PALS ADDRESSED ISSUES
PEDIATRIC ADVANCE LIFE SUPPORT
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CIRCULATION 2015
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PEDIATRIC RESUSCITATION 2015
PALS ALGORITHM
▸ Pulseless arrest
▸ Tachycardia
▸ Bradycardia
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PEDIATRIC RESUSCITATION 2015
PULSELESS ARREST
▸ Ventricular fibrillation (VF)
▸ Pulseless ventricular tachycardia (pVT)
▸ Pulseless electrical activity (PEA)
▸ Asystole
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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
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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
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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
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4. ANTIARRHYTHMIC MEDICATIONS FOR SHOCK-REFRACTORY VF OR PULSELESS VT
2015
Amiodarone or Lidocaine
2010
Amiodarone
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2015
Reasonable to give Epinephrine during
cardiac arrest
2010
Epinephrine should be given for pulseless arrest
5. VASOPRESSORS FOR RESUSCITATION
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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
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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
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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
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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
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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%
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PULSELESS ARREST ALGORITHM2010 2015
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TACHYCARDIA ALGORITHM (SAME)2010 2015
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BRADYCARDIA ALGORITHM (SAME)2010 2015
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