Implementation of EPLS European Paediatric Life Support courses improves Survival and Quality of Life of Paediatric Sepsis Patients

Wermter B (1,3,4), Wessel A (1), Ganzer C (1), Sasse M (1,2)(1) Department of Paediatric Cardiology and Intensive Care, MHH Medical School Hannover(2):Paediatric/Neonatal Section, German Sepsis Society(3) Educational Department, White Cross Medical Emergency Association Southtyrol(4) Paediatric Working Group, European Resuscitation Council

MHH Medizinische Hochschule HannoverPädiatrische Kardiologie & IntensivmedizinDirektor: A. Wessel

Pädiatrische Intensivstation 67M. Sasse - C. Ganzer

Carl-Neuberg-Straße 1D 30625 Hannover

wermter.burkhard@mh-hannover.de sasse.michael@mh-hannover.de

www.Kinderintensiv.de

PÄDIATRISCHE

KARDIOLOGIE & INTENSIVMEDIZIN

Prof. Dr. Armin Wessel

International Sepsis Forum ISF

SOCIEDADE PORTUGUESA DE PEDIATRIA

Introduction: Since 2000/2001 clear progress in the treatment of severe

sepsis: immediate & aggressive therapy; mortality & morbidity decrease significantly in our unit, but non in our region.

Objectives: to improve treatment of paediatric septic shock in children.

Methods: Regional paediatric intensive care network (PIN) reference PICU &

25 children’s hospitals in Lower Saxony, Saxony-Anhalt & Nordrhine-Westphaly, (2003).: 3.000.000 inhabitants. Standardised treatment/training of septic shock including standard resuscitation courses EPLS with intraosseous access, fluid-/drug-management, recognition of critical ill child, septic shock scenarios & post resuscitation care. Highly advanced Simulation Training since 2008. Implementation of emergency training, diagnosis & treatment of Waterhouse-Friedrichsen syndrome with human protein C concentrate (PC) by symposia, workshops & 6-months training periods for physicians of the network in

reference PICU. 24-h-Service for transport & consultation provided by central PICU.

Results: Implementation of EPLS in own PICU & network with

international cooperation: 24 courses, 2 instructor courses, 450 participants & 30 instructors inside the network. 8 courses outside the network.Treatment of 26 children with septic shock (herein 17 patients with Waterhouse-Friedrichsen syndrome WFS) within the network, 1 patient of non network hospital. Announcement-time: 15 min. - 1 h (not network patient: 8 h.). Consultation was requested by hospitals via phone; treatment was induced immediately. Transportation-Team of tertiary centre went to patients by ambulance or helicopter. Continuation of treatment on site & after transfer, in the tertiary centre. All patients showed typical signs of WFS with purpura fulminans & severe multi organ failure. None of the patient died. One patient had necrosis of skin, already present at admission. The others had restitution ad integrum. The patient from outside presented several areas of necrosis, needed ECMO, 1 lower leg was amputated. No adverse effects submistrating PC concentrate. Patients were retransferred to network hospitals as soon as possible.

Conclusions: EPLS is a significant factor for pediatric survival leading to active networking with high acceptance. EPLS it is an important tool for standard treatment and training. Survival rate & outcome after implementation of new treatments & trainings were excellent.

... excellent results:

ICU- and Emergency Ambulances of Firebrigade HannoverRegional ICU-Helicopter (HSD Hannover - Team DRF German Air Rescue)‏

Joint Meetings, lectures, paediatric critical care workshops (examples: accesses, emergency echocardiography...)‏

Senior collegues of PICU are introducing during a 2-month periode collegues from

Network-Hospitals in the PICU-work

Paediatric Life Support courses and Paediatric Sepsis EPLS European Paediatric Life Support- and Instructor-courses of ERC European Resuscitation Council has been introduced in 2004 by the Alpine Paediatric Life Support Trainingcenter Southtyrol & White Cross

Southtyrol in cooperation with 13 european Countries (Italy, Spain, Portugal, Switzerland, Belgium, The Netherlands, Norway, Malta, United Kingdom, Slovenia, Hungary, Poland, Greece)

EPLS-courses created an Instructor-family in the network between 2004-2008 with strong personal and professional relationships between the hospitals increasing the impact of the Regional Paediatric Intensiv Care

Network

Cooperation with Paediatric Working Group GRC German

Resuscitation Council & German Paediatric

Resuscitation Councilwww.wk-cb.bz.it

Alpine PLS Trainingcenter Southtyrol

www.provinz.bz.it/se/PaedNotMed

Paediatric Simulation & EPLS in the Network

Dep. Paediatric Cardiology & Paediatric Intensiv Care (MHH)‏

DRF German Air Rescue

White Cross Southtyrol (Italy)‏

Alpinee PLS Trainingcenter Southtyrol

Firebrigade Hannover DRK German Red Cross Lower Saxony

& DRK-School GoslarSt. John’s School Hannover

Regional PaediatricIntensive Care

Network

Hannover Lower Saxony / Germany

145

eEPLS* European Paediatric Life Support Course:

standard resuscitation-course with standard manoevers for Sepsis (*= identical procedures in PALS-course of AHA American Heart Association - www.americanheart.org) :

Early Recognition of Criticall ill childIntraosseous AccessFluid-/DrugmanagementSepsis-ScenariosPostresuscitation Care, ... www.ERC.edu

www.Kinderintensiv.de www.ERC.edu

...and 24h-Service:

consultation / transportation + Standardization of diagnosis & treatments =