Paediatric Resuscitation Update

Bedside Critical Care, Daydream IslandSeptember 2012

Dr Francis Lockie,

Paediatric Emergency Department

Women’s and Children’s Hospital

MedSTAR Emergency Medical Retrieval

South Australia

Talk outline

• Scope of arrests in children– Out-of hospital– In hospital

• Resus update

• Improve survival– Training– Met teams

Out-of-Hospital Pediatric Cardiac Arrest: An Epidemiologic Review and Assessment of Current Knowledge

Ann Emerg Med. 2005 Dec;46(6):512-22

41 studies5000 out of hospital paediatric arrestsOverall survival 12.1%, Neurologically intact 4%

JAMA. 2006;295(1):50-57

Survival to hospital discharge 27% in kids (vs 18% in adults)Good neurological outcome in 17% (vs 13%) OR First pulseless rhythm

oVF/pulseless VT: 14% vs 23%oAsystole 40% vs 35%oPEA 24% vs 32%

• Arrest in 111 of >100 000 admissions• ROSC in 73%• Survival to discharge 36%• Hypotensive-bradycardia 66%• Asystole 15%• VF / pulseless VT 9%• SVT

2010 Update

JAMA. 2010;304(13):1447-1454

No bystander CPR 5.2%Conventional CPR 7.8%COCPR 13.3%

JAMA. 2010;304(13):1447-1454

Pediatric Anesthesia 2009 19 (Suppl. 1): 46–54

Uncuffed

– Age/4 + 4– Minimize airway

oedema– Larger internal

diameter– Age/2+12 cm at

lips (oral)

Cuffed

– Age/4 + 3– Improved airway

protection– Higher airway

pressures– Reduced

laryngoscopy attempts

Where exactly does the intraosseous (IO) fit?

ILCOR 2005

ILCOR 2010

Where exactly does the intraosseous (IO) fit?

Concerns re: complications•Pain•Success•Extravasation•Growth plate injury•osteomyelitis

• 95 patients• Mean age 5.5• 95% success• 10 seconds or less• Pain score 2.3

Pediatr Emerg Care 2008

• 291 patients• 34% arrested• 86% placed in

community hospitals• 37% mortality

• NO COMPLICATIONS

Hansen Pediatr Emerg Care 2011

Pediatr Crit Care Med 2009 Vol. 10, No. 3

• Total hospital deaths decreased

from 4.38 to 2.87 / 1000 admissions• 34 hospital deaths prevented each year of

MET operation• Survival increased from 35% to 74%• Annual calls went from 46 to 202 with MET

3 days 1 day 90mins

1920-2120 350-500 Free

Paediatric Life Support for Healthcare Rescuers

Basic Life Support occurs in the community by lay people with no or little equipment

• The first 5 -10 minutes of a paediatric collapse in a healthcare setting

• Includes CRM: teamwork, leadership• Good uptake

– 8000 completed the e-learning– 3600 completed short practical course– 517 trainers– 30 Super trainers

• Will be pre-requisite for DETECT junior in NSW

• Adopted by Sunshine Coast, Qld

• Adopted by ACT Health

• Available to other States and Territories for minimal cost

Resus4kids.com.au fenton.oleary@health.nsw.gov.au

Other issues covered

• Family presence during resus

• ECMO

• Complex congenital heart disease

• Trauma– C-A-B approach– Fluid restrictive resus

Other issues covered

• Family presence during resus• ECMO• Complex congenital heart disease• Trauma

– C-A-B approach– Fluid restrictive resus

• Don’t forget – Parent education– Public health measures

Summary

• Scope of paediatric arrests

• Whip through some recent changes

• How we can improve paediatric resus outcomes for our patients– Individual– Hospitals– State