2019 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Abstract

This 2019 focused update to the American Heart Association pediatric advanced life support guidelines follows the 2018 and 2019 systematic reviews performed by the Pediatric Life Support Task Force of the International Liaison Committee on Resuscitation. It aligns with the continuous evidence review process of the International Liaison Committee on Resuscitation, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update provides the evidence review and treatment recommendations for advanced airway management in pediatric cardiac arrest, extracorporeal cardiopulmonary resuscitation in pediatric cardiac arrest, and pediatric targeted temperature management during post-cardiac arrest care. The writing group analyzed the systematic reviews and the original research published for each of these topics. For airway management, the writing group concluded that it is reasonable to continue bag-mask ventilation (versus attempting an advanced airway such as endotracheal intubation) in patients with out-of-hospital cardiac arrest. When extracorporeal membrane oxygenation protocols and teams are readily available, extracorporeal cardiopulmonary resuscitation should be considered for patients with cardiac diagnoses and in-hospital cardiac arrest. Finally, it is reasonable to use targeted temperature management of 32°C to 34°C followed by 36°C to 37.5°C, or to use targeted temperature management of 36°C to 37.5°C, for pediatric patients who remain comatose after resuscitation from out-of-hospital cardiac arrest or in-hospital cardiac arrest. This 2019 focused update to the American Heart Association (AHA) pediatric advanced life support (PALS) guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care (ECC) is based on 3 systematic reviews 1-3 and the resulting

Development and Usability of a Novel Interactive Tablet App (PediAppRREST) to Support the Management of Pediatric Cardiac Arrest: Pilot High-Fidelity Simulation-Based Study

“…The app was designed to guide the team leader to perform resuscitation interventions in the sequence/timing and modality reported by the American Heart Association (AHA) PALS 2015 guidelines [ 6 - 8 ]. In the design process we took into account the results of a prior study conducted by our research team [ 31 ], which assessed deviations from guidelines in PCA simulation scenarios managed by pediatric residents without the use of any cognitive aid.…”

“…Deviations from PALS guidelines recommendations were defined as delays and errors according to a novel checklist adapted to our intervention and scenario. We derived this new measure from the checklist, denominated c-DEV, published by Wolfe et al [ 20 ] and we integrated it with evidence-based guidelines [ 6 - 8 ], previously reported scoring tools [ 41 - 44 ], and checklists [ 45 , 46 ]; we named our new modified checklist c-DEVplus ( Multimedia Appendix 2 ). It includes 16 items which represent correct critical actions for pediatric resuscitation.…”

Knowledge on Sudden Unexplained Infant Death-related Safe Sleep Practices and Infant Cardiopulmonary Resuscitation in Pediatric Nurses

“…The K-ICPR tool was developed in similar way to the K-SSSP. After reviewing infant CPR guidelines by the American Heart Association and the Korean Association of Cardiopulmonary Resuscitation [18,19], 5 items were created to assess knowledge on securing the airway, the ratio of chest compressions to breaths in one-person rescue, the rate and method of chest compressions, and the removal of inhaled foreign bodies. The structure of the items was either true/false or multiplechoice questions and a range of possible scores of 0 to 5.…”

A Modified Advanced Cardiac Life Support Algorithm

“…Life will usually emphasize treatment of tachy/ brady, and the concept of assessing stability, with expert consultation in the case of a stable patient, while dead will emphasize treatment as shockable or non-shockable to prompt early shock and the consideration of differential diagnoses [1,2].…”