Paediatric life support: An advisory statement by the Pediatric Life Support Working Group of the International Liaison Committee on Resuscitation

Background-Pediatric cardiopulmonary resuscitation (CPR) for >20 minutes has been considered futile after pediatric inhospital cardiac arrests. This concept has recently been questioned, although the effect of CPR duration on outcomes has not recently been described. Our objective was to determine the relationship between CPR duration and outcomes after pediatric in-hospital cardiac arrests. Methods and Results-We examined the effect of CPR duration for pediatric in-hospital cardiac arrests from the Get WithThe Guidelines--Resuscitation prospective, multicenter registry of in-hospital cardiac arrests. We included 3419 children from 328 US and Canadian Get With The Guidelines-Resuscitation sites with an in-hospital cardiac arrest between January 2000 and December 2009. Patients were stratified into 5 patient illness categories: surgical cardiac, medical cardiac, general medical, general surgical, and trauma. Survival to discharge was 27.9%, but only 19.0% of all cardiac arrest patients had favorable neurological outcomes. Between 1 and 15 minutes of CPR, survival decreased linearly by 2.1% per minute, and rates of favorable neurological outcome decreased by 1.2% per minute. Adjusted probability of survival was 41% for CPR duration of 1 to 15 minutes and 12% for >35 minutes. Among survivors, favorable neurological outcome occurred in 70% undergoing <15 minutes of CPR and 60% undergoing CPR >35 minutes. Compared with general medical patients, surgical cardiac patients had the highest adjusted odds ratios for survival and favorable neurological outcomes, 2.5 (95% confidence interval, 1.8-3.4) and 2.7 (95% confidence interval, 2.0-3.9), respectively. Conclusions-CPR duration was independently associated with survival to hospital discharge and neurological outcome.Among survivors, neurological outcome was favorable for the majority of patients. Performing CPR for >20 minutes is not futile in some patient illness categories.

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“…5,14 Although recent pediatric data indicate that some children survive with CPR of increased duration, this has not been rigorously evaluated.…”

Section: Clinical Perspective On P 451mentioning

confidence: 99%

Duration of Cardiopulmonary Resuscitation and Illness Category Impact Survival and Neurologic Outcomes for In-hospital Pediatric Cardiac Arrests

et al. 2013

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“…Finally, it is important to document resuscitation interventions and responses in order to understand an individual infant's pathophysiology as well as to improve resuscitation performance and study resuscitation outcomes. 5 9 to comprehensive basic and advanced resuscitation for the newly born. 10 Careful review of the guidelines of constituent organizations [11][12][13][14][15][16][17] and current international literature formed the basis for the 1999 ILCOR advisory statement.…”

Section: Introductionmentioning

confidence: 99%

International Guidelines for Neonatal Resuscitation: An Excerpt From the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science

2000

Pediatrics

415

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The International Guidelines 2000 Conference on Cardiopulmonary Resuscitation (CPR) and Emergency Cardiac Care (ECC) formulated new evidenced-based recommendations for neonatal resuscitation. These guidelines comprehensively update the last recommendations, published in 1992 after the Fifth National Conference on CPR and ECC. As a result of the evidence evaluation process, significant changes occurred in the recommended management routines for: • Meconium-stained amniotic fluid: If the newly born infant has absent or depressed respirations, heart rate <100 beats per minute (bpm), or poor muscle tone, direct tracheal suctioning should be performed to remove meconium from the airway. • Preventing heat loss: Hyperthermia should be avoided. • Oxygenation and ventilation: 100% oxygen is recommended for assisted ventilation; however, if supplemental oxygen is unavailable, positive-pressure ventilation should be initiated with room air. The laryngeal mask airway may serve as an effective alternative for establishing an airway if bag-mask ventilation is ineffective or attempts at intubation have failed. Exhaled CO2 detection can be useful in the secondary confirmation of endotracheal intubation. • Chest compressions: Compressions should be administered if the heart rate is absent or remains <60 bpm despite adequate assisted ventilation for 30 seconds. The 2-thumb, encircling-hands method of chest compression is preferred, with a depth of compression one third the anterior-posterior diameter of the chest and sufficient to generate a palpable pulse. • Medications, volume expansion, and vascular access: Epinephrine in a dose of 0.01–0.03 mg/kg (0.1–0.3 mL/kg of 1:10,000 solution) should be administered if the heart rate remains <60 bpm after a minimum of 30 seconds of adequate ventilation and chest compressions. Emergency volume expansion may be accomplished with an isotonic crystalloid solution or O-negative red blood cells; albumin-containing solutions are no longer the fluid of choice for initial volume expansion. Intraosseous access can serve as an alternative route for medications/volume expansion if umbilical or other direct venous access is not readily available. • Noninitiation and discontinuation of resuscitation: There are circumstances (relating to gestational age, birth weight, known underlying condition, lack of response to interventions) in which noninitiation or discontinuation of resuscitation in the delivery room may be appropriate.

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“…영아의 경우 심정지가 발생시 즉각적이고 효과적인 가슴 압박과 인공호흡은 환자를 살리기 위한 매우 중요한 요소 로써 최근 그 중요성이 더욱 강조되고 있다. 효과적인 심폐 소생술을 시행하기 위해서는 가슴 압박시 압박점의 적절한 위치, 압박 속도, 압박 깊이가 환자의 생존율에 중요한 요 소로 작용하고 (11)(12)(13) 있음에도 불구하고, 영아의 경우 성인 에 비해 심정지 발생빈도가 낮기에 영아 심폐소생술에 대 한 연구는 활발하게 이루어지지 않고 있다 (14,15) . …”

Section: 서 론unclassified

The Effect of Two Fingers-Chest Compression Using the Supporting Instrument During Infant Cardiopulmonary Resuscitation

Jung¹,

Roh²,

Shin³

et al. 2015

Fire Science and Engineering

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This paper aims to compare the effectiveness of the chest compression when a person pushes on the infant's chest by using two fingers with the support during infant cardiopulmonary resuscitation, with the effectiveness of it without the support, and to find which one is better. For the study, 50 college woman students were tested during the simulation and the result of the test has been analyzed by chi-square test, Fisher's exact test. In case of the chest compression by using the support, the depth of the chest compression comes to 3.73 ± 0.33 cm. On the other hand, in case of the chest compression without the support, 2.50 ± 0.59 cm. It is founded that the method of pushing on the chest by using the support is more effective than that without the support (p < 0.001). It is concluded that the way that a person pushes on the infant's chest by using two fingers with the support during infant cardiopulmonary resuscitation has turned out to be more effective and useful. It is thought that in the future, the further study for it should be conducted.

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Paediatric life support: An advisory statement by the Pediatric Life Support Working Group of the International Liaison Committee on Resuscitation

Cited by 16 publications

References 0 publications

Duration of Cardiopulmonary Resuscitation and Illness Category Impact Survival and Neurologic Outcomes for In-hospital Pediatric Cardiac Arrests

Duration of Cardiopulmonary Resuscitation and Illness Category Impact Survival and Neurologic Outcomes for In-hospital Pediatric Cardiac Arrests

International Guidelines for Neonatal Resuscitation: An Excerpt From the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care: International Consensus on Science

The Effect of Two Fingers-Chest Compression Using the Supporting Instrument During Infant Cardiopulmonary Resuscitation

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