Pediatric Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Maconochie, Ian; Aickin, Richard; Hazinski, Mary Fran; Atkins, Dianne L.; Bingham, Robert; Couto, Thomaz Bittencourt; Guerguerian, Anne‐Marie; Ng, Kee-Chong; Nuthall, Gabrielle; Ong, Gene Yong-Kwang; Reis, Amélia G.; Schexnayder, Stephen M.; Scholefield, Barnaby R; Tijssen, Janice A.; Nolan, Jerry P.; Voorde, Patrick Van de; Zaritsky, Arno; Caen, Allan R. de

doi:10.1542/peds.2020-038505b

Cited by 48 publications

(66 citation statements)

References 147 publications

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“…Although animal studies have indicated air is as good as 100% O 2 during this procedure, clinical data are lacking 19 . It is however interesting that the new ILCOR recommendations for paediatric life support phrase this differently: ‘There is insufficient information to recommend a specific inspired oxygen concentration for ventilation during attempted resuscitation after cardiac arrest in infants and children’ 20 . Perhaps the neonatal and paediatric recommendations regarding this issue should be harmonised?…”

Section: Discussionmentioning

confidence: 99%

A critical review of the 2020 International Liaison Committee on Resuscitation treatment recommendations for resuscitating the newly born infant

2021

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The 2020 recommendations from the International Liaison Committee on Resuscitation are an improved version of the 2015 version. The algorithm and 15 procedures are unchanged from 2015, but there are six procedures with new or changed recommendations. One new recommendation is briefing/debriefing following neonatal resuscitation. Procedures with changed suggestions/recommendations are as follows: suctioning of non‐vigorous infants delivered through meconium‐stained amniotic fluid, sustained inflation of preterm infants, optimising epinephrine (adrenaline), vascular access and discontinuing resuscitative efforts. Conclusion In this review, we summarise the present recommendations and offer additional comments and views regarding heart rate detection, cord clamping, oxygenation and thermal control.

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Section: Discussionmentioning

confidence: 99%

A critical review of the 2020 International Liaison Committee on Resuscitation treatment recommendations for resuscitating the newly born infant

2021

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“…The main finding of higher levels of ECO 2 as a predictor of survival is similar to results from cardiopulmonary resuscitation after the newborn period. 11,12 However, newborns in need of positive pressure ventilation at birth are rarely in cardiac arrest. In a recent study of apnoeic newborns, the first recorded HR was distributed in two peaks around 60 and 165 bpm.…”

Section: Discussionmentioning

confidence: 99%

Expired carbon dioxide during newborn resuscitation as predictor of outcome

et al. 2021

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Aim: To explore and compare expired CO 2 (ECO 2 ) and heart rate (HR), during newborn resuscitation with bag-mask ventilation, as predictors of 24-h outcome.Methods: Observational study from March 2013 to June 2017 in a rural Tanzanian hospital. Side-stream measures of ECO 2 , ventilation parameters, HR, clinical information, and 24-h outcome were recorded in live born bag-mask ventilated newborns with initial HR < 120 bpm. We analysed the data using logistic regression models and compared areas under the receiver operating curves (AUC) for ECO 2 and HR within three selected time intervals after onset of ventilation (0À30 s, 30.1À60 s and 60.1À300 s).Results: Among 434 included newborns (median birth weight 3100 g), 378 were alive at 24 h, 56 had died. Both ECO 2 and HR were independently significant predictors of 24-h outcome, with no differences in AUCs. In the first 60 s of ventilation, ECO 2 added extra predictive information compared to HR alone. After 60 s, ECO 2 lost significance when adjusted for HR. In 70% of newborns with initial ECO 2 <2% and HR < 100 bpm, ECO 2 reached !2% before HR ! 100 bpm. Survival at 24 h was reduced by 17% per minute before ECO 2 reached !2% and 44% per minute before HR reached !100 bpm.Conclusions: Higher levels and a faster rise in ECO 2 and HR during newborn resuscitation were independently associated with improved survival compared to persisting low values. ECO 2 increased before HR and may serve as an earlier predictor of survival.

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“…Therefore, we observed the clinical development and frequently reassessed it, with advanced airway management tools on standby. In the out-of-hospital setting, bag-mask ventilation rather than tracheal intubation or insertion of a supraglottic airway may be recommended [4,8,9]. Indications for intubation or laryngeal mask are respiratory failure or ineffective bag-mask ventilation [4,8].…”

Section: Literature Reviewmentioning

confidence: 99%

“…According to the current guidelines, atropine can be used for bradycardia caused by increased vagal tone or anticholinergic drug toxicity. Epinephrine may be administered to infants and children when bradycardia and poor perfusion are unresponsive to ventilation and oxygenation [8,9]. In the case of poor or absent perfusion, CPR should be started.…”

Section: Literature Reviewmentioning

confidence: 99%

Bradycardia in a newborn with accidental severe hypothermia: treat or don’t touch? A case report

Kuonen

Riva

Erdoes

2021

Scand J Trauma Resusc Emerg Med

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Background Hypothermia significantly affects mortality and morbidity of newborns. Literature about severe accidental hypothermia in neonates is limited. We report a case of a neonate suffering from severe accidental hypothermia. An understanding of the physiology of neonatal thermoregulation and hypothermia is important to decide on treatment. Case presentation A low-birth-weight newborn was found with severe accidental hypothermia (rectal temperature 25.7 °C) due to prolonged exposure to low ambient temperature. The newborn presented bradycardic, bradypnoeic, lethargic, pale and cold. Bradycardia, bradypnea and impaired consciousness were interpreted in the context of the measured body temperature. Therefore, no reanimation or intubation was initiated. The newborn was closely monitored and successfully treated only with active and passive rewarming. Conclusion Clinical parameters such as heart frequency, blood pressure, respiration and consciousness must be interpreted in light of the measured body temperature. Medical treatment should be adapted to the clinical presentation. External rewarming can be a safe and effective measure in neonatal patients.

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Pediatric Life Support 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Cited by 48 publications

References 147 publications

A critical review of the 2020 International Liaison Committee on Resuscitation treatment recommendations for resuscitating the newly born infant

A critical review of the 2020 International Liaison Committee on Resuscitation treatment recommendations for resuscitating the newly born infant

Expired carbon dioxide during newborn resuscitation as predictor of outcome

Bradycardia in a newborn with accidental severe hypothermia: treat or don’t touch? A case report

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