Update in Paediatric Advanced Life Support
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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
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Talk outline
• Scope of arrests in children– Out-of hospital– In hospital
• Resus update
• Improve survival– Training– Met teams
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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%
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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%
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• Arrest in 111 of >100 000 admissions• ROSC in 73%• Survival to discharge 36%• Hypotensive-bradycardia 66%• Asystole 15%• VF / pulseless VT 9%• SVT
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2010 Update
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JAMA. 2010;304(13):1447-1454
No bystander CPR 5.2%Conventional CPR 7.8%COCPR 13.3%
JAMA. 2010;304(13):1447-1454
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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
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Where exactly does the intraosseous (IO) fit?
ILCOR 2005
ILCOR 2010
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Where exactly does the intraosseous (IO) fit?
Concerns re: complications•Pain•Success•Extravasation•Growth plate injury•osteomyelitis
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• 95 patients• Mean age 5.5• 95% success• 10 seconds or less• Pain score 2.3
Pediatr Emerg Care 2008
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• 291 patients• 34% arrested• 86% placed in
community hospitals• 37% mortality
• NO COMPLICATIONS
Hansen Pediatr Emerg Care 2011
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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
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3 days 1 day 90mins
1920-2120 350-500 Free
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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
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• 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 [email protected]
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Other issues covered
• Family presence during resus
• ECMO
• Complex congenital heart disease
• Trauma– C-A-B approach– Fluid restrictive resus
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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
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Summary
• Scope of paediatric arrests
• Whip through some recent changes
• How we can improve paediatric resus outcomes for our patients– Individual– Hospitals– State