What’s new in paediatric resuscitationJason Acworth

• PEM research is a relatively new field in the world of research and as

such offers huge scope for future research

• In Australia and New Zealand we have the Paediatric Research in

Emergency Departments International Collaborative (PREDICT)

research network which leads many multi-site clinically significant trials

in PEM

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PEM Research in Australia & NZ

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The Utstein formula for survival

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The Utstein Formula of Survival

ILCOR CoSTR✓ New science

Instructional Design Features✓ Quality CPR for

training & events

Knowledge Translation &

Implementation Systems

✓ Kids Save Lives✓ Arrest Registries

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ILCOR CoSTR✓ New science

Instructional Design Features✓ Quality CPR for

training & events

Knowledge Translation &

Implementation Systems

✓ Kids Save Lives✓ Arrest Registries

TREATMENT RECOMMENDATIONS

• We suggest that bystanders provide CPR with ventilation for infants and children younger than 18 years with OHCA (weak recommendation, very low quality evidence)

• We continue to recommend that if bystanders can’t provide rescue breaths as part of CPR for infants and children younger than 18 years with OHCA, they should at least provide chest compressions.

Maconochie I, Aickin R, Atkins D, et al. CPR : Chest Compression to Ventilation Ratio-Bystander-Pediatric CoSTR. ILCOR Pediatric Life Support Task Force, 2017 June 30. Available from: www.ilcor.org

Chest Compression to Ventilation Ratio for Bystander Paediatric CPR

30:2 > 30 > 0

Chest Compression to Ventilation Ratio for Bystander Paediatric CPR

• Primary outcome = Favourable neurological outcome

• National OHCA registry data from USA & Japan

TREATMENT RECOMMENDATIONS

• We recommend emergency medical dispatch centers offer dispatch-assisted CPR instructions for presumed pediatric cardiac arrest (strong recommendation, very low certainty evidence).

• We recommend emergency dispatchers provide CPR instructions for pediatric cardiac arrest when no bystander CPR is in progress (strong recommendation, low certainty evidence).

Tijssen JA, Aickin R, Atkins D, et al. Dispatcher instruction in CPR (pediatrics) CoSTR. ILCOR Pediatric Life Support Task Force, 2019 January 25. Available from: www.ilcor.org

Dispatcher Instructions in Paediatric CPR

Dispatcher Instructions in Paediatric CPR

• Paediatric OHCA Registry Data

Bystander CPR

improves OHCA

outcome

DA-CPR increased

bystander CPR rate

and decreased time

to CPR initiation

DA-CPR increased

survival at 1 month

(vs no bystander CPR)

= 31 more survivors

per 1000 OHCA

TREATMENT RECOMMENDATIONS

• We suggest the use of BMV rather than TI or SGA in the management of children during cardiac arrest in the out-of-hospital setting (weak recommendation, very low certainty evidence).

• We can make no recommendation about the use of TI or SGA in the management of children with cardiac arrest in the in-hospital setting owing to limited evidence

Nuthall G, Van de Voorde P, Atkins DL, et al. Advanced Airway Interventions in Pediatric Cardiac Arrest -Pediatric CoSTR. ILCOR Pediatric Life Support Task Force, 2019 March 21. Available from: www.ilcor.org

Advanced Airway Interventions in Paediatric Cardiac Arrest

Advanced Airway Interventions in Paediatric OHCA

> or• Primary outcome = Survival with good neurological outcome

• Only 1 Paediatric Clinical Trial + Cohort studies

• No benefit from AAW interventions and some suggested harm

• Effective BMV, TI, and SGA are all difficult skills that require training

• Benefit or harm may differ across settings

TREATMENT RECOMMENDATIONS

• We suggest using TTM 32-34⁰C or TTM 36-37.5⁰C for comatose pediatric patients (> 24 hours to 18 years of age) who achieved ROSC after OHCA or IHCA (weak recommendation, very low certainty of evidence).

Aickin RP, de Caen AR, Atkins DL, et al. Pediatric targeted temperature management post cardiac arrest -Pediatric CoSTR. ILCOR Pediatric Life Support Task Force, 2019 Feb 25. Available from: www.ilcor.org

Paediatric Temperature Management after Arrest

Paediatric Temperature Management after Arrest

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• Primary outcome = Good neurobehavioral survival long-term

• 2 Paediatric RCTs

o Data not extrapolated from adult studies

• Registry data suggests fever is bad

TREATMENT RECOMMENDATION

• We suggest amiodarone or lidocaine be used in the treatment of paediatric shock-refractory VF/pVT (weak recommendation, very low quality evidence).

Atkins DL, Aickin RP, Bingham R, et al. Antiarrhythmic Drugs for Cardiac Arrest in Adults and Children CoSTR. ILCOR Pediatric Life Support Task Force 2018 May 30. Available from www.ilcor.org

Anti-Arrhythmic Drugs for Paediatric Cardiac Arrest

Anti-Arrhythmic Drugs for Paediatric Cardiac Arrest

=

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ILCOR CoSTR✓ ILCOR Update ✓ New science

Instructional Design Features✓ Quality CPR for

training & events

Knowledge Translation &

Implementation Systems

✓ Kids Save Lives✓ Arrest Registries

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ILCOR CoSTR✓ ILCOR Update ✓ New science

Instructional Design Features✓ Quality CPR for

training & events

Knowledge Translation &

Implementation Systems

✓ Kids Save Lives✓ Arrest Registries

• easy and effective

• very open approach pre-puberty

• 2 hrs training per year

• optimal age ~12 years

• “multiplier’ effect

• social benefits of “willing to help”

Kids Save LivesTraining school children in cardiopulmonary resuscitation worldwide

Böttiger BW, Van Aken H. Kids save lives. Resuscitation 2015;94:A5–7

ANZ OHCA registry

ANZ OHCA registry

• n=19,722 OHCA cases during 2015 (102 cases per 100,000 population)

• Bystander CPR performed in only 41%

• After attempted resuscitation:

• 28% survived event

• 12% survived to discharge

• Paediatric OHCA <500 (<2.5% of cohort)

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