What are the latest guidelines for cardiopulmonary resuscitation following pediatric cardiac arrest?
BEEM Bottom Line
Why is this study important?
Why is this guideline and at least some of its recommendations important? This Pediatric Advanced Life Support (PALS) update is a clinical practice guideline (CPG) for pediatric cardiopulmonary resuscitation (CPR) following cardiac arrest (CA) with specific recommendations for in-hospital (IHCA) and out-of-hospital (OHCA) cardiac arrest. The causes for pediatric CA differ from the adult population, and prior guidelines extrapolated results from adult studies that were incorporated in the PALS guidelines. The 2019 update includes new trials that are specific to infants and children and focuses on airway management, extracorporeal CPR (ECPR) and targeted temperature management (TTM) following CA.
- Airway: Advanced airway skills in pediatric patients can be challenging for those who do not perform it regularly. Bag-mask ventilation (BVM) is an easy skill to teach and retain, but requires interruption during CPR and increases the risk of aspiration. Comparison was made between BVM versus endotracheal intubation / supraglottic airway. The guidelines recommended that BVM is reasonable compared with the advanced airway interventions for OHCA, but did not have any specific opinion for IHCA.
- ECPR: ECPR requires rapid initiation of extracorporeal membrane oxygenation (ECMO) in patients with intermittent return of spontaneous circulation (ROSC). ECMO is primarily available in specialized pediatric centres and is commonly used in patients with cardiac pathology. The recommendations are for ECPR for IHCA in patients with cardiac diagnoses where ECMO expertise is available.
- TTM: Therapeutic hypothermia decreased metabolic demand reduces free radical production and lowers the apoptosis rate. While proven beneficial in adults with ROSC, TTM is left to the discretion of the clinician for pediatric CA victims as a reasonable option.
Which, if any, threats to validity are most likely to have an impact on the results and how?
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