Update in Paediatric Advanced Life Support

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

Talk outline

• Scope of arrests in children– Out-of hospital– In hospital

• Resus update

• Improve survival– Training– Met teams

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%

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%

• Arrest in 111 of >100 000 admissions• ROSC in 73%• Survival to discharge 36%• Hypotensive-bradycardia 66%• Asystole 15%• VF / pulseless VT 9%• SVT

2010 Update

JAMA. 2010;304(13):1447-1454

No bystander CPR 5.2%Conventional CPR 7.8%COCPR 13.3%

JAMA. 2010;304(13):1447-1454

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

Where exactly does the intraosseous (IO) fit?

ILCOR 2005

ILCOR 2010

Where exactly does the intraosseous (IO) fit?

Concerns re: complications•Pain•Success•Extravasation•Growth plate injury•osteomyelitis

• 95 patients• Mean age 5.5• 95% success• 10 seconds or less• Pain score 2.3

Pediatr Emerg Care 2008

• 291 patients• 34% arrested• 86% placed in

community hospitals• 37% mortality

• NO COMPLICATIONS

Hansen Pediatr Emerg Care 2011

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

3 days 1 day 90mins

1920-2120 350-500 Free

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

• 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 fenton.oleary@health.nsw.gov.au

Other issues covered

• Family presence during resus

• ECMO

• Complex congenital heart disease

• Trauma– C-A-B approach– Fluid restrictive resus

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

Summary

• Scope of paediatric arrests

• Whip through some recent changes

• How we can improve paediatric resus outcomes for our patients– Individual– Hospitals– State