Paediatric Resuscitation Update Bedside Critical Care, Daydream Island September 2012 Dr Francis Lockie, Paediatric Emergency Department Women’s and Children’s Hospital MedSTAR Emergency Medical Retrieval South Australia
Dec 05, 2014
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 [email protected]
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