2019 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

This 2019 focused update to the American Heart Association pediatric advanced life support guidelines follows the 2018 and 2019 systematic reviews performed by the Pediatric Life Support Task Force of the International Liaison Committee on Resuscitation. It aligns with the continuous evidence review process of the International Liaison Committee on Resuscitation, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update provides the evidence review and treatment recommendations for advanced airway management in pediatric cardiac arrest, extracorporeal cardiopulmonary resuscitation in pediatric cardiac arrest, and pediatric targeted temperature management during post-cardiac arrest care. The writing group analyzed the systematic reviews and the original research published for each of these topics. For airway management, the writing group concluded that it is reasonable to continue bag-mask ventilation (versus attempting an advanced airway such as endotracheal intubation) in patients with out-of-hospital cardiac arrest. When extracorporeal membrane oxygenation protocols and teams are readily available, extracorporeal cardiopulmonary resuscitation should be considered for patients with cardiac diagnoses and in-hospital cardiac arrest. Finally, it is reasonable to use targeted temperature management of 32°C to 34°C followed by 36°C to 37.5°C, or to use targeted temperature management of 36°C to 37.5°C, for pediatric patients who remain comatose after resuscitation from out-of-hospital cardiac arrest or in-hospital cardiac arrest.

2019 American Heart Association Focused Update on Pediatric Basic Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

This 2019 focused update to the American Heart Association pediatric basic life support guidelines follows the 2019 systematic review of the effects of dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) on survival of infants and children with out-of-hospital cardiac arrest. This systematic review and the primary studies identified were analyzed by the Pediatric Task Force of the International Liaison Committee on Resuscitation. It aligns with the International Liaison Committee on Resuscitation's continuous evidence review process, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update summarizes the available pediatric evidence supporting DA-CPR and provides treatment recommendations for DA-CPR for pediatric out-of-hospital cardiac arrest. Four new pediatric studies were reviewed. A systematic review of this data identified the association of a significant improvement in the rates of bystander CPR and in survival 1 month after cardiac arrest with DA-CPR. The writing group recommends that emergency medical dispatch centers offer DA-CPR for presumed pediatric cardiac arrest, especially when no bystander CPR is in progress. No recommendation could be made for or against DA-CPR instructions when bystander CPR is already in progress.

2019 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

This 2019 focused update to the American Heart Association pediatric advanced life support guidelines follows the 2018 and 2019 systematic reviews performed by the Pediatric Life Support Task Force of the International Liaison Committee on Resuscitation. It aligns with the continuous evidence review process of the International Liaison Committee on Resuscitation, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update provides the evidence review and treatment recommendations for advanced airway management in pediatric cardiac arrest, extracorporeal cardiopulmonary resuscitation in pediatric cardiac arrest, and pediatric targeted temperature management during post-cardiac arrest care. The writing group analyzed the systematic reviews and the original research published for each of these topics. For airway management, the writing group concluded that it is reasonable to continue bag-mask ventilation (versus attempting an advanced airway such as endotracheal intubation) in patients with out-of-hospital cardiac arrest. When extracorporeal membrane oxygenation protocols and teams are readily available, extracorporeal cardiopulmonary resuscitation should be considered for patients with cardiac diagnoses and in-hospital cardiac arrest. Finally, it is reasonable to use targeted temperature management of 32°C to 34°C followed by 36°C to 37.5°C, or to use targeted temperature management of 36°C to 37.5°C, for pediatric patients who remain comatose after resuscitation from out-of-hospital cardiac arrest or in-hospital cardiac arrest.

2019 American Heart Association Focused Update on Pediatric Basic Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care.

This 2019 focused update to the American Heart Association pediatric basic life support guidelines follows the 2019 systematic review of the effects of dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) on survival of infants and children with out-of-hospital cardiac arrest. This systematic review and the primary studies identified were analyzed by the Pediatric Task Force of the International Liaison Committee on Resuscitation. It aligns with the International Liaison Committee on Resuscitation's continuous evidence review process, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update summarizes the available pediatric evidence supporting DA-CPR and provides treatment recommendations for DA-CPR for pediatric out-of-hospital cardiac arrest. Four new pediatric studies were reviewed. A systematic review of this data identified the association of a significant improvement in the rates of bystander CPR and in survival 1 month after cardiac arrest with DA-CPR. The writing group recommends that emergency medical dispatch centers offer DA-CPR for presumed pediatric cardiac arrest, especially when no bystander CPR is in progress. No recommendation could be made for or against DA-CPR instructions when bystander CPR is already in progress.

Effect of residual leaning force on intrathoracic pressure during mechanical ventilation in children.

AIM: Determine the effect of residual leaning force on intrathoracic pressure (ITP) in healthy children receiving mechanical ventilation. We hypothesized that application of significant residual leaning force (2.5kg or 20% of subject body weight) would be associated with a clinically important change in ITP. METHODS: IRB-approved pilot study of healthy, anesthetized, paralyzed mechanically ventilated children (6 months to 7 years). Peak endotracheal pressure (ETP), a surrogate of ITP, was continuously measured before and during serial incremental increases in sternal force from 10% to 25% of the subject's body weight. A delta ETP of >or=2.0cmH(2)O was considered clinically significant. RESULTS: 13 healthy, anesthetized, paralyzed mechanically ventilated children (age: 26+/-24m, range: 6.5-87m; weight: 13+/-5kg, range: 7.4-24.8kg) were enrolled. Peak ETP increased from baseline for all force applications (10% body weight: mean difference of 0.8cmH(2)O, p<0.01; 15% body weight: mean difference of 1.1cmH(2)O, p<0.01; 20% body weight: mean difference of 1.5cmH(2)O, p<0.01; 25% body weight: mean difference of 1.89cmH(2)O, p<0.01). Residual leaning force of >or=2.5kg was associated with a 2.0cmH(2)O change in peak ETP (odds ratio 7.5; CI(95) 1.5-37.7; p=0.014) while sternal force >or=20% body weight was not (odds ratio 2.4; CI(95) 0.6-9.2; p=0.2). CONCLUSION: In healthy anesthetized children, changes in ETP were detectable at residual leaning forces as low as 10% of subject body weight. Residual leaning force of 2.5kg was associated with increases in ETP >or=2.0cmH(2)O.

The voice advisory manikin (VAM): an innovative approach to pediatric lay provider basic life support skill education.

AIM: To determine the efficacy of immediate, standardized, corrective audio feedback training as supplied by the voice advisory manikin (VAM) compared to high quality standardized instructor feedback training for the initial acquisition of 1-rescuer lay provider pediatric BLS skills. MATERIALS AND METHODS: Lay care providers of hospitalized children 8-18 years were randomized to VAM (n=23) or standardized human instruction (SHI, n=27) training in one-rescuer pediatric BLS. After an identical video/instructor introduction to CPR and 20 min of training in their respective group, quantitative CPR psychomotor skill data was recorded during 3-min CPR testing epochs. All manikins used in training and testing sessions were identical in outside appearance and feel of doing CPR. The primary outcome measure was CPR psychomotor skill success defined prospectively as 70% correct chest compressions (CC) and ventilations (V). Subjects not attaining these success goals retrained for 5 min in their respective training group and were retested. Data analysis using student t-test and chi2-tests as appropriate. RESULTS: VAM trainees delivered more total CC/min (58.7+/-7.9 versus 47.6+/-10.5, p<0.001), correct CC/min (47.9+/-15.7 versus 31.2+/-16.0, p<0.001), total V/min (7.8+/-1.2 versus 6.4+/-1.4, p<0.001), and correct V/min (5.4+/-1.9 versus 3.1+/-1.6, p<0.001). Overall error rates per individual were lower in VAM trainees for chest compressions (18.1+/-23.2% versus 34.9+/-28.8%, p<0.03) and ventilations (32.0+/-19.7% versus 50.7+/-24.1%, p<0.005). More VAM (12/23, 52%) than SHI (1/26, 4%) trainees passed the initial skill tests (p