Novelties in the pediatric cardiopulmonary resuscitation recommendations and lines of development in Spain.

OBJECTIVES: To analyse the 2020 international and European recommendations for Paediatric cardiopulmonary resuscitation (CPR), highlighting the most important changes and propose lines of development in Spain. METHODS: Critical analysis of the paediatric cardiopulmonary resuscitation recommendations of the European Resuscitation Council. RESULTS: The most relevant changes in the CPR recommendations for 2020 are in basic CPR the possibility of activating the emergency system after performing the five rescue ventilations with the mobile phone on loudspeaker, and in advanced CPR, bag ventilation between two rescuers if possible, the administration of epinephrine as soon as a vascular access is obtained, the increase in the respiratory rate in intubated children between 10 and 25 bpm according to their age and the importance of controlling the quality and coordination of CPR. In CPR training, the importance of training non-technical skills such as teamwork, leadership and communication and frequent training to reinforce and maintain competencies is highlighted. CONCLUSIONS: It is essential that training in Paediatric CPR in Spain follows the same recommendations and is carried out with a common methodology, adapted to the characteristics of health care and the needs of the students. The Spanish Paediatric and Neonatal Cardiopulmonary Resuscitation Group should coordinate this process, but the active participation of all paediatricians and health professionals who care for children is also essential.

Evaluation of Pediatric Immediate Life Support Courses by the Students.

A retrospective analysis was performed of 1637 questionnaires among students of immediate pediatric life support (IPLS) courses. All theory and practice classes and organization and methods received an average score higher than 8.5 except for the schedule and time devoted to developing contents. All parameters evaluating instructors' skills received a score higher than 9. Participants requested more time to practice and for course adaptation to their specific professionals needs. IPLS courses are highly valued by students. The duration of IPLS practice sessions should be increased and the course should be adapted to the specific professional needs of participants.

Novedades en las recomendaciones de reanimación cardiopulmonar pediátrica y líneas de desarrollo en España / Novelties in the paediatric cardiopulmonary resuscitation recommendations and lines of development in Spain

Objetivos: Analizar las recomendaciones internacionales y europeas de reanimación cardiopulmonar (RCP) pediátrica del 2020, resaltar los cambios más importantes y plantear líneas de desarrollo en España. Métodos: Análisis crítico de las recomendaciones de RCP pediátrica del European Resuscitation Council. Resultados: Los cambios más relevantes en las recomendaciones de RCP del año 2020 son: en la RCP básica, la posibilidad de activar el sistema de emergencias tras realizar las 5 ventilaciones de rescate con el teléfono móvil en altavoz, y en la RCP avanzada, la ventilación con bolsa entre 2 reanimadores si es posible, la administración de adrenalina en cuanto se canaliza un acceso vascular en los ritmos no desfibrilables, el aumento de la frecuencia respiratoria en los niños intubados entre 10 y 25rpm de acuerdo a su edad y la importancia de controlar la calidad y coordinación de la RCP. En la formación en RCP se destaca la importancia de la formación de las habilidades no técnicas como el trabajo en equipo, liderazgo y la comunicación, y el entrenamiento frecuente para reforzar y mantener las competencias. Conclusiones: Es esencial que la formación en RCP pediátrica en España siga las mismas recomendaciones y se realice con una metodología común, adaptada a las características de la atención sanitaria y las necesidades de los alumnos. El Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal debe coordinar este proceso, pero es esencial la participación activa de todos los pediatras y profesionales sanitarios que atienden a los niños. (AU)

Objectives: To analyse the 2020 international and European recommendations for paediatric cardiopulmonary resuscitation (CPR), highlight the most important changes and propose lines of development in Spain. Methods: Critical analysis of the paediatric cardiopulmonary resuscitation recommendations of the European Resuscitation Council. Results: The most relevant changes in the CPR recommendations for 2020 are in basic CPR the possibility of activating the emergency system after performing the five rescue ventilations with the mobile phone on loudspeaker, and in advanced CPR, bag ventilation between two rescuers if possible, the administration of epinephrine as soon as a vascular access is obtained, the increase in the respiratory rate in intubated children between 10 and 25bpm according to their age and the importance of controlling the quality and coordination of CPR. In CPR training, the importance of training non-technical skills such as teamwork, leadership and communication and frequent training to reinforce and maintain competencies is highlighted. Conclusions: It is essential that training in paediatric CPR in Spain follows the same recommendations and is carried out with a common methodology, adapted to the characteristics of health care and the needs of the students. The Spanish Paediatric and Neonatal Cardiopulmonary Resuscitation Group should coordinate this process, but the active participation of all paediatricians and health professionals who care for children is also essential. (AU)

[Novelties in the paediatric cardiopulmonary resuscitation recommendations and lines of development in Spain]. / Novedades en las recomendaciones de reanimación cardiopulmonar pediátrica y líneas de desarrollo en España.

OBJECTIVES: To analyse the 2020 international and European recommendations for paediatric cardiopulmonary resuscitation (CPR), highlight the most important changes and propose lines of development in Spain. METHODS: Critical analysis of the paediatric cardiopulmonary resuscitation recommendations of the European Resuscitation Council. RESULTS: The most relevant changes in the CPR recommendations for 2020 are in basic CPR the possibility of activating the emergency system after performing the five rescue ventilations with the mobile phone on loudspeaker, and in advanced CPR, bag ventilation between two rescuers if possible, the administration of epinephrine as soon as a vascular access is obtained, the increase in the respiratory rate in intubated children between 10 and 25bpm according to their age and the importance of controlling the quality and coordination of CPR. In CPR training, the importance of training non-technical skills such as teamwork, leadership and communication and frequent training to reinforce and maintain competencies is highlighted. CONCLUSIONS: It is essential that training in paediatric CPR in Spain follows the same recommendations and is carried out with a common methodology, adapted to the characteristics of health care and the needs of the students. The Spanish Paediatric and Neonatal Cardiopulmonary Resuscitation Group should coordinate this process, but the active participation of all paediatricians and health professionals who care for children is also essential.

25 años de cursos de reanimación cardiopulmonar pediátrica en España / 25 years of paediatric cardiopulmonary resuscitation courses in Spain

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[Current international recommendations for pediatric cardiopulmonary resuscitation: the European guidelines]. / Actualización de las recomendaciones internacionales de reanimación cardiopulmonar pediátrica (RCP): recomendaciones europeas de RCP pediátrica.

OBJECTIVES: This summary of the European guidelines for pediatric cardiopulmonary resuscitation (CPR) emphasizes the main changes and encourages health care professionals to keep their pediatric CPR knowledge and skills up to date. Basic and advanced pediatric CPR follow the same algorithm in the 2015 guidelines. The main changes affect the prevention of cardiac arrest and the use of fluids. Fluid expansion should not be used routinely in children with fever in the abuse of signs of shock because too high a volume can worsen prognosis. Rescue breaths should last around 1 second in basic CPR, making pediatric recommendations consistent with those for adults. Chest compressions should be at least as deep as one-third the anteroposterior diameter of the thorax. Most children in cardiac arrest lack a shockable rhythm, and in such cases a coordinated sequence of breaths, chest compressions, and administration of adrenalin is essential. An intraosseous canula may be the first choice for introducing fluids and medications, especially in young infants. In treating supraventricular tachycardia with cardioversion, an initial dose of 1 J/kg is currently recommended (vs the dose of 0.5 J/kg previously recommended). After spontaneous circulation is recovered, measures to control fever should be taken. The goal is to reach a normal temperature even before arrival to the hospital.

OBJETIVO: Este artículo resume las recomendaciones europeas de reanimación cardiopulmonar (RCP) pediátricas, destacando los principales cambios e intenta animar a los profesionales a actualizar y mantener sus conocimientos y habilidades en RCP pediátrica. Las recomendaciones europeas del año 2015 mantienen el mismo algoritmo de actuación en la RCP básica y avanzada pediátrica. Los cambios más significativos son: en la prevención de la parada cardiaca (PC), los niños con enfermedad febril sin signos de shock no deben recibir de forma rutinaria expansiones de fluidos porque un volumen excesivo puede empeorar el pronóstico. En la RCP básica se recomienda que la administración de la respiración dure alrededor de 1 segundo, para unificar las recomendaciones con las del adulto. En las compresiones torácicas el esternón debe deprimirse por lo menos un tercio del diámetro torácico anteroposterior. En el niño, la mayoría de las PC tienen ritmos no desfibrilables y en ellos la secuencia coordinada de ventilación y compresiones torácicas y administración de adrenalina es el tratamiento esencial. La vía intraósea, sobre todo en los lactantes, puede ser el acceso vascular de primera elección. En el tratamiento de la taquicardia supraventricular, cuando se realice cardioversión como tratamiento, se recomienda utilizar una dosis inicial de 1 J/kg (antes se recomendaba 0,5 J/kg). En los cuidados postresucitación tras la recuperación de la circulación espontánea, se deben tomar medidas para evitar la fiebre, teniendo como objetivo conseguir la normotermia ya desde el ámbito extrahospitalario.

Actualización de las recomendaciones internacionales de reanimación cardiopulmonar pediátrica (RCP): recomendaciones europeas de RCP pediátrica / Current international recommendations for pediatric cardiopulmonary resuscitation: the European guidelines

Este artículo resume las recomendaciones europeas de reanimación cardiopulmonar (RCP) pediátricas, destacando los principales cambios e intenta animar a los profesionales a actualizar y mantener sus conocimientos y habilidades en RCP pediátrica. Las recomendaciones europeas del año 2015 mantienen el mismo algoritmo de actuación en la RCP básica y avanzada pediátrica. Los cambios más significativos son: en la prevención de la parada cardiaca (PC), los niños con enfermedad febril sin signos de shock no deben recibir de forma rutinaria expansiones de fluidos porque un volumen excesivo puede empeorar el pronóstico. En la RCP básica se recomienda que la administración de la respiración dure alrededor de 1 segundo, para unificar las recomendaciones con las del adulto. En las compresiones torácicas el esternón debe deprimirse por lo menos un tercio del diámetro torácico anteroposterior. En el niño, la mayoría de las PC tienen ritmos no desfibrilables y en ellos la secuencia coordinada de ventilación y compresiones torácicas y administración de adrenalina es el tratamiento esencial. La vía intraósea, sobre todo en los lactantes, puede ser el acceso vascular de primera elección. En el tratamiento de la taquicardia supraventricular, cuando se realice cardioversión como tratamiento, se recomienda utilizar una dosis inicial de 1 J/kg (antes se recomendaba 0,5 J/kg). En los cuidados postresucitación tras la recuperación de la circulación espontánea, se deben tomar medidas para evitar la fiebre, teniendo como objetivo conseguir la normotermia ya desde el ámbito extrahospitalario (AU)

This summary of the European guidelines for pediatric cardiopulmonary resuscitation (CPR) emphasizes the main changes and encourages health care professionals to keep their pediatric CPR knowledge and skills up to date. Basic and advanced pediatric CPR follow the same algorithm in the 2015 guidelines. The main changes affect the prevention of cardiac arrest and the use of fluids. Fluid expansion should not be used routinely in children with fever in the abuse of signs of shock because too high a volume can worsen prognosis. Rescue breaths should last around 1 second in basic CPR, making pediatric recommendations consistent with those for adults. Chest compressions should be at least as deep as one-third the anteroposterior diameter of the thorax. Most children in cardiac arrest lack a shockable rhythm, and in such cases a coordinated sequence of breaths, chest compressions, and administration of adrenalin is essential. An intraosseous canula may be the first choice for introducing fluids and medications, especially in young infants. In treating supraventricular tachycardia with cardioversion, an initial dose of 1 J/kg is currently recommended (vs the dose of 0.5 J/kg previously recommended). After spontaneous circulation is recovered, measures to control fever should be taken. The goal is to reach a normal temperature even before arrival to the hospital (AU)

Novedades en las recomendaciones de reanimación cardiopulmonar pediátrica / The latest in paediatric resuscitation recommendations

La parada cardiaca en niños tiene una elevada mortalidad. Para mejorar los resultados de la reanimación cardiopulmonar (RCP) es esencial la difusión de las recomendaciones internacionales de RCP y el entrenamiento de los profesionales sanitarios y la población general. Este artículo resume las recomendaciones europeas de RCP pediátrica de 2015, que están basadas en la revisión de los avances en RCP y el consenso en la ciencia y de tratamiento realizados por el Consejo Internacional de Resucitación. Las recomendaciones españolas de RCP pediátrica elaboradas por el Grupo Español de Reanimación Cardiopulmonar Pediátrica y Neonatal son una adaptación de las recomendaciones europeas y serán las utilizadas para la formación en reanimación a los profesionales sanitarios y la población general. En el artículo se destacan los principales cambios con respecto a las anteriores del 2010 en prevención de la parada cardiaca, diagnóstico de la parada cardiaca, RCP básica, RCP avanzada y cuidados posresucitación, y se presentan los algoritmos de tratamiento de RCP básica, desobstrucción de la vía aérea y RCP avanzada

Cardiac arrest has a high mortality in children. To improve the performance of cardiopulmonary resuscitation, it is essential to disseminate the international recommendations and the training of health professionals and the general population in resuscitation. This article summarises the 2015 European Paediatric Cardiopulmonary Resuscitation recommendations, which are based on a review of the advances in cardiopulmonary resuscitation and consensus in the science and treatment by the International Council on Resuscitation. The Spanish Paediatric Cardiopulmonary Resuscitation recommendations, developed by the Spanish Group of Paediatric and Neonatal Resuscitation, are an adaptation of the European recommendations, and will be used for training health professionals and the general population in resuscitation. This article highlights the main changes from the previous 2010 recommendations on prevention of cardiac arrest, the diagnosis of cardiac arrest, basic life support, advanced life support and post-resuscitation care, as well as reviewing the algorithms of treatment of basic life support, obstruction of the airway and advanced life support

[The latest in paediatric resuscitation recommendations]. / Novedades en las recomendaciones de reanimación cardiopulmonar pediátrica.

Cardiac arrest has a high mortality in children. To improve the performance of cardiopulmonary resuscitation, it is essential to disseminate the international recommendations and the training of health professionals and the general population in resuscitation. This article summarises the 2015 European Paediatric Cardiopulmonary Resuscitation recommendations, which are based on a review of the advances in cardiopulmonary resuscitation and consensus in the science and treatment by the International Council on Resuscitation. The Spanish Paediatric Cardiopulmonary Resuscitation recommendations, developed by the Spanish Group of Paediatric and Neonatal Resuscitation, are an adaptation of the European recommendations, and will be used for training health professionals and the general population in resuscitation. This article highlights the main changes from the previous 2010 recommendations on prevention of cardiac arrest, the diagnosis of cardiac arrest, basic life support, advanced life support and post-resuscitation care, as well as reviewing the algorithms of treatment of basic life support, obstruction of the airway and advanced life support.

Effectiveness and long-term outcome of cardiopulmonary resuscitation in paediatric intensive care units in Spain.

OBJECTIVE: To analyse the immediate effectiveness of resuscitation and long-term outcome of children who suffered a cardiorespiratory arrest when admitted to paediatric intensive care units (PICU). DESIGN AND SETTING: Secondary analysis of data from an 18-month prospective, multicentre study analysing cardiorespiratory arrest in children in 16 paediatric intensive care units in Spain. PATIENTS AND METHODS: We studied 116 children between 7 days and 17 years of age. Data were recorded according to the Utstein style. Analysed outcome variables were sustained return of spontaneous circulation (ROSC), survival to hospital discharge and survival at 1 year. Neurological and general performance outcome was assessed by means of the Paediatric Cerebral Performance Category (PCPC) and the Paediatric Overall Performance Category (POPC) scales. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: In 80 patients (69%) ROSC was achieved and it was sustained > 20 min in 69 (59.5%). At one-year follow-up, 40 children (34.5%) were alive. Survival was not associated with sex, age or weight of patients. Mortality from cardiac arrest was higher than respiratory arrest (69.8% versus 40%, p = 0.01). Patients with sepsis had a higher mortality than other diagnostic groups. Mechanically ventilated children and those treated with vasoactive drugs had a higher mortality. Initial mortality was slightly higher in patients with slow ECG rhythms (35.7%) compared to those with ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) (27.2%). Duration of resuscitation effort was correlated with mortality (p < 0.0001). Patients who required one or more doses of adrenaline had also a higher mortality (77.8% versus 20.7%, p < 0.0001) and survivors needed less doses of adrenaline (0.85 +/- 1.14 versus 4.4+/-2.9, p < 0.0001). At hospital discharge 86.8 and 84.6% of patients had scores 1 or 2 (normal or near-normal) in the PCPC and POPC scales. At 1-year follow-up these figures were 90.8 and 86.3%, respectively. CONCLUSION: One-third of children who suffer a cardiac or respiratory arrest when admitted to PICU survive, and most of them had a good long-term neurological and functional outcome. The duration of cardiopulmonary resuscitation attempts is the best indicator of mortality.

Outcome of out-of-hospital cardiorespiratory arrest in children.

OBJECTIVE: To analyze the characteristics and outcome of out-of-hospital cardiorespiratory arrest in children in Spain. METHODS: Secondary analysis of data from a prospective, multicenter study analyzing cardiorespiratory arrest in children. Ninety-five children between 7 days and 16 years with cardiorespiratory arrest. Data were recorded according to the Utstein style. The outcome variables were the sustained return of spontaneous circulation (initial survival), and survival at 1 year (final survival). Neurologic and general performance outcome was assessed by the Pediatric Cerebral Performance Category (PCPC) scale and the Pediatric Overall Performance Category (POPC) scale. RESULTS: Initial survival was 47.3% and 1-year survival was 26.4%. Mortality was higher in children younger than 1 year. Survival of patients with respiratory arrest (82.1%) was significantly higher than survival of cardiac arrest victims (14.4%). Patients who were initially resuscitated by laypersons or paramedics had higher survival (53.6%) than those who were initially resuscitated by doctors and/or nurses (15.2%) (P < 0.01). Mortality was higher in the patients who presented slow rhythms (asystole, severe bradycardia) or pulseless electrical activity than in those presenting ventricular fibrillation (P = 0.001). Multivariate logistic regression revealed that the best indicator of mortality was duration of cardiopulmonary resuscitation longer than 20 minutes. After 1 year, most survivors had normal or mild disability. CONCLUSIONS: Mortality of out-of-hospital cardiorespiratory arrest in children is high. When resuscitation is started soon by layperson or paramedics, survival is increased. Duration of resuscitation efforts is the best indicator of mortality. Most of survivors had good long-term neurologic outcome.

Long-term outcome of paediatric cardiorespiratory arrest in Spain.

OBJECTIVE: To analyse the final outcome of cardiorespiratory arrest (CRA) in children and the neurological and functional state of survivors at 1 year. METHODS: An 18-month prospective, multicentre study analysing out-of-hospital and in-hospital CRA in children was carried out; 283 children between 7 days and 17 years of age were included. CRA and resuscitation data were registered according to Utstein style. The outcome variables were: sustained return of spontaneous circulation (initial survival), and survival at 1 year (final survival). The status of survivors was evaluated by means of the paediatric cerebral performance category (PCPC) scale and the paediatric overall performance category (POPC) scale at Paediatric Intensive Care Unit discharge, at hospital discharge, and at 1 year follow-up. RESULTS: In 283 children, 311 CRA episodes, 73 respiratory arrests (23.5%) and 238 cardiac arrests (76.5%) were analysed. Seventeen children suffered more than one CRA episode (range: 2-6). The initial survival was 60.2% and 1-year survival was 33.2%. The final survival was significantly higher in respiratory arrest than in cardiac arrest patients (70.0% versus 21.1%) (P < 0.0001). After 1 year follow-up, 87.3% of patients had scores 1 or 2 on the PCPC scale and 84.0% had scores 1 or 2 in the POPC scale; these results indicate that 1 year after CRA, the majority of survivors had normal neurological and functional status or showed only mild disability. CONCLUSIONS: Prognosis of CRA in children continues to be poor in terms of survival but quite good in terms of neurological and functional status among survivors. Additional strategies and efforts are needed to improve the short-term prognosis of paediatric CRA. However, the long-term outcome of survivors is reassuring.

Characteristics and outcome of cardiorespiratory arrest in children.

OBJECTIVE: To analyse the present day characteristics and outcome of cardio-respiratory arrest in children in Spain. DESIGN: An 18-month prospective, multicentre study analysing out-of-hospital and in-hospital cardio-respiratory arrest in children. PATIENTS AND METHODS: Two hundred and eighty-three children between 7 days and 17 years of age with cardio-respiratory arrest. Data were recorded according to the Utstein style. The outcome variables were the sustained return of spontaneous circulation (initial survival), and survival at 1 year (final survival). Three hundred and eleven cardio-respiratory arrest episodes, composed of 70 respiratory arrests and 241 cardiac arrests in 283 children were studied. Accidents were the most frequent cause of out-of-hospital arrest (40%), and cardiac disease was the leading cause (31%) of in-hospital arrest. Initial survival was 60.2% and 1 year survival was 33.2%. The final survival was higher in patients with respiratory arrest (70%) than in patients with cardiac arrest (21.1%) (P <0.0001). Although many individual factors correlated with mortality, multivariate logistic regression revealed that the best indicator of mortality was a duration of cardiopulmonary resuscitation of over 20 min (odds ratio: 10.35; 95% CI 4.59-23.32). CONCLUSIONS: In Spain, the present mortality from cardio-respiratory arrest in children remains high. Survival after respiratory arrest is significantly higher than after cardiac arrest. The duration of cardiopulmonary resuscitation attempt is the best indicator of mortality of cardio-respiratory arrest in children.