Written by Clay Smith
The 2020 AHA pediatric basic and advanced life support guidelines have been updated. Here is the Spoon Feed.
Why does this matter?
The last AHA update to these guidelines was in 2015. Here’s what’s new.
That darn baby is still choking…
“High-quality cardiopulmonary resuscitation (CPR) is the foundation of resuscitation. New data reaffirm the key components of high-quality CPR: providing adequate chest compression rate and depth, minimizing interruptions in CPR, allowing full chest recoil between compressions, and avoiding excessive ventilation.”
Comment: Depth is 1.5 inches (4cm).
“A respiratory rate of 20 to 30 breaths per minute is new for infants and children who are (a) receiving CPR with an advanced airway in place or (b) receiving rescue breathing and have a pulse.”
Comment: The respiratory rate is now 20-30 per minute if providing ventilation. This is up from 10-12.
“For patients with nonshockable rhythms, the earlier epinephrine is administered after CPR initiation, the more likely the patient is to survive.”
Comment: This is a similar recommendation to adult ALS. We covered this back in 2018.
“Using a cuffed endotracheal tube decreases the need for endotracheal tube changes.”
Comment: This is a significant change. Calculate cuffed tube size with age/4 + 3.5.
“The routine use of cricoid pressure does not reduce the risk of regurgitation during bag-mask ventilation and may impede intubation success.”
Comment: Amen to that!
“For out-of-hospital cardiac arrest, bag-mask ventilation results in the same resuscitation outcomes as advanced airway interventions such as endotracheal intubation.”
Comment: We covered this article in JAMA and another in Resuscitation about this.
“Resuscitation does not end with return of spontaneous circulation (ROSC). Excellent post–cardiac arrest care is critically important to achieving the best patient outcomes. For children who do not regain consciousness after ROSC, this care includes targeted temperature management and continuous electroencephalography monitoring. The prevention and/or treatment of hypotension, hyperoxia or hypoxia, and hypercapnia or hypocapnia is important.”
Comment: Well, there you have it.
“After discharge from the hospital, cardiac arrest survivors can have physical, cognitive, and emotional challenges and may need ongoing therapies and interventions.”
Comment: Most children would benefit from post-arrest rehabilitation services.
“Naloxone can reverse respiratory arrest due to opioid overdose, but there is no evidence that it benefits patients in cardiac arrest.”
Comment: With opioid misuse prevalent, children may be inadvertently exposed or may take opioids intentionally. Altered mental status or respiratory depression may be opioid related and respond to naloxone. Don’t delay resuscitative interventions while waiting for naloxone to (possibly) work.
“Fluid resuscitation in sepsis is based on patient response and requires frequent reassessment. Balanced crystalloid, unbalanced crystalloid, and colloid fluids are all acceptable for sepsis resuscitation. Epinephrine or norepinephrine infusions are used for fluid-refractory septic shock.”
Comment: But balanced fluid is probably better than NS. Definitely no hypotonic fluid in children any longer.
Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation. 2020 Oct 20;142(16_suppl_2):S469-S523. doi: 10.1161/CIR.0000000000000901. Epub 2020 Oct 21.
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