Maintaining a diastolic blood pressure (DBP) of >/=25mm Hg in infants and >/= 30mm Hg in children over age 1 during CPR was associated with improved survival to discharge and improved neurologically intact survival.  This is possible only if a child arrests and has invasive BP monitoring in place but is a good reminder that high quality CPR in all patients drastically impacts survival.

Patients in PEA arrest with organized cardiac activity on bedside ultrasound appear to have better survival than those with disorganized, agonal cardiac activity and may respond to treatments not usually performed in standard ACLS, like continuous vasoactive drips during arrest.

Sudden cardiac arrest (SCA) is very rare during sports activities 0.76/100,000.  They found only 3 cases that could have been identified by a sports physical prior to competition.  NNT = 146,000.

Patients who had blunt trauma with CPR > 10 minutes, penetrating trauma with CPR > 15 minutes, or asystole without tamponade should not undergo resuscitative thoracotomy in the ED as it would be futile.

The AHA has released new guidelines for management of ventricular arrhythmias.  Here is what you need to know.

According to this large systematic review, in adults a 30:2 compression to ventilation ratio was better than 15:2.  For kids, either ratio was better than compression only CPR, except under 1 year in which ventilations did not improve outcome beyond compression-only.

Delayed ROSC may occur after cessation of CPR - the so called Lazarus phenomenon.  The incidence is around 6/1000 cases and usually occurred within 3-8 minutes after CPR cessation.  All patients eventually died; 4 of 5 had PEA. It may be wise to allow 10 minutes before pronouncing death (or 4 days if the patient is actually named Lazarus).

Gasping during cardiac arrest was associated with improved neurologically intact survival.  The practical take-home is to avoid premature cessation of CPR if any signs of gasping or agonal respirations are present and to avoid suppression of spontaneous gasping during CPR.

Use of a supraglottic airway (SGA) was associated with improved survival with a good neurological outcome.

Current PALS (and ACLS) algorithms recommend repeat epinephrine doses q3-5 minutes.  This study suggested that this is too frequent.  If doses were spaced 8-10 minutes, pediatric patients had significantly better survival.