ILCOR’s draft guidelines

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On October 15th This year ILCOR (International Liaison Committee on Resuscitation) will publish its updated recommendations in Circulation. ILCOR’s guidance is currently available in draft form at https://volunteer.heart.org/apps/pico/Pages/default.aspx where public comment is invited.

Just in case you haven’t had time to read the draft yet, the highlights of the paediatric section are summarised below. It’s a bit obvious but we have to remind you this is an interpretation of a draft document, it is NOT new guidance. If you would like to comment on any of these points you can do so on ILCOR’s website (link above) and you have until Feb 28th.

 

  1. ABC is still better than CAB in managing paediatric arrest.
  2. Compression only CPR is not recommended in kids.
  3. ECMO should be provided to kids who arrest with an underlying cardiac disease in a hospital that is ECMO capable.   There is no evidence on which to make a recommendation about the role of ECMO in the management of paediatric cardiac arrest without known underlying cardiac disease.
  4. We should be using ETCO2 to guide CPR aiming for >10-15mmHg.
  5. Defibrillation should still be with 2-4J/Kg (i.e no change to the Australian standard 4J/Kg).
  6. We should be using paediatric early warning scores for hospitalized children.
  7. Ventilation post ROSC should aim for a pCO2 in the normal physiologic range.
  8. Paediatric MET teams should be implemented in hospitals that care for children.
  9. EEG within the first 7 days of cardiac arrest should be used for prognostication.
  10. We should continue to teach rescuers to compress the chest by 1/3 in infants and children undergoing CPR.
  11. Pupillary reactivity post arrest should be used as a prognostic factor for survival to discharge. Serum NSE and S100B levels may assist in prognostication.
  12. ECMO, if available, should be used for management of myocarditis with high-risk features (arrhythmia, lactic acidosis, renal or liver dysfunction).
  13. We should not titrate the FiO2 to avoid hyperoxaemia post ROSC.
  14. There is no evidence to recommend targeted temperature management.
  15. Atropine is suggested for routine premedication for emergent intubation in infants and children.
  16. We should be using fluid/inotropes to avoid hypotension post ROSC.

 

 

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Paediatric emergency physician interested in education, retrieval medicine and simulation. Lives in Brisbane where he enjoys falling off his mountain bike and being outsmarted by his pre-teen children.

@paedsem | + Ben Lawton | Ben’s DFTB posts

Author: Ben Lawton

Paediatric emergency physician interested in education, retrieval medicine and simulation. Lives in Brisbane where he enjoys falling off his mountain bike and being outsmarted by his pre-teen children.

@paedsem | + Ben Lawton | Ben’s DFTB posts

2 Responses to "ILCOR’s draft guidelines"

  1. Anand Swaminathan
    Anand Swaminathan 3 years ago .Reply

    Thanks for the great summary!

    Surprised to see atropine still included as pretreatment for RSI. The lit behind using atropine is sparse and there’s at least some literature showing atropine does not help (http://1.usa.gov/1F1VDYp). Are you guys routinely administering as pretreatment?

  2. Ben Lawton
    Ben Lawton 3 years ago .Reply

    Hi Swami, they do say it’s a weak recommendation with very low quality evidence and seems to be based largely on this 2013 observational study by Jones et al with ICU mortality as a primary outcome http://www.ncbi.nlm.nih.gov/pubmed/23468997, rather than hyper salivation during ketamine sedation as in the study you reference above. I do not routinely use atropine (and do use ketamine for most of my intubations). While I am always open to evolution in my practice I wouldn’t consider the Jones study practice changing. Thanks for your comment.