ILCOR 2015 – paediatric summary

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Cite this article as:
Towers, A. ILCOR 2015 – paediatric summary, Don't Forget the Bubbles, 2015. Available at:
http://doi.org/10.31440/DFTB.7723

The International Liaison Committee on Resuscitation (ILCOR) is a collaboration between resuscitation groups worldwide. Every few years, they do an enormous evidence based review of resuscitation science which informs resuscitation guidelines all over the world.

The 2015 ILCOR consensus document (International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations) was published on 15th October 2015 and covers all aspects of resuscitation for all patient populations.

If you’re anything like me, you’ll agree that wordy documents like this can’t be read quickly (in this case even the Executive Summary is 31 pages!) so to save us all some time, I’ve summarised the recommendations with a focus on paediatrics.

Important note; this is an international consensus document and does not constitute new guidelines. Over the coming months, all the national resuscitation groups will assimilate this information into updated resuscitation guidelines so please don’t change your practice until your national updated guidelines have been published!

 

TOP TIPS (summary of my summary of the executive summary!)

  1. Paediatric rapid response/medical emergency teams should be implemented in hospitals caring for children
  2. We should consider using less volume when treating patients in shock, especially if febrile without overt signs of shock – the key is to reassess frequently
  3. Rescue breaths should always be provided first if able
  4. ECMO should be considered for infants and children with cardiac diagnoses and an in-hospital cardiac arrest in a hospital with ECMO facilities
  5. Intra-arrest prognostication – still needs to be multifactorial however positive patient outcome predictors are initial shockable rhythm and age (<1 year if in-hospital arrest and >1 year if out-of-hospital arrest) – duration of arrest is not useful by itself
  6. After ROSC
  • Keep normothermic or therapeutic hypothermia
  • Check PaO2 and PCO2
  • BP should be kept >50th centile for age with fluid and inotropes
  • EEG within 7 days may help with prognostication – not enough evidence to recommend at this stage

Pre cardiac arrest care

  • Response systems and assessment
    • There should be paediatric rapid response/MET systems
    • Not enough evidence re PEWS
  • Atropine for intubation
    • Not enough evidence
  • Pre arrest care for dilated cardiomyopathy/myocarditis
    • Not enough evidence
  • Pre arrest care of shock
    • Consider using less volume of isotonic crystalloid for improved outcome; especially if febrile without overt signs of shock
    • Frequent reassessment is key to guide further volume supplementation

BLS during cardiac arrest

  • C-A-B or A-B-C ?
    • Not enough evidence
  • Compression depth
    • Infants = 1/3 AP depth or 4cm
    • Children = 1/3 AP depth or 5cm
  • Compressions only
    • Should always provide rescue breaths if able
    • If unable, then compressions only

Paeds ALS during cardiac arrest

  • Defib energy
    • 2-4 J/kg if VF/pVT
    • Unable to comment on 2nd dose energy
  • Invasive BP or ETCO2 to guide CPR quality
    • Not enough evidence
  • Vasopressor or antiarrhythmics in cardiac arrest
    • Not enough evidence to comment
    • Continue to support use of adrenaline (but evidence is limited)
    • Lidocaine or amiodarone improve short term outcomes in shock resistant VF/pVT but few data on long term outcomes
  • ECMO
    • Consider ECMO for infants and children with cardiac diagnoses if in-hospital arrest in ECMO centre
    • Not enough evidence re out of hospital arrests or without cardiac diagnoses
  • Intra-arrest prognostication
    • In-hospital arrest: positive patient outcome predictors are age <1 year and presence of initial shockable rhythm
    • Out-of-hospital arrest: positive patient outcome predictors are age >1 year and presence of initial shockable rhythm
    • Duration of arrest: not helpful by itself
    • Obligatory to assimilate multiple factors to help prognosticate

Post cardiac arrest care

  • If remain unconscious after ROSC; better outcome if fever avoided, moderate therapeutic hypothermia OR strict maintenance of normothermia
  • Post ROSC PaO2 and ventilation
    • Measure PaO2 post ROSC: target a value appropriate for specific patient’s condition OR within standard normal range
    • Measure PaCO2 post ROSC: target value appropriate for specific patient’s condition
  • Post ROSC fluid/inotropes
    • Strong recommendation for parenteral fluids and/or inotropes to keep BP ≥50th centile
  • Post ROSC EEG as prognosticator
    • EEG within first 7 days may assist prognostication (cannot be recommended as not enough evidence)
  • Post ROSC predictive factors
    • Multiple variables should be used

References/further reading:

 

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Ashley Towers is a paediatric trainee, usually based in Wessex in the UK but currently working in Melbourne, Australia. She has an interest in emergency medicine with a splash of cardiology and critical care for good measure.

Author: Ashley Towers Ashley Towers is a paediatric trainee, usually based in Wessex in the UK but currently working in Melbourne, Australia. She has an interest in emergency medicine with a splash of cardiology and critical care for good measure.

One Response to "ILCOR 2015 – paediatric summary"

  1. Brendan
    Brendan 3 years ago .Reply

    Great post, thanks! Really helpful. Your summary mentions the post-ROSC blood pressure should be kept above the 50th centile for age. The ILCOR update states it should be the above the 5th centile i think, have I got this completely wrong?

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