AHA 2015 Update For CPR and ECC: PALS

On CPR

  • Conventional CPR should be given as most cardiac arrest in children is due to respiratory failure. However, if rescuers are unwilling/unable to give rescue breath, compression only CPR is better than no CPR.

On resuscitation

  • No excessive fluid during resuscitation
  • No atropine for intubation (in 2010, atropine was recommended due to reports of paradoxical bradycardia during intubation).
  • It is REASONABLE to give epinephrine (in 2010, epinephrine SHOULD be given in pulseless cardiac arrrest)
    – Differ from adults: epinephrine should be given ASAP in non shockable rhythm
  • Lidocaine and amiodarone maybe given for refractory VF
    – Compared to amiodarone, lidocaine increases chance of ROSC but no difference between 2 drugs in survival to hospital discharge
    – DIffer from adult: no recommendation about lidocaine use in adult refractory VF; lidocaine in adult is associated with increased mortality if given after MI; use of lidocaine is only suggested AFTER ROSC to prevent recurrence of VF

Post-cardiac arrest

  • Hypothermia is no better than normothermia in children; fever should be avoided
    – In OHCA, it is reasonable to put the children in 5 days of normothermia; for IHCA, no evidence supporting hypothermia over normothermia
    – Differ from adult: TTM has been shown to improve neurological outcome post ROSC in adults. A temperature range of 33 (hypothermia) to 36 (normothermia) has been recommended as the target temperature in TTM.
  • Avoid hypotension and hypoxemia post-cardiac arrest.
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