PALS Update
1) Advanced Airway Interventions in Pediatric Cardiac Arrest
Recommendation—Updated 2019:
BMV is reasonable compared with advanced airway interventions (endotracheal intubation or SGA) in the management of children during cardiac arrest in the out-of-hospital setting (Class 2a; Level of Evidence C-LD).
We cannot make a recommendation for or against the use of an advanced airway for IHCA management. In addition, no recommendation can be made about which advanced airway intervention is superior in either OHCA or IHCA.
During OHCA, transport time, provider skill level and experience, and equipment availability should be considered in the selection of the most appropriate airway intervention. If BMV is ineffective despite appropriate optimization, more advanced airway interventions should be considered.
2. ECPR for IHCA (in hospital cardiac arrest)
ECPR is defined as the rapid deployment of venoarterial ECMO during active CPR or for patients with intermittent return of spontaneous circulation.
Recommendation—Updated 2019:
ECPR may be considered for pediatric patients with cardiac diagnoses who have IHCA in settings with existing ECMO protocols, expertise, and equipment (Class 2b; Level of Evidence C-LD).
3. POST–CARDIAC ARREST TTM
(
targeted temperature management)
Recommendations—Updated 2019:
Continuous measurement of core temperature during TTM is recommended (Class 1; Level of Evidence B-NR). For infants and children between 24 hours and 18 years of age who remain comatose after OHCA or IHCA, it is reasonable to use either TTM 32°C to 34°C followed by TTM 36°C to 37.5°C or to use TTM 36°C to 37.5°C (Class 2a; Level of Evidence B-NR).
