Pediatric resuscitation: an advisory statement from the Pediatric Working Group of the International Liaison Committee on Resuscitation.

This summary document reflects the deliberation of the Pediatric Working Group of the International Liaison Committee on Resuscitation (ILCOR). The ILCOR goal is to improve consistency of guidelines issued by international resuscitation councils and associations. The purpose of this summary is to highlight areas of conflict or controversy in current pediatric basic and advanced life support guidelines,1 2 3 4 5 outline solutions considered, and provide recommendations reached by consensus of the working group. Unresolved issues are listed and a few areas of active guideline research interest and investigation are highlighted. This document does not include a complete list of guidelines for which there is no perceived controversy. The algorithm/decision tree figures presented attempt to illustrate a common flow of assessments and interventions. Whenever possible, this was coordinated to complement the basic life support (BLS) and advanced life support (ALS) algorithms used for adult victims. Since arrest of the newly born infant presents unique resuscitation challenges in terms of etiology, physiology, and required resources, the working group developed a separate section addressing initial resuscitation of the newly born. Other areas of departure from the adult algorithms are noted and the rationale explained in text. In the absence of specific pediatric data (outcome validity), recommendations may be made or supported on the basis of common sense (face validity) or ease of teaching or skill retention (construct validity). Practicality of recommendations in the context of local resources (technology and personnel) and customs must always be considered. In compiling this document, it was surprising to the working group participants how few differences exist among current pediatric guidelines advocated by the American Heart Association, the Heart and Stroke Foundation of Canada, the European Resuscitation Council, the Australian Resuscitation Council, and the Resuscitation Councils of Southern Africa. The epidemiology and outcome of pediatric cardiopulmonary …

[1]  M. Hazinski.  Is pediatric resuscitation unique? Relative merits of early CPR and ventilation versus early defibrillation for young victims of prehospital cardiac arrest. , 1995, Annals of emergency medicine.

[2]  B. Goldstein,et al.  Retinal Hemorrhages Following Cardiopulmonary Resuscitation , 1993, Clinical pediatrics.

[3]  Zhen Z. Yu,et al.  Quantitative analysis of acoustic emission signals , 1987 .

[4]  High-dose epinephrine in adult cardiac arrest. , 1992, The New England journal of medicine.

[5]  H. Werman,et al.  Adrenergic agonists during cardiopulmonary resuscitation. , 1990, Resuscitation.

[6]  J. Desforges.  Current concepts : intraosseous infusion , 1990 .

[7]  A. Dietrich,et al.  Pediatric patients requiring CPR in the prehospital setting. , 1995, Annals of emergency medicine.

[8]  H. Tunstall-Pedoe,et al.  Survey of 3765 cardiopulmonary resuscitations in British hospitals (the BRESUS Study): methods and overall results. , 1992, BMJ.

[9]  M. Goetting,et al.  High-dose epinephrine improves outcome from pediatric cardiac arrest. , 1991, Annals of emergency medicine.

[10]  D. Andropoulos,et al.  Plasma epinephrine concentrations after intraosseous and central venous injection during cardiopulmonary resuscitation in the lamb. , 1990, The Journal of pediatrics.

[11]  Effect of injection site on circulation times during cardiac arrest. , 1988, Critical care medicine.

[12]  R. Passman,et al.  Factors influencing outcome of cardiopulmonary resuscitation in children , 1986, Pediatric emergency care.

[13]  P. Kleinman,et al.  Cardiopulmonary resuscitation and rib fractures in infants. A postmortem radiologic-pathologic study. , 1994, JAMA.

[14]  J. A. Kaplan,et al.  Patterns of Facial Resuscitation Injury in Infancy , 1994, The American journal of forensic medicine and pathology.

[15]  K. Feldman,et al.  Child abuse, cardiopulmonary resuscitation, and rib fractures. , 1984, Pediatrics.

[16]  N. Kissoon,et al.  Comparison of the acid‐base status of blood obtained from intraosseous and central venous sites during steady‐ and low‐flow states , 1993, Critical care medicine.

[17]  J. Mateer,et al.  Intraosseous infusion: an alternative route of pediatric intravascular access. , 1985, Annals of emergency medicine.

[18]  D. Greene,et al.  INVESTIGATION OF UPPER AIRWAY PROBLEMS IN RESUSCITATION 1. Studies of Pharyngeal X‐rays and Performance by Laymen , 1961, Anesthesiology.

[19]  D. Powner,et al.  Cardiopulmonary resuscitation‐related injuries , 1984, Critical care medicine.

[20]  E. Segedin,et al.  Nasal airway versus oral route for infant resuscitation , 1995, The Lancet.

[21]  E. Molyneux,et al.  Audit of paediatric cardiopulmonary resuscitation. , 1993, Archives of disease in childhood.

[22]  C. Barton,et al.  A randomized clinical trial of high-dose epinephrine and norepinephrine vs standard-dose epinephrine in prehospital cardiac arrest. , 1992, JAMA.

[23]  R. Cummins,et al.  CPR and the Single Rescuer: At What Age Should You "Call First" Rather Than "Call Fast?"☆☆☆★ , 1995 .

[24]  S. O'kelly,et al.  The palpation of pulses , 1996 .

[25]  A. Hallstrom,et al.  Epidemiology of cardiac arrest and resuscitation in children. , 1983, Annals of emergency medicine.

[26]  R. Melker.  Asynchronous and other alternative methods of ventilation during CPR. , 1984, Annals of emergency medicine.

[27]  M. Sagy,et al.  Pediatric cardiopulmonary resuscitation outcome. , 1988, Journal of medicine.

[28]  C. Otto,et al.  Bystander Cardiopulmonary Resuscitation Is Ventilation Necessary? , 1993, Circulation.

[29]  M. Banner,et al.  Ventilation during CPR: two-rescuer standards reappraised. , 1984, Annals of emergency medicine.

[30]  Deborah S. Smith,et al.  Prehospital countershock treatment of pediatric asystole. , 1989, American Journal of Emergency Medicine.

[31]  M. Hazinski,et al.  Recommended guidelines for uniform reporting of pediatric advanced life support: the Pediatric Utstein Style. A statement for healthcare professionals from a task force of the American Academy of Pediatrics, the American Heart Association, and the European Resuscitation Council. , 1995, Resuscitation.

[32]  N. Kissoon,et al.  Comparison of pH and carbon dioxide tension values of central venous and intraosseous blood during changes in cardiac output , 1994, Critical care medicine.

[33]  T. Parke.  Unexplained pneumoperitoneum in association with basic cardiopulmonary resuscitation efforts. , 1993, Resuscitation.

[34]  A. Aitkenhead,et al.  COMPARISON OF ENDOTRACHEAL AND PERIPHERAL INTRAVENOUS ADRENALINE IN CARDIAC ARREST Is the Endotracheal Route Reliable? , 1987, The Lancet.

[35]  N. Kissoon,et al.  Comparison of fluid infusion rates among peripheral intravenous and humerus, femur, malleolus, and tibial intraosseous sites in normovolemic and hypovolemic piglets. , 1993, Annals of emergency medicine.

[36]  V. Nadkarni,et al.  CPR in children. , 1987, Annals of emergency medicine.

[37]  E. Krongrad,et al.  Terminal cardiac electrical activity in pediatric patients. , 1983, The American journal of cardiology.

[38]  T. Rosenthal,et al.  Epinephrine blood concentrations after peripheral bronchial versus endotracheal administration of epinephrine in dogs , 1992, Critical care medicine.

[39]  J. Perlman,et al.  Cardiopulmonary resuscitation in the delivery room. Associated clinical events. , 1995, Archives of pediatrics & adolescent medicine.

[40]  M. C. Rogers,et al.  Age-related changes in chest geometry during cardiopulmonary resuscitation. , 1987, Journal of applied physiology.

[41]  M. Hazinski,et al.  Recommended guidelines for uniform reporting of pediatric advanced life support: the pediatric Utstein style. A statement for healthcare professionals from a task force of the American Academy of Pediatrics, the American Heart Association, and the European Resuscitation Council. , 1995, Pediatrics.

[42]  J. Krischer,et al.  Complications of CPR. , 1981, Critical care medicine.

[43]  R. Dieckmann,et al.  High-dose epinephrine in pediatric out-of-hospital cardiopulmonary arrest. , 1995, Pediatrics.

[44]  W. King,et al.  Outcome and cost at a children's hospital following resuscitation for out-of-hospital cardiopulmonary arrest. , 1995, Archives of pediatrics & adolescent medicine.

[45]  W. Tweed,et al.  Appraisal of pediatric cardiopulmonary resuscitation. , 1980, Canadian Medical Association journal.

[46]  P. Pepe,et al.  A comparison of standard-dose and high-dose epinephrine in cardiac arrest outside the hospital. The Multicenter High-Dose Epinephrine Study Group. , 1992, The New England journal of medicine.

[47]  R. Koehler,et al.  Epinephrine dosage effects on cerebral and myocardial blood flow in an infant swine model of cardiopulmonary resuscitation. , 1991, Anesthesiology.

[48]  J. Menegazzi,et al.  Lower esophageal sphincter pressure during prolonged cardiac arrest and resuscitation. , 1995, Annals of emergency medicine.

[49]  R. Berg,et al.  Femoral venous pulsations during open-chest cardiac massage , 1994 .

[50]  S. Cohle,et al.  Pediatric injuries from cardiopulmonary resuscitation. , 1996, Annals of emergency medicine.

[51]  E. Gonzalez,et al.  Guidelines for cardiopulmonary resuscitation and emergency cardiac care. , 1987, Clinical pharmacy.

[52]  M. Rieder,et al.  Results of inpatient pediatric resuscitation , 1986, Critical care medicine.

[53]  C. Shearman,et al.  Peripheral pulse palpation: an unreliable physical sign. , 1992, Annals of the Royal College of Surgeons of England.

[54]  B. McCrindle,et al.  Outcome of out-of-hospital cardiac or respiratory arrest in children. , 1996, The New England journal of medicine.

[55]  O'Rourke Pp.  Outcome of children who are apneic and pulseless in the emergency room. , 1986 .

[56]  C. Otto,et al.  A randomized, blinded trial of high-dose epinephrine versus standard-dose epinephrine in a swine model of pediatric asphyxial cardiac arrest. , 1996, Critical care medicine.

[57]  C. Fahrenbruch,et al.  Out-of-hospital ventricular fibrillation in children and adolescents: causes and outcomes. , 1995, Annals of emergency medicine.

[58]  G. Lower,et al.  Pediatric cardiopulmonary arrests in rural populations. , 1990, Pediatrics.

[59]  G. Fleisher,et al.  Death and resuscitation in the pediatric emergency department. , 1995, Annals of emergency medicine.

[60]  S. Blaylock,et al.  THE EFFECT OF KETOROLAC ON THE POSTOPERATIVE NARCOTIC REQUIREMENTS OF GYNECOLOGICAL SURGERY OUTPATIENTS , 1991 .

[61]  D. Torphy,et al.  Cardiorespiratory arrest and resuscitation of children. , 1984, American journal of diseases of children.

[62]  V. Nadkarni,et al.  Effects of different techniques of endotracheal epinephrine administration in pediatric porcine hypoxic-hypercarbic cardiopulmonary arrest. , 1994 .

[63]  C. Peek,et al.  Effect of immediate resuscitation on children with submersion injury. , 1994, Pediatrics.

[64]  J. R. Roberts,et al.  Comparison of the pharmacological effects of epinephrine administered by the intravenous and endotracheal routes. , 1978, JACEP.