Pediatric Basic and Advanced Life Support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Abstract

The 2010 ILCOR Pediatric Task Force experts developed 55 questions related to pediatric resuscitation. Topics were selected based on the 2005 Consensus on Science and Treatment Recommendations (CoSTR) document,1,2 emerging science, and newly identified issues. Not every topic reviewed for the 2005 International Consensus on Science was reviewed in the 2010 evidence evaluation process. In general, evidence-based worksheets were assigned to at least 2 authors for each topic. The literature search strategy was first reviewed by a “worksheet expert” for completeness. The expert also approved the final worksheet to ensure that the levels of evidence were correctly assigned according to the established criteria. Worksheet authors were requested to draft CoSTR statements (see Part 3: Evidence Evaluation Process). Each worksheet author or pair of authors presented their topic to the Task Force in person or via a webinar conference, and Task Force members discussed the available science and revised the CoSTR draft accordingly. These draft CoSTR summaries were recirculated to the International Liaison Committee on Resuscitation (ILCOR) Pediatric Task Force for further refinement until consensus was reached. Selected controversial and critical topics were presented at the 2010 ILCOR International Evidence Evaluation conference in Dallas, Texas, for further discussion to obtain additional input and feedback. This document presents the 2010 international consensus on the science, treatment, and knowledge gaps for each pediatric question. The most important changes or points of emphasis in the recommendations for pediatric resuscitation since the publication of the 2005 ILCOR International Consensus on CPR and ECC Science With Treatment Recommendations1,2 are summarized in the following list. The scientific evidence supporting these changes is detailed in this document. Additional evidence shows that healthcare providers do not reliably determine the presence or absence of a pulse in infants or children. New evidence documents the important role of ventilations in CPR for infants and children. However, rescuers who are unable or unwilling to provide ventilations should be encouraged to perform compression-only CPR. To achieve effective chest compressions, rescuers should compress at least one third the anterior-posterior dimension of the chest. This corresponds to approximately 1½ inches (4 cm) in most infants and 2 inches (5 cm) in most children. When shocks are indicated for ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in infants and children, an initial energy dose of 2 to 4 J/kg is reasonable; doses higher than 4 J/kg, especially if delivered with a biphasic defibrillator, may be safe and effective. More data support the safety and effectiveness of cuffed tracheal tubes in infants and young children, and the formula for selecting the appropriately sized cuffed tube was updated. The safety and value of using cricoid pressure during emergency intubation are not clear. Therefore, the application of cricoid pressure should be modified or discontinued if it impedes ventilation or the speed or ease of intubation. Monitoring capnography/capnometry is recommended to confirm proper endotracheal tube position. Monitoring capnography/capnometry may be helpful during CPR to help assess and optimize quality of chest compressions. On the basis of increasing evidence of potential harm from exposure to high-concentration oxygen after cardiac arrest, once spontaneous circulation is restored, inspired oxygen concentration should be titrated to limit the risk of hyperoxemia. Use of a rapid response system in a pediatric inpatient setting may be beneficial to reduce rates of cardiac and respiratory arrest and inhospital mortality. Use of a bundled approach to management of pediatric septic shock is recommended. The young victim of a sudden, unexpected cardiac arrest should have an unrestricted, complete autopsy, if possible, with special attention to the possibility of an underlying condition that predisposes to a fatal arrhythmia. Appropriate preservation and genetic analysis of tissue should be considered; detailed testing may reveal an inherited “channelopathy” that may also be present in surviving family members.