Pediatric Advanced Life Support Research Articles

Different Respiratory Rates during Resuscitation in a Pediatric Animal Model of Asphyxial Cardiac Arrest.

AimsActual resuscitation guidelines recommend 10 respirations per minute (rpm) for advanced pediatric life support. This respiratory rate (RR) is much lower than what is physiological for children. The aim of this study is to compare changes in ventilation, oxygenation, haemodynamics and return of spontaneous circulation (ROSC) rates with three RR.MethodsAn experimental model of asphyxial cardiac arrest (CA) in 46 piglets (around 9.5 kg) was performed. Resuscitation with three different RR (10, 20 and 30 rpm) was carried out. Haemodynamics and gasometrical data were obtained at 3, 9, 18 and 24 minutes after beginning of resuscitation. Measurements were compared between the three groups.ResultsNo statistical differences were found in ROSC rate between the three RR (37.5%, 46.6% and 60% in the 10, 20 and 30 rpm group respectively P = 0.51). 20 and 30 rpm groups had lower PaCO2 values than 10 rpm group at 3 minutes (58 and 55 mmHg vs 75 mmHg P = 0.08). 30 rpm group had higher PaO2 (61 mmHg) at 3 minutes than 20 and 10 rpm groups (53 and 45 mmHg P = 0.05). No significant differences were found in haemodynamics or tissue perfusion between hyperventilated (PaCO2 <30 mmHg), normoventilated (30–50 mmHg) and hypoventilated (>50 mmHg) animals. PaO2 was significantly higher in hyperventilated (PaO2 153 mmHg) than in normoventilated (79 mmHg) and hypoventilated (47 mmHg) piglets (P<0.001).ConclusionsOur study confirms the hypothesis that higher RR achieves better oxygenation and ventilation without affecting haemodynamics. A higher RR is associated but not significantly with better ROSC rates.

The incorporation of focused history in checklist for early recognition and treatment of acute illness and injury.

BackgroundDiagnostic error and delay are critical impediments to the safety of critically ill patients. Checklist for early recognition and treatment of acute illness and injury (CERTAIN) has been developed as a tool that facilitates timely and error-free evaluation of critically ill patients. While the focused history is an essential part of the CERTAIN framework, it is not clear how best to choreograph this step in the process of evaluation and treatment of the acutely decompensating patient.MethodsAn un-blinded crossover clinical simulation study was designed in which volunteer critical care clinicians (fellows and attendings) were randomly assigned to start with either obtaining a focused history choreographed in series (after) or in parallel to the primary survey. A focused history was obtained using the standardized SAMPLE model that is incorporated into American College of Trauma Life Support (ATLS) and Pediatric Advanced Life Support (PALS). Clinicians were asked to assess six acutely decompensating patients using pre – determined clinical scenarios (three in series choreography, three in parallel). Once the initial choreography was completed the clinician would crossover to the alternative choreography. The primary outcome was the cognitive burden assessed through the NASA task load index. Secondary outcome was time to completion of a focused history.ResultsA total of 84 simulated cases (42 in parallel, 42 in series) were tested on 14 clinicians. Both the overall cognitive load and time to completion improved with each successive practice scenario, however no difference was observed between the series versus parallel choreographies. The median (IQR) overall NASA TLX task load index for series was 39 (17 – 58) and for parallel 43 (27 – 52), p = 0.57. The median (IQR) time to completion of the tasks in series was 125 (112 – 158) seconds and in parallel 122 (108 – 158) seconds, p = 0.92.ConclusionIn this clinical simulation study assessing the incorporation of a focused history into the primary survey of a non-trauma critically ill patient, there was no difference in cognitive burden or time to task completion when using series choreography (after the exam) compared to parallel choreography (concurrent with the primary survey physical exam). However, with repetition of the task both overall task load and time to completion improved in each of the choreographies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12873-016-0099-9) contains supplementary material, which is available to authorized users.

Correction to: Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.

In the article by de Caen et al, “Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support: 2015 International Consensus on Cardiopulmonary …

Validity of Mothers' Reports of Children's Weight in Japan.

Estimation methods for pediatric weight have not been evaluated for Japanese children. This study aimed to assess the accuracy of mothers' reports of their children's weight in Japan. We also evaluated potential alternatives to the estimation of weight, including the Broselow tape (BT), Advanced Pediatric Life Support (APLS), and Park's formulae. We prospectively collected cross-sectional data on a convenience sample of 237 children aged less than 10 years who presented to a general pediatric outpatient clinic with their mothers. Each weight estimation method was evaluated using Bland- Altman plots and by calculating the proportion within 10% and 20% of the measured weight. Mothers' reports of weight were the most accurate method, with 94.9% within 10% of the measured weight, the lowest mean difference (0.27kg), and the shortest 95% limit of agreement (－1.4 to 1.9kg). The BT was the most reliable alternative, followed by APLS and Park's formulae. Mothers' reports of their children 's weight are more accurate than other weight estimation methods. When no report of a child's weight by the mother is available, BT is the best alternative. When an aged-based formula is the only option, the APLS formula is preferred.

The Effects of Pediatric Advanced Life Support Guidelines on Pediatric Trauma Airway Management

Recent Pediatric Advanced Life Support (PALS) guidelines have deemphasized the use of advanced airways in short transport. It is unclear if guideline recommendations have altered practice. We sought to determine if a temporal change exists in the number of prehospital pediatric trauma intubations since the 2005 PALS guidelines update. This is an institutional review board-approved, retrospective, single-center study. Reviewed all pediatric trauma activations where patients younger than 19 years were intubated at the scene, en route or at the level 1 trauma center during 2006 to 2011. Specific complications collected were esophageal intubations, mainstem intubations and need for re-intubations. There were 1012 trauma activations, 1009 pediatric patients, 300 (29.7%) intubated during transport to Children's Hospital of Wisconsin Pediatric Trauma Center (PTC) or upon arrival. Mean age of 9.5 ± 5.9 years. Fifty-seven percent (n = 172) were intubated before PTC, 31.7% (n = 95) field intubations, 25.7% (n = 77) outside facility intubations. 44% (n = 132) at PTC. Age was not a significant variable. There was no difference in the proportion of injured children requiring intubation who were intubated before arrival to the PTC. Those intubated in the field versus a facility had significantly increased mortality (P = 0.0002), longer hospital days (P = 0.0004) including intensive care unit days (P = 0.0003) and ventilator days (P = 0.0003) even when adjusted for illness severity. There was no significant change in the proportion of pretrauma room intubations following the 2005 PALS guidelines even when adjusted for illness or injury severity. Children injured farther from the PTC and more severely injured children were more likely to be intubated before arrival at the PTC.

Cardiopulmonary Resuscitation in Congenital and Acquired Heart Disease.

The Pediatric Advanced Life Support recommendations were developed for otherwise healthy infants and children with normal cardiac anatomy. Patients with acquired and congenital heart disease require specific considerations that may differ from the Pediatric Advanced Life Support recommendations. Our aim is to present prearrest, arrest, and postarrest considerations that are unique to children with congenital and acquired heart disease. MEDLINE and PubMed. A clear understanding of the underlying anatomy and physiology of congenital and acquired heart disease is imperative in order to employ the appropriate modifications to the current Pediatric Advanced Life Support recommendations and to optimize outcomes.

Part 6. Pediatric advanced life support: 2015 Korean Guidelines for Cardiopulmonary Resuscitation

Part 6. Pediatric advanced life support: 2015 Korean Guidelines for Cardiopulmonary Resuscitation

Update

In Brief The 2015 update from the American Heart Association for pediatric Basic Life Support (BLS) and Pediatric Advanced Life Support (PALS) guidelines contains evidence-based recommendations for care supported by the latest research. Although the changes in the guidelines are few, the new information needs to be integrated into existing pediatric BLS and PALS algorithms. Explore the changes here. The 2015 update from the American Heart Association for pediatric Basic Life Support and Pediatric Advanced Life Support guidelines contains evidence-based recommendations for care supported by the latest research. Explore the changes here.

Paediatric acute care: Highlights from the PAC-APLS conference, Sydney, 2015.

The Paediatric Acute Care Conference (PACC) is an annual conference organised by Advanced Paediatric Life Support (APLS) Australia to advance paediatric acute care topics for clinicians in pre-hospital medicine, EDs, acute paediatrics, intensive care and anaesthesia. All PACC content is made available free online (https://vimeo.com/aplsaustralia). The PAC conference 2015 was held at Coogee, Sydney. We provide a summary of some of the presentations.

Emergency weight estimation lookup tables for New Zealand children aged 5-10years.

To derive novel emergency weight estimation tables for New Zealand children aged 5-10years using ethnicity and sex to increase accuracy and precision. Using an existing dataset (collected in five New Zealand primary schools during July 2013; n=376), body mass index and current emergency weight estimates were calculated. Stepwise regression with Akanke Information produced two best-fit models for predicting weight, one based on age and the other on height. Potential explanatory variables included ethnicity, sex and body habitus. The length-based model included height, ethnicity and body habitus. Accuracy (weight estimates within 10% of actual weight) for the length-based lookup table (74.8%) was similar to that for the Broselow-Luten tape (73.4%). The age-based model included age, sex, ethnicity and body habitus. Accuracy (51.3%) for the age-based lookup table was better than for existing formulae including Shann (45.7%), Advanced Paediatric Life Support (39.1%) and Theron (28.7%). The most accurate method for weight estimation in Auckland children aged 5-10years is either the novel length-based lookup table or the existing Broselow-Luten tape. When length-based methods are not possible, the age-based lookup tables incorporating age, sex, ethnicity and body habitus are more accurate than existing methods of weight estimation.

Simulation-based training bundle significantly reduces time to oxygen delivery via needle cricothyroidotomy in airway emergency

Needle cricothyroidotomy is a simple but potentially life-saving emergency airway manoeuvre used to provide oxygenation during a ‘cannot intubate, cannot ventilate’ (CICV) emergency.1 ,2 The procedure involves inserting a large...

Book review: Paediatric emergency medication book

This book provides a quick, easy-to-access, weight-based guide to resuscitation of infants and children. It includes medication dosing in resuscitation situations, endotracheal tube size and positioning, and emergency management of seizures, asthma, anaphylaxis and electrolyte disorders. The formatting, content and presentation have been carefully considered to achieve this aim and to make it a valuable resource. Weight-based guidelines are presented for 2–80 kg, in a clear colour-coded format. The information for each weight is presented over two pages. It provides everything you need in a resuscitation setting at a glance, including tables for resuscitation, endotracheal tube size, and induction and paralytic drugs. Information on drugs used in severe asthma, status epilepticus and electrolyte abnormalities is also included. Layout is the same irrespective of the weight selected which helps readers to become familiar with this resource. Infusion guidelines are also provided, although many institutions may have these preprogrammed in their infusion pumps. The book is spiral bound with sturdy laminated pages, making it waterproof and durable. It is easy to turn to the weight needed and access the information required in a timely fashion. The first three pages contain Advanced Paediatric Life Support (APLS) algorithms for basic and advanced life support, and status epilepticus. This is an excellent resource for medical and nursing staff working with sick infants and children, be that frequently or occasionally, in an inpatient ward setting, mixed emergency department or paediatric emergency department. It provides clear, easily accessible important information in a visually appealing format. The section on electrolyte abnormalities is particularly useful. It could also be used as a resource for education and specifically simulation – APLS Australia have already adopted it for this use.

Improvement of Skills in Cardiopulmonary Resuscitation of Pediatric Residents by Recorded Video Feedbacks.

To evaluate the pediatric residents' cardiopulmonary resuscitation (CPR) skills, and their improvements after recorded video feedbacks. Pediatric residents from a university hospital were enrolled. The authors surveyed the level of pediatric resuscitation skill confidence by a questionnaire. Eight psychomotor skills were evaluated individually, including airway, bag-mask ventilation, pulse check, prompt starting and technique of chest compression, high quality CPR, tracheal intubation, intraosseous, and defibrillation. The mock code skills were also evaluated as a team using a high-fidelity mannequin simulator. All the participants attended a concise Pediatric Advanced Life Support (PALS) lecture, and received video-recorded feedback for one hour. They were re-evaluated 6 wk later in the same manner. Thirty-eight residents were enrolled. All the participants had a moderate to high level of confidence in their CPR skills. Over 50% of participants had passed psychomotor skills, except the bag-mask ventilation and intraosseous skills. There was poor correlation between their confidence and passing the psychomotor skills test. After course feedback, the percentage of high quality CPR skill in the second course test was significantly improved (46% to 92%, p=0.008). The pediatric resuscitation course should still remain in the pediatric resident curriculum and should be re-evaluated frequently. Video-recorded feedback on the pitfalls during individual CPR skills and mock code case scenarios could improve short-term psychomotor CPR skills and lead to higher quality CPR performance.

Correlates of Performance of Healthcare Workers in Emergency, Triage, Assessment and Treatment plus Admission Care (ETAT+) Course in Rwanda: Context Matters.

BackgroundThe Emergency, Triage, Assessment and Treatment plus Admission care (ETAT+) course, a comprehensive advanced pediatric life support course, was introduced in Rwanda in 2010 to facilitate the achievement of the fourth Millennium Development Goal. The impact of the course on improving healthcare workers (HCWs) knowledge and practical skills related to providing emergency care to severely ill newborns and children in Rwanda has not been studied.ObjectiveTo evaluate the impact of the ETAT+ course on HCWs knowledge and practical skills, and to identify factors associated with greater improvement in knowledge and skills.MethodsWe used a one group, pre-post test study using data collected during ETAT+ course implementation from 2010 to 2013. The paired t-test was used to assess the effect of ETAT+ course on knowledge improvement in participating HCWs. Mixed effects linear and logistic regression models were fitted to explore factors associated with HCWs performance in ETAT+ course knowledge and practical skills assessments, while accounting for clustering of HCWs in hospitals.Results374 HCWs were included in the analysis. On average, knowledge scores improved by 22.8/100 (95% confidence interval (CI) 20.5, 25.1). In adjusted models, bilingual (French & English) participants had a greater improvement in knowledge 7.3 (95% CI 4.3, 10.2) and higher odds of passing the practical skills assessment (adjusted odds ratio (aOR) = 2.60; 95% CI 1.25, 5.40) than those who were solely proficient in French. Participants who attended a course outside of their health facility had higher odds of passing the skills assessment (aOR = 2.11; 95% CI 1.01, 4.44) than those who attended one within their health facility.ConclusionsThe current study shows a positive impact of ETAT+ course on improving participants’ knowledge and skills related to managing emergency pediatric and neonatal care conditions. The findings regarding key factors influencing ETAT+ course outcomes demonstrate the importance of considering key contextual factors (e.g., language barriers) that might affect HCWs performance in this type of continuous medical education.

A Child's Last Hours'Multidisciplinary Training in End-of-Life Care in Children's Hospitals: Adolescent With Cystic Fibrosis

Abstract Introduction This resource is one of a three-module workshop using a case-based approach to teach interprofessional learners about end-of-life (EOL) care in dying hospitalized patients. Th...

Retention Curves for Pediatric and Neonatal Intubation Skills After Simulation-Based Training.

We evaluated the retention of pediatric and neonatal intubation performance abilities of clinicians trained on a simulated or live tissue model at 3 intervals after initial training to assess competency degradation related to either training modality or retention interval. We implemented a quasi-experimental design with purposive sampling to assess performance differences between 171 subjects randomly assigned to 1 of 3 intervals after initial training: 6 weeks, 18 weeks, or 52 weeks. Training followed the American Heart Association Pediatric Advanced Life Support and Neonatal Resuscitation Program protocols with hands-on practice using 1 of 2 models (live feline or simulated feline). Assessment data were captured using validated instruments and analyzed using analysis of variance with repeated measures (statistical significance set at P < 0.05). Cognitive retention scores decreased significantly (P = 0.000) from posttraining cognitive scores. There were no significant differences between posttraining and retention scores for pediatric and neonatal performances. Both affect and self-efficacy retention scores decreased significantly (P = 0.000) from posttraining scores at 18 and 52 weeks, but remained constant at 6 weeks. Retention scores for all dimensions showed a significant difference between subjects with varying amounts of experience performing pediatric and neonatal intubation, such that those with more experience scored higher those with less (P < 0.003). Retention performance outcomes decreased sufficiently from posttraining scores to suggest that training refreshment could serve to maintain posttraining competency in the ability to perform pediatric and neonatal intubation. Retraining intervals may be best aligned with provider experience levels. Future research focusing on the effect of variable interval refresher training on retention in pediatric and neonatal intubation is merited.

Experience of Pediatric Advanced Life Support (PALS) provider courses in a tertiary care centre of Pakistan

Background: Pediatric Advanced Life Support (PALS) courses prepare candidates to respond to life-threatening emergencies in children. Objective: To describe the experiences of teaching the PALS course in a developing country. Methods: We described the experience of teaching PALS courses conducted according to guidelines of American Heart Association to physicians and nurses at Aga Khan University Hospital from January 2011 to December 2015. The outcome of the courses was recorded as passing of participants both in written test as well as skill stations. The passing score for test was 84%. We also recorded participant’s evaluation of the course. Data were entered in the excel sheet and descriptive statistics were applied. Results: During 5 years, 1044 candidates participated in 88 PALS courses. Majority were female (n=732, 70.1%). Physicians and nurses were 383 (36.6%) and 661(63.3%) respectively. Besides pediatricians, 373 participants (35.7%) were from emergency department and other clinical area. A passing grade was achieved by 936 (89.6%) of participants; the mean test score for whole sample was 88.37%. Four PALS instructor courses were also conducted and 33 new instructors were added to instructor pool. Evaluation of the course by students revealed that 98% of student felt able to respond in emergency situations while 93% felt confident in the use of taught skills. Conclusion: We found that conducting PALS courses is a positive educational experience to participants which will help in saving the lives of acutely ill children by practical implications.

Is the Broselow Tape and APLS formula applicable to Nigerian children? The Kano experience

Background: Weight estimation is useful in pediatric practice; it is used in drug dosage calculation and for nutritional assessment. However, in comatose children actual weight measurement may not be possible therefore weight estimation becomes imperative. The Advanced Pediatric Life Support (APLS) formula and the Broselow Tape have been validated in most developed countries, but not in Nigerian children. Objective: To determine the performance of APLS formula and Broselow Tape in Nigerian children. Materials and Methods: The actual weight of 300 children in the Pediatric Emergency Unit and the Outpatient Department of Aminu Kano Teaching Hospital were taken using weighing scales and their length was also taken; these were compared with values estimated from their ages using the APLS formula and the Broselow Tape. Results: Both methods had similar pattern of performance, underestimating weight (39.7%) in the 1-year age group, and overestimation in the older age groups; however, these were within 95% limit of agreement. The overall average percentage difference was 5.3% and 5.4% for the Broselow Tape and APLS formula, respectively. The proportion of agreement within 10% of the actual weight were 36.8%, 48.8%, 64.3%, 48.1%, and 54.1% for 1, 2, 3, 4, and 5-year age groups, respectively. Conclusion: Both methods are of benefit in Nigerian children, although they underestimated weight in children within the 1-year-age-group.

Effect of scene simulation-based teaching on pediatric advanced life support training in medical students

Objective To assess the effect of scene simulation-based teaching on pediatric advanced life support(PALS) skills in medical students. Methods The students of two grades of Department of Pediatrics in Capital Medical University participated in the PALS training.All of them had the examination of theory and skills of critical illness management and cardiopulmonary resuscitation in children before and after the scene simulation-based teaching on PALS.The questionnaire was filled out and the data was analyzed after the training. Results Fifty-one students completed the training.The average score after the training was significantly higher than that before the training(86.51±7.16 vs.53.85±14.24, P<0.05). After the training, the error rate of ECG recognition, etiological identification and treatment of the disease, and the dosage as well as usage of medicine was significantly decreased(64.7% vs.15.7%, 71.0% vs.10.5%, 73.2% vs.25.9%). All of the students could use the defibrillator correctly and the students' satisfaction rate was more than 94%. Conclusion Scene simulation-based teaching on PALS skills can improve the theory and skills of critical illness management and cardiopulmonary resuscitation of children in medical students. Key words: Pediatric advanced life support; Scene simulation-based teaching

Pediatric advanced life support and sedation of pediatric dental patients.

Programs provided by the Korea Association of Cardiopulmonary Resuscitation include Basic Life Support (BLS), Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS), and Korean Advanced Life Support (KALS). However, programs pertinent to dental care are lacking. Since 2015, related organizations have been attempting to develop a Dental Advanced Life Support (DALS) program, which can meet the needs of the dental environment. Generally, for initial management of emergency situations, basic life support is most important. However, emergencies in young children mostly involve breathing. Therefore, physicians who treat pediatric dental patients should learn PALS. It is necessary for the physician to regularly renew training every two years to be able to immediately implement professional skills in emergency situations. In order to manage emergency situations in the pediatric dental clinic, respiratory support is most important. Therefore, mastering professional PALS, which includes respiratory care and core cases, particularly upper airway obstruction and respiratory depression caused by a respiratory control problem, would be highly desirable for a physician who treats pediatric dental patients. Regular training and renewal training every two years is absolutely necessary to be able to immediately implement professional skills in emergency situations.