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2019 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart

Jonathan P Duff, Alexis A Topjian, Marc D Berg

    Circulation
    |November 15, 2019
    PubMed

    Insights

    For pediatric cardiac arrest, bag-mask ventilation is recommended over advanced airways. Extracorporeal cardiopulmonary resuscitation is advised for specific in-hospital cases. Targeted temperature management protocols are updated for post-arrest care.

    Area of Science:

    • Pediatric Emergency Medicine
    • Cardiology
    • Critical Care

    Background:

    • The American Heart Association (AHA) pediatric advanced life support guidelines are updated based on systematic reviews by the International Liaison Committee on Resuscitation (ILCOR).
    • This focused update incorporates new evidence into critical care recommendations for pediatric resuscitation.
    • The ILCOR's continuous evidence review process ensures guidelines reflect the latest scientific findings.

    Purpose of the Study:

    • To provide evidence-based recommendations for advanced airway management in pediatric cardiac arrest.
    • To outline indications for extracorporeal cardiopulmonary resuscitation (ECPR) in pediatric cardiac arrest.
    • To update guidelines on pediatric targeted temperature management (TTM) following cardiac arrest.

    Main Methods:

    • Systematic reviews of existing literature and original research were analyzed by the writing group.
    • Evidence was evaluated for advanced airway strategies, ECPR, and TTM in pediatric populations.
    • Recommendations were formulated based on the strength of the evidence.

    Main Results:

    • Bag-mask ventilation is recommended over advanced airway placement for out-of-hospital pediatric cardiac arrest.
    • Extracorporeal cardiopulmonary resuscitation should be considered for pediatric in-hospital cardiac arrest with cardiac diagnoses when ECMO is available.
    • Targeted temperature management protocols include either 32°C–34°C followed by 36°C–37.5°C, or a consistent 36°C–37.5°C for comatose pediatric survivors.

    Conclusions:

    • Current evidence supports bag-mask ventilation as a primary airway strategy in out-of-hospital pediatric cardiac arrest.
    • ECPR is a viable option for select pediatric in-hospital cardiac arrest cases.
    • Updated TTM guidelines offer flexible temperature targets for post-cardiac arrest care in children.

    Keywords:
    AHA Scientific Statementsadvanced cardiac life supportairway managementcardiopulmonary resuscitationextracorporeal membrane oxygenationheart arresthypothermia, inducedpediatrics

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