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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

    Pediatrics
    |November 16, 2019
    PubMed

    Insights

    This pediatric advanced life support update recommends bag-mask ventilation for out-of-hospital cardiac arrest and considering extracorporeal cardiopulmonary resuscitation for in-hospital cardiac arrest. Targeted temperature management protocols are also updated for post-cardiac arrest care.

    Area of Science:

    • Pediatric Emergency Medicine
    • Cardiology
    • Critical Care Medicine

    Background:

    • The American Heart Association (AHA) pediatric advanced life support (PALS) guidelines undergo periodic updates based on systematic reviews.
    • The International Liaison Committee on Resuscitation (ILCOR) conducts continuous evidence reviews, influencing PALS guideline revisions.
    • This focused update addresses critical areas in pediatric resuscitation: advanced airway management, extracorporeal cardiopulmonary resuscitation (ECPR), and targeted temperature management (TTM).

    Purpose of the Study:

    • To provide an evidence-based update on PALS guidelines for pediatric cardiac arrest.
    • To review and recommend optimal strategies for advanced airway management in pediatric out-of-hospital cardiac arrest (OHCA).
    • To outline recommendations for the use of ECPR in pediatric in-hospital cardiac arrest (IHCA) with cardiac diagnoses.
    • To present updated guidance on TTM for pediatric patients following cardiac arrest.

    Main Methods:

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

    Main Results:

    • For OHCA, bag-mask ventilation is recommended over immediate advanced airway placement.
    • ECPR should be considered for pediatric IHCA patients with cardiac diagnoses when ECPR resources are available.
    • For post-cardiac arrest care, TTM using either a 32°C-34°C followed by 36°C-37.5°C protocol, or a consistent 36°C-37.5°C protocol, is reasonable for comatose pediatric survivors.

    Conclusions:

    • Bag-mask ventilation remains a reasonable initial approach for advanced airway management in pediatric OHCA.
    • ECPR is a viable option for select pediatric IHCA patients when resources permit.
    • Flexible TTM protocols are recommended for pediatric post-cardiac arrest care to optimize outcomes.

    Keywords:
    advanced cardiac life supportairway managementcardiopulmonary resuscitationextracorporeal membrane oxygenationheart arresthypothermia, inducedpediatrics

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