Pediatric emergency medicine trisk 47

Given the poor prognosis of children who develop cardiopulmonary arrest, primary prevention efforts are crucial in improving childhood mortality.. This chapter will focus on the manageme

e-FIGURE 8.2 Rescue devices for airway management A: Laryngeal mask airway B: Esophageal Combitube (with close up) C: Laryngeal tube D: Perilaryngeal sealer (A:

Reprinted with permission from Guimaraes E, Davis M, Kirsch JR, et al Anesthesia Technician

and Technologist’s Manual 2nd ed Philadelphia, PA: Wolters Kluwer; 2019 B, C: Reprinted

with permission from Barash PG, Cahalan MK, Cullen BF, et al Clinical Anesthesia 8th ed.

Philadelphia, PA: Lippincott Williams & Wilkins; 2018.)

CHAPTER 9 ■ CARDIOPULMONARY

RESUSCITATION

SAGE MYERS, DANA ARONSON SCHINASI, FRANCES M NADEL, SHANNON M GAINES

GOALS OF EMERGENCY THERAPY

Cardiopulmonary resuscitation (CPR) is a series of interventions aimed at restoring and supporting vital function after apparent death The immediate goal

of resuscitation is to reestablish substrate delivery to meet the metabolic needs of the myocardium, brain, and other vital organs The overall goal is to return the child to society without morbidity related to the underlying disease or the resuscitation process Given the poor prognosis of children who develop cardiopulmonary arrest, primary prevention efforts are crucial in improving childhood mortality This chapter will focus on the management of the critically ill child and neonate based on the 2015 American Heart Association (AHA) CPR Resuscitation Guidelines, Pediatric Advanced Life Support (PALS) principles, the literature, and our experience

INCIDENCE

It is estimated that of the more than 6,000 children who suffer an out-of-hospital cardiac arrest (OHCA) annually, only 5% to 12% will survive, most with significant neurologic injury U.S mortality rates related to age in years for 2017 are shown in Table 9.1 There has been little improvement in pediatric OHCA

outcomes over the past two decades Of note, mortality rates of children less than

1 year old approach the rates of people over 54 years old Table 9.2 describes the

leading causes of death for children and young adults After the first year of life, unintentional injury is the most common cause of death and therefore, preventable

RELATED CHAPTERS

Resuscitation and Stabilization

A General Approach to the Ill or Injured Child: Chapter 7 Airway: Chapter 8

Shock: Chapter 10

Interfacility Transport and Stabilization: Chapter 11

Medical Emergencies

Cardiac Emergencies: Chapter 86

Procedures and Appendices

Prehospital Care: Chapter 134

The Children’s Hospital of Philadelphia Clinical Pathways

ED Pathway for End-of-Life Care

URL:

https://www.chop.edu/clinical-pathway/end-of-life-care-clinical-pathway

Authors: D Corwin, MD; E Friedlaender, MD, MPH; L Zinns, MD; T.

Kang, MD, MSCE; C Feudtner, MD, PhD, MPH; W Morrison, MD, MBE; J Hwang, MD, MHS; D Albert, RN, BSN, CPN, CPEN; W

Frankenberger, RN, MSN, CCNS; B Rodio, RN, BSN, CEN, CPHQ

Posted: October 2015, last revised May 2018

Clinical Pathway for Therapeutic Hypothermia Treatment for Neonates With Hypoxic Ischemic Encephalopathy (HIE)

URL:

https://www.chop.edu/clinical-pathway/therapeutic-hypothermia-hypoxic-ischemic-encephalopathy-hie-clinical-pathway

Authors : J Flibotte, MD; K Dysart, MD; J Stoller, MD; A Vossough,

MD; L Billinghurst, MD; N Abend, MD; S Massey, MD; A Zanno,

MD; N Pouppirt, MD; N Cook, MD; C Hufnal, MD; V Martin, MD; J Carroll, MSN; L Heimall, MSN; F Fung, MD; M Fitzgerald, MD; A Bustin, PharmD; H Monk Bodenstab, PharmD

Posted: December 2018

Clinical Pathway for the Care of Children Post-CPR

URL:

https://www.chop.edu/clinical-pathway/cardiac-arrest-post-cpr-clinical-pathway

Authors: A Topjian, MD; L Hutchins, MSN; P Meaney, MD; V.

Nadkarni, MD; R Berg, MD; J Blinder, MD; A Dewitt, MD; T Conlon, MD; J Fowler, MD

Posted: August 2013, last revised December 2015, January 2018

PATIENT CHARACTERISTICS

Age

Children less than 1 year of age have a much higher incidence and worse rate of survival from OHCA than older children or teens In large population-based studies of children who were resuscitated after an OHCA, over 60% were infants