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2015~ Liu Yueh-Ping ,M.D.Department of Emergency Medicine ,NTUH

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PALS training is more important for HCP

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Pediatric Cardiac Arrest: state of the artSurvival to discharge from out-of-hospital pediatric cardiac arrest (PCA) has not changed in 20 years remains at 6% 3% for infants 9% for children and adolescents5

Poor outcomes of pediatric traumatic arrestExamined cohort of 118 children 16 ISS ISS Bull(1975 ) ISS 50% 15-44 ISS=40 45-64 ISS=29 >65 ISS=20

PCPC1 Normal2 Mild cerebral disability3 Moderate cerebral disability4 Severe cerebral disability5 Coma or vegetative state6 Brain death

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Pediatric out of hospital cardiac arrestEMS systems and healthcare providers should identify and strengthen weak links in the chain of survivalTopjian and BergCirculation 2012Field et al Circulation 20107

In-hospital PCA: state of the artSurvival from in-house cardiac arrest in infants and children has improved significantly1980s: 9%2000s: 17%2006: 27%8

What changed in the hospital Earlier recognition of clinical deteriorationMore aggressive implementation of resuscitation guidelinesImplementation of formal rapid response teams (RRT) or medical emergency teams (MET)Decreased number of cardiac arrests and respiratory arrests by as much as 72%Decreased hospital mortality by 35%9

2015 (ERC)

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Pediatric advanced life support2015 American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC)

Welcome to an introduction of the 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Advancements in medical science are continuously evolving and improving survival outcomes. 2010 marks the 50th anniversary of the first medical publication to document cardiac arrest patient survival following closed chest compression. The American Heart Association is more dedicated than ever before to reducing death and disability from cardiovascular diseases and stroke.

The 2010 Guidelines are based on an international evidence evaluation process: hundreds of resuscitation scientists and experts evaluated, discussed, and debated thousands of peer-reviewed publications to identify the most current evidence-based information.By implementing the recommendations in the new guidelines, you will be up-to-date with the latest scientific studies and current best practices in resuscitation science.Bystanders, first responders, and healthcare providers all play crucial roles in the Chain of Survival. Together, we continue to improve survival for victims of cardiac arrest by emphasizing high-quality chest compressions, increasing frequency of bystander CPR, and providing excellent post-cardiac arrest care.

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To deliver acute and critical care to the youngest of patients, you must be up-to-date with the latest science and treatment recommendations for pediatric advanced life support (PALS). In the 2010 AHA Guidelines for CPR and ECC, you will find evidence-based best-practices about pediatric resuscitation and training. This introductory course will familiarize you with important changes affecting PALS and the scientific rationale behind the new recommendations. 12

AHA Image/Graphic Needed Here - Image of team resuscitation

Part 11: PBLS & CPR QualityPart 12: Pediatric ALSPart 13: Neonatal ResuscitationScience updates to CPR and ECC

By completing this course, you will be able to describe relevant science updates to Pediatric Basic Life Support, Pediatric Advanced Life Support, and Neonatal Resuscitation. You will gain new information about best practices related to team approaches and systems of care. And you will be able to find in-depth information about the Guidelines from AHA's Highlights and Circulation publications. You also will be prepared to take next steps in your education, certification, and implementation of the AHA recommendations.13

Learn and Live

Chain of Survival

This new section of the 2010 AHA Guidelines for CPR and ECC has been added to address the growing body of evidence guiding best practices for teaching and learning resuscitation skills. Recommendations here are meant to improve implementation of the Chain of Survival and best practices related to teams and systems of care. This section of the course highlights the recommendations specific to advanced life saving courses.14

Pediatric BASIC life support2015 American Heart Association Guidelines for Cardiopulmonary Resuscitation (CPR) and Emergency Cardiovascular Care (ECC)

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Key Issues in Pediatric Life Support C-A-B CPR 1 HCP CPR 6 cm BLS 100 120 / BLS

Many key issues in pediatric basic life support are the same as those in adult basic life support: emphasizing high-quality chest compressions of adequate rate and depth, allowing chest recoil after each compression, minimizing interruptions in chest compressions, and avoiding excessive ventilation.

For basic life support in children, there are new recommendations on compression depth and the use of AED for infants, and a de-emphasis of the pulse check for healthcare providers.16

1 HCPCPR 1 HCP CPR ( 7 8)

Gasping = notbreathingPulse check