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sábado, 18 de abril de 2020

ILCOR 2019 updated guidelines

RSA - April 17, 2020 - By Bornstein K
In late 2019, the International Liaison Committee on Resuscitation (ILCOR) released its updated guidelines for adult and pediatric resuscitation, informing the United States-based American Heart Association (AHA)/Advanced Cardiac Life Support (ACLS) focused protocol update.
Vasopressor Use 
  1. Despite research suggesting low efficacy in improving positive ultimate outcomes beyond improved ROSC and survival to hospital, epinephrine is still “strongly recommended” as the evidence is not strong enough to indicate removing it from routine use.
    1. However, epinephrine is no panacea, so maintain focus on high quality basic life support (e.g., recognize cardiac arrest early, defibrillate early and minimize interruptions in compressions). Aggressively find and treat reversible causes of arrest. 
  2. Administer epinephrine early in non-shockable rhythms. 
  3. In shockable rhythms, consider administration of epinephrine after initial defibrillation attempts are unsuccessful during CPR.
Advanced Airway Interventions
  1. Airway management utilizing endotracheal intubation has been deemphasized. As before, chest compressions should not be interrupted for placement of an endotracheal tube, particularly if alternative strategies are available and effective. 
  2. There is not enough good evidence to direct choice between airway management strategies in pediatric cardiac arrest patients in the in-hospital setting.
    1. BMV alone may be reasonable. 
    2. Consider local expert guidance.
ECPR
  1. Where ECPR is available, consider it as a rescue modality for patients in which conventional CPR is failing and a reversible cause of arrest can be managed.
  2. For pediatric cardiac arrest patients with history of congenital heart disease, ECPR is more strongly supported by the literature base.
Targeted Temperature Management in Pediatric Cardiac Arrest
  1. More data is needed on pediatric TTM. 
  2. Consider implementing TTM in the post–cardiac arrest period to maintain core temperature <37.5°C.