Clinical Practice Guidelines: Resuscitation/Paediatric

1 Clinical Practice Guidelines: Resuscitation/Paediatric Policy code CPG_RE_RP_0620. Date June, 2020. Purpose To ensure consistent management of paediatric patients who require resuscitation. Scope Applies to Queensland Ambulance Service (QAS) Clinical staff. Health care setting Pre-hospital assessment and treatment. Population Applies to all ages unless stated otherwise. Source of funding Internal 100%. Author Clinical Quality & Patient Safety Unit, QAS. Review date June, 2023. Information security UNCLASSIFIED Queensland Government Information Security Classification Framework.

2 URL While the QAS has attempted to contact all copyright owners, this has not always been possible. The QAS would welcome notification from any copyright holder who has been omitted or incorrectly acknowledged. All feedback and suggestions are welcome. Please forward to: Disclaimer The Digital Clinical Practice Manual is expressly intended for use by QAS paramedics when performing duties and delivering ambulance services for, and on behalf of, the QAS. The QAS disclaims, to the maximum extent permitted by law, all responsibility and all liability (including without limitation, liability in negligence) for all expenses, losses, damages and costs incurred for any reason associated with the use of this manual, including the materials within or referred to throughout this document being in any way inaccurate, out of context, incomplete or unavailable.

3 State of Queensland (Queensland Ambulance Service) 2020. This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives International License You are free to copy and communicate the work in its current form for non-commercial purposes, as long as you attribute the State of Queensland, Queensland Ambulance Service and comply with the licence terms. If you alter the work, you may not share or distribute the modified work. To view a copy of this license, visit For copyright permissions beyond the scope of this license please contact: Resuscitation Paediatric June, 2020.

4 Differences between paediatric and adult resuscitation reflect the different aetiologies of cardiorespiratory arrest between children and adults, as well as their distinct anatomy Clinical features U NC O NTR O L L D WH E N PR IN T ED. and physiology. Most paediatric arrests are caused by hypoxaemia, hypotension, or E. both, with the vast majority having an initial cardiac rhythm of profound bradycardia or asystole.[1] The incidence of VF or pulseless VT in paediatric patients is low No signs of life: - unresponsive (approximately 10%) compared with adult cardiac arrest.

5 [2] - not breathing normally The mainstays of paediatric resuscitation include: - pulse cannot be confidently palpated within 10 seconds, OR. Ensure high quality continuous CPR (depth, rate and recoil ). Signs of inadequate perfusion: T ED. Administer oxygen and ventilate. IN.. U N C.. O NTR O L L ED WH E N PR. Correct reversible causes. Plan actions before interrupting CPR. - unresponsive - pallor or central cyanosis Synchronise ventilation via an advanced airway ( LMA) - pulse less than: throughout continuous compressions - 60 bpm in an infant (less than 1 year).

6 - 40 bpm in a child 1 12 years Additional information U N C O NT R O L L ED WH E N PR IN T ED. The first rhythm analysis for paediatrics 1 year or older must be conducted using the defibrillator in AED mode. If a shock is recommended, Risk assessment appropriately trained officers have the option of switching to manual mode to select the appropriate weight based joule setting prior to defibrillation. If there is uncertainty, resuscitation The defibrillator mode (AED or Manual) for all subsequent analyses is at should be commenced.

7 The discretion of the ambulance clinician. U N C O NT R O L L PR IN T ED. Patients may present with an infrequent, irregular, gasping inspiratory ED WH E N. respiration effort (agonal respiration). This is common in the first few minutes of a cardiac arrest and should not delay the commencement of resuscitation efforts.[3]. Figure If using an LMA, breaths should be delivered during a pause in chest compressions.[4]. QUEENSLAND AMBULANCE SERVICE 277. CPG: Clinician safety CPG: Standard cares CPG: Resuscitation General guidelines CPG: Resuscitation Special circumstances Manage as per: Potential airway obstruction (foreign body)?

8 Y CPG: Foreign body airway obstruction N. U NC O NTR O L L ED WH E N PR IN T ED Immediately commence CPR. Single officer (30:2). Two officer (15:2). Apply pads and commence immediate AED rhythm analysis (< 1 year Manual defibrillation mode / 1 year AED). Shockable rhythm VF/VT? N PEA/asystole T ED. Y. U N C O NTR O L L ED WH E N PR IN. Perform 3 x 2 minute CPR cycles with rhythm assessment after each cycle Deliver single DCCS*. * Paediatric Defibrillation Corpuls3 Manual Mode - 6 years (25 kg) 200 J (via adult pads).

9 - < 6 years 4 J/kg (via paediatric pads). Commence 2 minutes of CPR Corpuls3 AED Mode DURING CPR CONSIDER: Basic airway adjuncts - 6 years (25 kg) 200 J (via adult pads). CPR metronome - 1 year (10 kg) to < 6 years 50 J. corPatch CPR sensor (via paediatric pads). IMPORTANT: Clinicians are to U N C O NT R O L L ED WH E N PR IN T. confirm the patient's cardiac rhythm E. every 2 minutes. In the non-traumatic cardiac arrest no laryngoscopy, LMA, ETT or IV access is to be attempted D Switching from AED to Manual defibrillation mode - < 1 year 4 J/kg Manual Mode (via paediatric pads) the use of AED Mode is not recommended for patients < 1 year of age.

10 In the first 6 minutes after QAS Proceed only after 3 x 2 minute cycles of CPR have been performed * Reversible causes arrival UNLESS glottic foreign body Hypoxia is suspected. Hypothermia Continue with 2 minutes of CPR. Hypovolaemia Note: Clinicians are only to perform Hypo/hyperkalaemia procedures for which they have DURING CPR CONSIDER: FOR REFRACTORY VF/VT CONSIDER: Hydrogen ion (acidosis). U N C O NT R O L L ED H E. authorisation by the QAS. N PR. received specific training and W IN T ED LMA. IV access Adrenaline Reversible causes*.