Interpretation of the updated 2019 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care of children and newborns_West China Medical Journal

Authors：

ZHOU Yan ^1,2 ,  LI Xihong ^1,2

1. Department of Emergency, West China Second University Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LI Xihong, Email: hilixihong@163.com

Keywords：

American Heart Association; Basic life support; Advanced life support; Guidelines; Children; Newborns

DOI：

10.7507/1002-0179.201911154

Video：

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In November 2019, the American Heart Association updated guidelines for cardiopulmonary resuscitation (CPR) and emergency cardiovascular care. This update is not a comprehensive revision of the 2015 version. The updates for children and newborns mainly include three aspects: ① Pediatric basic life support: A. It is recommended that emergency medical dispatch centers offer dispatcher-assisted CPR instructions for presumed pediatric cardiac arrest. B. It is recommended that emergency dispatchers provide CPR instructions for pediatric cardiac arrest when no bystander CPR is in progress. ② Pediatric advanced life support: A. The bag-mask ventilation is reasonable compared with advanced airway interventions (endotracheal intubation or supraglottic airway) in the management of children during out-of-hospital cardiac arrest (OHCA). B. The extracorporeal CPR may be considered for pediatric patients with cardiac diagnoses who have in-hospital cardiac arrest (IHCA) in settings with existing extracorporeal membrane oxygenation protocols, expertise, and equipment. C. Continuous measurement of core temperature during targeted temperature management is recommended; for infants or children between 24 hours and 18 years of age who remain comatose after OHCA or IHCA, targeted temperature management is recommened. ③ Neonatal resuscitation: A. In term and late-preterm newborns (≥35 weeks of gestation) receiving respiratory support at birth, the initial use of 21% oxygen is reasonable. B. One hundred percent oxygen should not be used to initiate resuscitation because it is associated with excess mortality. C. In preterm newborns (<35 weeks of gestation) receiving respiratory support at birth, it may be reasonable to begin with 21% to 30% oxygen.

Citation： ZHOU Yan, LI Xihong. Interpretation of the updated 2019 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care of children and newborns. West China Medical Journal, 2019, 34(11): 1227-1232. doi: 10.7507/1002-0179.201911154 Copy

1.	Duff JP, Topjian AA, Berg MD, et al. 2019 American Heart Association focused update on pediatric basic life support: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2019.(2019-11-14)[2019-11-15]. https://doi.org/10.1161/CIR.0000000000000736.
2.	Duff JP, Topjian AA, Berg MD, et al. 2019 American Heart Association focused update on pediatric advanced life support: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2019.(2019-11-14)[2019-11-15]. https://doi.org/10.1161/CIR.0000000000000731.
3.	Escobedo MB, Aziz K, Kapadia VS, et al. 2019 American Heart Association focused update on neonatal resuscitation: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2019. (2019-11-14)[2019-11-15]. https://doi.org/10.1161/CIR.0000000000000729.
4.	Sasson C, Rogers MA, Dahl J, et al. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes, 2010, 3(1): 63-81.
5.	Goto Y, Maeda T, Goto Y. Impact of dispatcher-assisted bystander cardiopulmonary resuscitation on neurological outcomes in children with out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study. J Am Heart Assoc, 2014, 3(3): e000499.
6.	Lerner EB, Sayre MR, Brice JH, et al. Cardiac arrest patients rarely receive chest compressions before ambulance arrival despite the availability of pre-arrival CPR instructions. Resuscitation, 2008, 77(1): 51-56.
7.	Chang I, Ro YS, Shin SD, et al. Association of dispatcher-assisted bystander cardiopulmonary resuscitation with survival outcomes after pediatric out-of-hospital cardiac arrest by community property value. Resuscitation, 2018, 132: 120-126.
8.	Nikolaou N, Dainty KN, Couper K, et al. A systematic review and meta-analysis of the effect of dispatcher-assisted CPR on outcomes from sudden cardiac arrest in adults and children. Resuscitation, 2019, 138: 82-105.
9.	Song KJ, Shin SD, Park CB, et al. Dispatcher-assisted bystander cardiopulmonary resuscitation in a metropolitan city: a before-after population-based study. Resuscitation, 2014, 85(1): 34-41.
10.	Besnier E, Damm C, Jardel B, et al. Dispatcher-assisted cardiopulmonary resuscitation protocol improves diagnosis and resuscitation recommendations for out-of-hospital cardiac arrest. Emerg Med Australas, 2015, 27(6): 590-596.
11.	Akahane M, Ogawa T, Tanabe S, et al. Impact of telephone dispatcher assistance on the outcomes of pediatric out-of-hospital cardiac arrest. Crit Care Med, 2012, 40(5): 1410-1416.
12.	Ro YS, Shin SD, Song KJ, et al. Effects of dispatcher-assisted cardiopulmonary resuscitation on survival outcomes in infants, children, and adolescents with out-of-hospital cardiac arrests. Resuscitation, 2016, 108: 20-26.
13.	Lavonas EJ, Ohshimo S, Nation K, et al. Advanced airway interventions for paediatric cardiac arrest: a systematic review and meta-analysis. Resuscitation, 2019, 138: 114-128.
14.	Holmberg MJ, Geri G, Wiberg S, et al. Extracorporeal cardiopulmonary resuscitation for cardiac arrest: a systematic review. Resuscitation, 2018, 131: 91-100.
15.	Buick JE, Wallner C, Aickin R, et al. Paediatric targeted temperature management post cardiac arrest: a systematic review and meta-analysis. Resuscitation, 2019, 139: 65-75.
16.	Moler FW, Silverstein FS, Holubkov R, et al. Therapeutic hypothermia after out-of-hospital cardiac arrest in children. N Engl J Med, 2015, 372(20): 1898-1908.
17.	Brunetti MA, Gaynor JW, Retzloff LB, et al. Characteristics, risk factors, and outcomes of extracorporeal membrane oxygenation use in pediatric cardiac ICUs: a report from the pediatric cardiac critical care consortium registry. Pediatr Crit Care Med, 2018, 19(6): 544-552.
18.	Lasa JJ, Rogers RS, Localio R, et al. Extracorporeal cardiopulmonary resuscitation (E-CPR) during pediatric in-hospital cardiopulmonary arrest is associated with improved survival to discharge: a report from the American Heart Association’s get with the guidelines-resuscitation (GWTG-R) registry. Circulation, 2016, 133(2): 165-176.
19.	Lamhaut L, Hutin A, Puymirat E, et al. A pre-hospital extracorporeal cardio pulmonary resuscitation (ECPR) strategy for treatment of refractory out hospital cardiac arrest: an observational study and propensity analysis. Resuscitation, 2017, 117: 109-117.
20.	Patricio D, Peluso L, Brasseur A, et al. Comparison of extracorporeal and conventional cardiopulmonary resuscitation: a retrospective propensity score matched study. Crit Care, 2019, 23(1): 27.
21.	Moler FW, Silverstein FS, Holubkov R, et al. Therapeutic hypothermia after in-hospital cardiac arrest in children. N Engl J Med, 2017, 376(4): 318-329.
22.	Bembea MM, Nadkarni VM, Diener-West M, et al. Temperature patterns in the early postresuscitation period after pediatric inhospital cardiac arrest. Pediatr Crit Care Med, 2010, 11(6): 723-730.
23.	Saugstad OD. Resuscitation of newborn infants: from oxygen to room air. Lancet, 2010, 376(9757): 1970-1971.
24.	Vento M, Moro M, Escrig R, et al. Preterm resuscitation with low oxygen causes less oxidative stress, inflammation, and chronic lung disease. Pediatrics, 2009, 124(3): e439-e449.
25.	Vento M, Sastre J, Asensi MA, et al. Room-air resuscitation causes less damage to heart and kidney than 100% oxygen. Am J Respir Crit Care Med, 2005, 172(11): 1393-1398.
26.	Welsford M, Nishiyama C, Shortt C, et al. Initial oxygen use for preterm newborn resuscitation: a systematic review with meta-analysis. Pediatrics, 2019, 143(1): e20181828.
27.	Wyckoff MH, Aziz K, Escobedo MB, et al. Part 13: neonatal resuscitation: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2015, 132(18 Suppl 2): S543-S560.
28.	Oei JL, Saugstad OD, Lui K, et al. Targeted oxygen in the resuscitation of preterm infants, a randomized clinical trial. Pediatrics, 2017, 139(1): e20161452.

1. Duff JP, Topjian AA, Berg MD, et al. 2019 American Heart Association focused update on pediatric basic life support: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2019.(2019-11-14)[2019-11-15]. https://doi.org/10.1161/CIR.0000000000000736.
2. Duff JP, Topjian AA, Berg MD, et al. 2019 American Heart Association focused update on pediatric advanced life support: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2019.(2019-11-14)[2019-11-15]. https://doi.org/10.1161/CIR.0000000000000731.
3. Escobedo MB, Aziz K, Kapadia VS, et al. 2019 American Heart Association focused update on neonatal resuscitation: an update to the American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2019. (2019-11-14)[2019-11-15]. https://doi.org/10.1161/CIR.0000000000000729.
4. Sasson C, Rogers MA, Dahl J, et al. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes, 2010, 3(1): 63-81.
5. Goto Y, Maeda T, Goto Y. Impact of dispatcher-assisted bystander cardiopulmonary resuscitation on neurological outcomes in children with out-of-hospital cardiac arrests: a prospective, nationwide, population-based cohort study. J Am Heart Assoc, 2014, 3(3): e000499.
6. Lerner EB, Sayre MR, Brice JH, et al. Cardiac arrest patients rarely receive chest compressions before ambulance arrival despite the availability of pre-arrival CPR instructions. Resuscitation, 2008, 77(1): 51-56.
7. Chang I, Ro YS, Shin SD, et al. Association of dispatcher-assisted bystander cardiopulmonary resuscitation with survival outcomes after pediatric out-of-hospital cardiac arrest by community property value. Resuscitation, 2018, 132: 120-126.
8. Nikolaou N, Dainty KN, Couper K, et al. A systematic review and meta-analysis of the effect of dispatcher-assisted CPR on outcomes from sudden cardiac arrest in adults and children. Resuscitation, 2019, 138: 82-105.
9. Song KJ, Shin SD, Park CB, et al. Dispatcher-assisted bystander cardiopulmonary resuscitation in a metropolitan city: a before-after population-based study. Resuscitation, 2014, 85(1): 34-41.
10. Besnier E, Damm C, Jardel B, et al. Dispatcher-assisted cardiopulmonary resuscitation protocol improves diagnosis and resuscitation recommendations for out-of-hospital cardiac arrest. Emerg Med Australas, 2015, 27(6): 590-596.
11. Akahane M, Ogawa T, Tanabe S, et al. Impact of telephone dispatcher assistance on the outcomes of pediatric out-of-hospital cardiac arrest. Crit Care Med, 2012, 40(5): 1410-1416.
12. Ro YS, Shin SD, Song KJ, et al. Effects of dispatcher-assisted cardiopulmonary resuscitation on survival outcomes in infants, children, and adolescents with out-of-hospital cardiac arrests. Resuscitation, 2016, 108: 20-26.
13. Lavonas EJ, Ohshimo S, Nation K, et al. Advanced airway interventions for paediatric cardiac arrest: a systematic review and meta-analysis. Resuscitation, 2019, 138: 114-128.
14. Holmberg MJ, Geri G, Wiberg S, et al. Extracorporeal cardiopulmonary resuscitation for cardiac arrest: a systematic review. Resuscitation, 2018, 131: 91-100.
15. Buick JE, Wallner C, Aickin R, et al. Paediatric targeted temperature management post cardiac arrest: a systematic review and meta-analysis. Resuscitation, 2019, 139: 65-75.
16. Moler FW, Silverstein FS, Holubkov R, et al. Therapeutic hypothermia after out-of-hospital cardiac arrest in children. N Engl J Med, 2015, 372(20): 1898-1908.
17. Brunetti MA, Gaynor JW, Retzloff LB, et al. Characteristics, risk factors, and outcomes of extracorporeal membrane oxygenation use in pediatric cardiac ICUs: a report from the pediatric cardiac critical care consortium registry. Pediatr Crit Care Med, 2018, 19(6): 544-552.
18. Lasa JJ, Rogers RS, Localio R, et al. Extracorporeal cardiopulmonary resuscitation (E-CPR) during pediatric in-hospital cardiopulmonary arrest is associated with improved survival to discharge: a report from the American Heart Association’s get with the guidelines-resuscitation (GWTG-R) registry. Circulation, 2016, 133(2): 165-176.
19. Lamhaut L, Hutin A, Puymirat E, et al. A pre-hospital extracorporeal cardio pulmonary resuscitation (ECPR) strategy for treatment of refractory out hospital cardiac arrest: an observational study and propensity analysis. Resuscitation, 2017, 117: 109-117.
20. Patricio D, Peluso L, Brasseur A, et al. Comparison of extracorporeal and conventional cardiopulmonary resuscitation: a retrospective propensity score matched study. Crit Care, 2019, 23(1): 27.
21. Moler FW, Silverstein FS, Holubkov R, et al. Therapeutic hypothermia after in-hospital cardiac arrest in children. N Engl J Med, 2017, 376(4): 318-329.
22. Bembea MM, Nadkarni VM, Diener-West M, et al. Temperature patterns in the early postresuscitation period after pediatric inhospital cardiac arrest. Pediatr Crit Care Med, 2010, 11(6): 723-730.
23. Saugstad OD. Resuscitation of newborn infants: from oxygen to room air. Lancet, 2010, 376(9757): 1970-1971.
24. Vento M, Moro M, Escrig R, et al. Preterm resuscitation with low oxygen causes less oxidative stress, inflammation, and chronic lung disease. Pediatrics, 2009, 124(3): e439-e449.
25. Vento M, Sastre J, Asensi MA, et al. Room-air resuscitation causes less damage to heart and kidney than 100% oxygen. Am J Respir Crit Care Med, 2005, 172(11): 1393-1398.
26. Welsford M, Nishiyama C, Shortt C, et al. Initial oxygen use for preterm newborn resuscitation: a systematic review with meta-analysis. Pediatrics, 2019, 143(1): e20181828.
27. Wyckoff MH, Aziz K, Escobedo MB, et al. Part 13: neonatal resuscitation: 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2015, 132(18 Suppl 2): S543-S560.
28. Oei JL, Saugstad OD, Lui K, et al. Targeted oxygen in the resuscitation of preterm infants, a randomized clinical trial. Pediatrics, 2017, 139(1): e20161452.

West China Medical Journal

Interpretation of the updated 2019 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care of children and newborns

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