Interpretation of the updated 2020 American Heart Association Guidelines for Pediatric Basic and Advanced Life Support and Neonatal Resuscitation_West China Medical Journal

Authors：

LIANG Bin ^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：

10.7507/1002-0179.202011007

Video：

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In October 2020, the American Heart Association issued the 2020 edition of guidelines for cardiopulmonary resuscitation and cardiovascular first aid, which comprehensively revised cardiopulmonary resuscitation and emergency cardiovascular care guidelines related to adults, children, newborns, resuscitation education science and treatment system. According to the latest edition of International Liaison Committee on Resuscitation’s classes of recommendation and levels of evidence, relevant suggestions are put forward. This article interprets the main updated and revised content, including children’s basic and advanced life support and neonatal resuscitation, in order to better guide emergency personnel and improve the quality of cardiopulmonary resuscitation and cardiovascular first aid.

Citation： LIANG Bin, LI Xihong. Interpretation of the updated 2020 American Heart Association Guidelines for Pediatric Basic and Advanced Life Support and Neonatal Resuscitation. West China Medical Journal, 2020, 35(11): 1324-1330. doi: 10.7507/1002-0179.202011007 Copy

1.	Topjian AA, Raymond TT, Atkins D, et al. Part 4: pediatric basic and advanced life support: 2020 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2020, 142(16_suppl_2): S469-S523.
2.	Aziz K, Lee HC, Escobedo MB, et al. Part 5: neonatal resuscitation: 2020 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2020, 142(16_suppl_2): S524-S550.
3.	Holmberg MJ, Wiberg S, Ross CE, et al. Trends in survival after pediatric in-hospital cardiac arrest in the United States. Circulation, 2019, 140(17): 1398-1408.
4.	Girotra S, Spertus JA, Li Y, et al. Survival trends in pediatric in-hospital cardiac arrests: an analysis from get with the guidelines-resuscitation. Circ Cardiovasc Qual Outcomes, 2013, 6(1): 42-49.
5.	Fink EL, Prince DK, Kaltman JR, et al. Unchanged pediatric out-of-hospital cardiac arrest incidence and survival rates with regional variation in North America. Resuscitation, 2016, 107: 121-128.
6.	Slomine BS, Silverstein FS, Christensen JR, et al. Neuropsychological outcomes of children 1 year after pediatric cardiac arrest: secondary analysis of 2 randomized clinical trials. JAMA Neurol, 2018, 75(12): 1502-1510.
7.	Brearley S, Shearman CP, Simms MH. Peripheral pulse palpation: an unreliable physical sign. Ann R Coll Surg Engl, 1992, 74(3): 169-171.
8.	Andersen LW, Berg KM, Saindon BZ, et al. Time to epinephrine and survival after pediatric in-hospital cardiac arrest. JAMA, 2015, 314(8): 802-810.
9.	Meert K, Telford R, Holubkov R, et al. Paediatric in-hospital cardiac arrest: Factors associated with survival and neurobehavioural outcome one year later. Resuscitation, 2018, 124: 96-105.
10.	Wolfe HA, Sutton RM, Reeder RW, et al. Functional outcomes among survivors of pediatric in-hospital cardiac arrest are associated with baseline neurologic and functional status, but not with diastolic blood pressure during CPR. Resuscitation, 2019, 143: 57-65.
11.	Niles DE, Duval-Arnould J, Skellett S, et al. Characterization of pediatric in-hospital cardiopulmonary resuscitation quality metrics across an international resuscitation collaborative. Pediatr Crit Care Med, 2018, 19(5): 421-432.
12.	Berg RA, Sutton RM, Reeder RW, et al. Association between diastolic blood pressure during pediatric in-hospital cardiopulmonary resuscitation and survival. Circulation, 2018, 137(17): 1784-1795.
13.	Herman ST, Abend NS, Bleck TP, et al. Consensus statement on continuous EEG in critically ill adults and children, part Ⅰ: indications. J Clin Neurophysiol, 2015, 32(2): 87-95.
14.	Sawyer KN, Camp-Rogers TR, Kotini-Shah P, et al. Sudden cardiac arrest survivorship: a scientific statement from the American Heart Association. Circulation, 2020, 141(12): e654-e685.
15.	Tinsley C, Hill JB, Shah J, et al. Experience of families during cardiopulmonary resuscitation in a pediatric intensive care unit. Pediatrics, 2008, 122(4): e799-804.
16.	Robinson SM, Mackenzie-Ross S, Campbell Hewson GL, et al. Psychological effect of witnessed resuscitation on bereaved relatives. Lancet, 1998, 352(9128): 614-617.
17.	Doolan A, Langlois N, Semsarian C. Causes of sudden cardiac death in young Australians. Med J Aust, 2004, 180(3): 110-112.
18.	Ong ME, Stiell I, Osmond MH, et al. Etiology of pediatric out-of-hospital cardiac arrest by coroner’s diagnosis. Resuscitation, 2006, 68(3): 335-342.
19.	Puranik R, Chow CK, Duflou JA, et al. Sudden death in the young. Heart Rhythm, 2005, 2(12): 1277-1282.
20.	Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med, 2020, 21(2): e52-e106.
21.	de Caen AR, Berg MD, Chameides L, et al. Part 12: pediatric advanced life support: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2015, 132(18 Suppl 2): S526-S542.
22.	Pollock MM, Ring JC, Fields AI. Shock in infants and children. Emerg Med Clin North Am, 1986, 4(4): 841-57.
23.	Cannon JW, Khan MA, Raja AS, et al. Damage control resuscitation in patients with severe traumatic hemorrhage:a practice management guideline from the Eastern Association for the surgery of trauma. J Trauma Acute Care Surg, 2017, 82(3): 605-617.
24.	Kanani AN, Hartshorn S. NICE clinical guideline NG39: major trauma: assessment and initial management. Arch Dis Child Educ Pract Ed, 2017, 102(1): 20-23.
25.	Henry S. ATLS advanced trauma life support. 10th Edition Student Course Manual. Chicago: American College of Surgeons, 2018: 48-58.
26.	Sutton RM, Reeder RW, Landis WP, et al. Ventilation rates and pediatric in-hospital cardiac arrest survival outcomes. Crit Care Med, 2019, 47(11): 1627-1636.
27.	Scholl L, Seth P, Kariisa M, et al. Drug and opioid-involved overdose deaths - United States, 2013-2017. MMWR Morb Mortal Wkly Rep, 2018, 67(5152): 1419-1427.
28.	Chen L, Zhang J, Pan G, et al. Cuffed versus uncuffed endotracheal tubes in pediatrics: a meta-analysis. Open Med (Wars), 2018, 13: 366-373.
29.	Chambers NA, Ramgolam A, Sommerfield D, et al. Cuffed vs. uncuffed tracheal tubes in children: a randomised controlled trial comparing leak, tidal volume and complications. Anaesthesia, 2018, 73(2): 160-168.
30.	de Wit M, Peelen LM, van Wolfswinkel L, et al. The incidence of postoperative respiratory complications: a retrospective analysis of cuffed vs uncuffed tracheal tubes in children 0-7 years of age. Paediatr Anaesth, 2018, 28(3): 210-217.
31.	Kojima T, Harwayne-Gidansky I, Shenoi AN, et al. Cricoid pressure during induction for tracheal intubation in critically Ⅲ children: a report from national emergency airway registry for children. Pediatr Crit Care Med, 2018, 19(6): 528-537.
32.	Miyake CY, Teele SA, Chen L, et al. In-hospital arrhythmia development and outcomes in pediatric patients with acute myocarditis. Am J Cardiol, 2014, 113(3): 535-540.
33.	Yarlagadda VV, Maeda K, Zhang Y, et al. Temporary circulatory support in U.S. children awaiting heart transplantation. J Am Coll Cardiol, 2017, 70(18): 2250-2260.
34.	Marino BS, Tibby SM, Hoffman GM. Resuscitation of the patient with the functionally univentricular heart. Curr Pediatr Rev, 2013, 9(2): 148-157.
35.	Vorhies EE, Ivy DD. Drug treatment of pulmonary hypertension in children. Paediatr Drugs, 2014, 16(1): 43-65.
36.	Patel A, Khatib MN, Kurhe K, et al. Impact of neonatal resuscitation trainings on neonatal and perinatal mortality:a systematic review and meta-analysis. BMJ Paediatr Open, 2017, 1(1): e000183.
37.	Dempsey E, Pammi M, Ryan AC, et al. Standardised formal resuscitation training programmes for reducing mortality and morbidity in newborn infants. Cochrane Database Syst Rev, 2015, 4(9): CD009106.
38.	Chopra A, Thakur A, Garg P, et al. Early versus delayed cord clamping in small for gestational age infants and iron stores at3 months of age - a randomized controlled trial. BMC Pediatr, 2018, 18(1): 234.
39.	Fogarty M, Osborn DA, Askie L, et al. Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. Am J Obstet Gynecol, 2018, 218(1): 1-18.
40.	Laptook AR, Bell EF, Shankaran S, et al. Admission temperature and associated mortality and morbidity among moderately and extremely preterm infants. J Pediatr, 2018, 192: 53-59.
41.	Lyu Y, Shah PS, Ye XY, et al. Association between admission temperature and mortality and major morbidity in preterm infants born at fewer than 33 weeks’ gestation. JAMA Pediatr, 2015, 169(4): e150277.
42.	Moore ER, Anderson GC, Bergman N, et al. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev, 2012, 5(5): CD003519.
43.	Foster JP, Dawson JA, Davis PG, et al. Routine oro/nasopharyngeal suction versus no suction at birth. Cochrane Database Syst Rev, 2017, 4(4): CD010332.
44.	Shah BA, Wlodaver AG, Escobedo MB, et al. Impact of electronic cardiac (ECG) monitoring on delivery room resuscitation and neonatal outcomes. Resuscitation, 2019, 143: 10-16.
45.	van Vonderen JJ, Hooper SB, Kroese JK, et al. Pulse oximetry measures a lower heart rate at birth compared with electrocardiography. J Pediatr, 2015, 166(1): 49-53.
46.	Ersdal HL, Mduma E, Svensen E, et al. Early initiation of basic resuscitation interventions including face mask ventilation may reduce birth asphyxia related mortality in low-income countries: a prospective descriptive observational study. Resuscitation, 2012, 83(7): 869-873.
47.	Upton CJ, Milner AD. Endotracheal resuscitation of neonates using a rebreathing bag. Arch Dis Child, 1991, 66(1 Spec No): 39-42.
48.	Menakaya J, Andersen C, Chirla D, et al. A randomised comparison of resuscitation with an anaesthetic rebreathing circuit or an infant ventilator in very preterm infants. Arch Dis Child Fetal Neonatal Ed, 2004, 89(6): F494-F496.
49.	Dunn MS, Kaempf J, de Klerk A, et al. Randomized trial comparing 3 approaches to the initial respiratory management of preterm neonates. Pediatrics, 2011, 128(5): e1069-e1076.
50.	Halling C, Sparks JE, Christie L, et al. Efficacy of Intravenous and Endotracheal Epinephrine during Neonatal Cardiopulmonary Resuscitation in the Delivery Room. J Pediatr, 2017, 185: 232-236.
51.	American Academy of Pediatrics Committee on Fetus and Newborn, Bell EF. Noninitiation or withdrawal of intensive care for high-risk newborns. Pediatrics, 2007, 119(2): 401-403.
52.	Cummings J, Committee on Fetus and Newborn. Antenatal counseling regarding resuscitation and intensive care before 25 weeks of gestation. Pediatrics, 2015, 136(3): 588-595.
53.	American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Obstetric care consensus No. 6: periviable birth. Obstet Gynecol, 2017, 130(4): e187-e199.
54.	Bang A, Patel A, Bellad R, et al. Helping babies breathe (HBB) training: what happens to knowledge and skills over time?. BMC Pregnancy Childbirth, 2016, 16(1): 364.
55.	Arlington L, Kairuki AK, Isangula KG, et al. Implementation of “helping babies breathe”: a 3-year experience in Tanzania. Pediatrics, 2017, 139(5): e20162132.

1. Topjian AA, Raymond TT, Atkins D, et al. Part 4: pediatric basic and advanced life support: 2020 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2020, 142(16_suppl_2): S469-S523.
2. Aziz K, Lee HC, Escobedo MB, et al. Part 5: neonatal resuscitation: 2020 American Heart Association Guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2020, 142(16_suppl_2): S524-S550.
3. Holmberg MJ, Wiberg S, Ross CE, et al. Trends in survival after pediatric in-hospital cardiac arrest in the United States. Circulation, 2019, 140(17): 1398-1408.
4. Girotra S, Spertus JA, Li Y, et al. Survival trends in pediatric in-hospital cardiac arrests: an analysis from get with the guidelines-resuscitation. Circ Cardiovasc Qual Outcomes, 2013, 6(1): 42-49.
5. Fink EL, Prince DK, Kaltman JR, et al. Unchanged pediatric out-of-hospital cardiac arrest incidence and survival rates with regional variation in North America. Resuscitation, 2016, 107: 121-128.
6. Slomine BS, Silverstein FS, Christensen JR, et al. Neuropsychological outcomes of children 1 year after pediatric cardiac arrest: secondary analysis of 2 randomized clinical trials. JAMA Neurol, 2018, 75(12): 1502-1510.
7. Brearley S, Shearman CP, Simms MH. Peripheral pulse palpation: an unreliable physical sign. Ann R Coll Surg Engl, 1992, 74(3): 169-171.
8. Andersen LW, Berg KM, Saindon BZ, et al. Time to epinephrine and survival after pediatric in-hospital cardiac arrest. JAMA, 2015, 314(8): 802-810.
9. Meert K, Telford R, Holubkov R, et al. Paediatric in-hospital cardiac arrest: Factors associated with survival and neurobehavioural outcome one year later. Resuscitation, 2018, 124: 96-105.
10. Wolfe HA, Sutton RM, Reeder RW, et al. Functional outcomes among survivors of pediatric in-hospital cardiac arrest are associated with baseline neurologic and functional status, but not with diastolic blood pressure during CPR. Resuscitation, 2019, 143: 57-65.
11. Niles DE, Duval-Arnould J, Skellett S, et al. Characterization of pediatric in-hospital cardiopulmonary resuscitation quality metrics across an international resuscitation collaborative. Pediatr Crit Care Med, 2018, 19(5): 421-432.
12. Berg RA, Sutton RM, Reeder RW, et al. Association between diastolic blood pressure during pediatric in-hospital cardiopulmonary resuscitation and survival. Circulation, 2018, 137(17): 1784-1795.
13. Herman ST, Abend NS, Bleck TP, et al. Consensus statement on continuous EEG in critically ill adults and children, part Ⅰ: indications. J Clin Neurophysiol, 2015, 32(2): 87-95.
14. Sawyer KN, Camp-Rogers TR, Kotini-Shah P, et al. Sudden cardiac arrest survivorship: a scientific statement from the American Heart Association. Circulation, 2020, 141(12): e654-e685.
15. Tinsley C, Hill JB, Shah J, et al. Experience of families during cardiopulmonary resuscitation in a pediatric intensive care unit. Pediatrics, 2008, 122(4): e799-804.
16. Robinson SM, Mackenzie-Ross S, Campbell Hewson GL, et al. Psychological effect of witnessed resuscitation on bereaved relatives. Lancet, 1998, 352(9128): 614-617.
17. Doolan A, Langlois N, Semsarian C. Causes of sudden cardiac death in young Australians. Med J Aust, 2004, 180(3): 110-112.
18. Ong ME, Stiell I, Osmond MH, et al. Etiology of pediatric out-of-hospital cardiac arrest by coroner’s diagnosis. Resuscitation, 2006, 68(3): 335-342.
19. Puranik R, Chow CK, Duflou JA, et al. Sudden death in the young. Heart Rhythm, 2005, 2(12): 1277-1282.
20. Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med, 2020, 21(2): e52-e106.
21. de Caen AR, Berg MD, Chameides L, et al. Part 12: pediatric advanced life support: 2015 American Heart Association Guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 2015, 132(18 Suppl 2): S526-S542.
22. Pollock MM, Ring JC, Fields AI. Shock in infants and children. Emerg Med Clin North Am, 1986, 4(4): 841-57.
23. Cannon JW, Khan MA, Raja AS, et al. Damage control resuscitation in patients with severe traumatic hemorrhage:a practice management guideline from the Eastern Association for the surgery of trauma. J Trauma Acute Care Surg, 2017, 82(3): 605-617.
24. Kanani AN, Hartshorn S. NICE clinical guideline NG39: major trauma: assessment and initial management. Arch Dis Child Educ Pract Ed, 2017, 102(1): 20-23.
25. Henry S. ATLS advanced trauma life support. 10th Edition Student Course Manual. Chicago: American College of Surgeons, 2018: 48-58.
26. Sutton RM, Reeder RW, Landis WP, et al. Ventilation rates and pediatric in-hospital cardiac arrest survival outcomes. Crit Care Med, 2019, 47(11): 1627-1636.
27. Scholl L, Seth P, Kariisa M, et al. Drug and opioid-involved overdose deaths - United States, 2013-2017. MMWR Morb Mortal Wkly Rep, 2018, 67(5152): 1419-1427.
28. Chen L, Zhang J, Pan G, et al. Cuffed versus uncuffed endotracheal tubes in pediatrics: a meta-analysis. Open Med (Wars), 2018, 13: 366-373.
29. Chambers NA, Ramgolam A, Sommerfield D, et al. Cuffed vs. uncuffed tracheal tubes in children: a randomised controlled trial comparing leak, tidal volume and complications. Anaesthesia, 2018, 73(2): 160-168.
30. de Wit M, Peelen LM, van Wolfswinkel L, et al. The incidence of postoperative respiratory complications: a retrospective analysis of cuffed vs uncuffed tracheal tubes in children 0-7 years of age. Paediatr Anaesth, 2018, 28(3): 210-217.
31. Kojima T, Harwayne-Gidansky I, Shenoi AN, et al. Cricoid pressure during induction for tracheal intubation in critically Ⅲ children: a report from national emergency airway registry for children. Pediatr Crit Care Med, 2018, 19(6): 528-537.
32. Miyake CY, Teele SA, Chen L, et al. In-hospital arrhythmia development and outcomes in pediatric patients with acute myocarditis. Am J Cardiol, 2014, 113(3): 535-540.
33. Yarlagadda VV, Maeda K, Zhang Y, et al. Temporary circulatory support in U.S. children awaiting heart transplantation. J Am Coll Cardiol, 2017, 70(18): 2250-2260.
34. Marino BS, Tibby SM, Hoffman GM. Resuscitation of the patient with the functionally univentricular heart. Curr Pediatr Rev, 2013, 9(2): 148-157.
35. Vorhies EE, Ivy DD. Drug treatment of pulmonary hypertension in children. Paediatr Drugs, 2014, 16(1): 43-65.
36. Patel A, Khatib MN, Kurhe K, et al. Impact of neonatal resuscitation trainings on neonatal and perinatal mortality:a systematic review and meta-analysis. BMJ Paediatr Open, 2017, 1(1): e000183.
37. Dempsey E, Pammi M, Ryan AC, et al. Standardised formal resuscitation training programmes for reducing mortality and morbidity in newborn infants. Cochrane Database Syst Rev, 2015, 4(9): CD009106.
38. Chopra A, Thakur A, Garg P, et al. Early versus delayed cord clamping in small for gestational age infants and iron stores at3 months of age - a randomized controlled trial. BMC Pediatr, 2018, 18(1): 234.
39. Fogarty M, Osborn DA, Askie L, et al. Delayed vs early umbilical cord clamping for preterm infants: a systematic review and meta-analysis. Am J Obstet Gynecol, 2018, 218(1): 1-18.
40. Laptook AR, Bell EF, Shankaran S, et al. Admission temperature and associated mortality and morbidity among moderately and extremely preterm infants. J Pediatr, 2018, 192: 53-59.
41. Lyu Y, Shah PS, Ye XY, et al. Association between admission temperature and mortality and major morbidity in preterm infants born at fewer than 33 weeks’ gestation. JAMA Pediatr, 2015, 169(4): e150277.
42. Moore ER, Anderson GC, Bergman N, et al. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev, 2012, 5(5): CD003519.
43. Foster JP, Dawson JA, Davis PG, et al. Routine oro/nasopharyngeal suction versus no suction at birth. Cochrane Database Syst Rev, 2017, 4(4): CD010332.
44. Shah BA, Wlodaver AG, Escobedo MB, et al. Impact of electronic cardiac (ECG) monitoring on delivery room resuscitation and neonatal outcomes. Resuscitation, 2019, 143: 10-16.
45. van Vonderen JJ, Hooper SB, Kroese JK, et al. Pulse oximetry measures a lower heart rate at birth compared with electrocardiography. J Pediatr, 2015, 166(1): 49-53.
46. Ersdal HL, Mduma E, Svensen E, et al. Early initiation of basic resuscitation interventions including face mask ventilation may reduce birth asphyxia related mortality in low-income countries: a prospective descriptive observational study. Resuscitation, 2012, 83(7): 869-873.
47. Upton CJ, Milner AD. Endotracheal resuscitation of neonates using a rebreathing bag. Arch Dis Child, 1991, 66(1 Spec No): 39-42.
48. Menakaya J, Andersen C, Chirla D, et al. A randomised comparison of resuscitation with an anaesthetic rebreathing circuit or an infant ventilator in very preterm infants. Arch Dis Child Fetal Neonatal Ed, 2004, 89(6): F494-F496.
49. Dunn MS, Kaempf J, de Klerk A, et al. Randomized trial comparing 3 approaches to the initial respiratory management of preterm neonates. Pediatrics, 2011, 128(5): e1069-e1076.
50. Halling C, Sparks JE, Christie L, et al. Efficacy of Intravenous and Endotracheal Epinephrine during Neonatal Cardiopulmonary Resuscitation in the Delivery Room. J Pediatr, 2017, 185: 232-236.
51. American Academy of Pediatrics Committee on Fetus and Newborn, Bell EF. Noninitiation or withdrawal of intensive care for high-risk newborns. Pediatrics, 2007, 119(2): 401-403.
52. Cummings J, Committee on Fetus and Newborn. Antenatal counseling regarding resuscitation and intensive care before 25 weeks of gestation. Pediatrics, 2015, 136(3): 588-595.
53. American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Obstetric care consensus No. 6: periviable birth. Obstet Gynecol, 2017, 130(4): e187-e199.
54. Bang A, Patel A, Bellad R, et al. Helping babies breathe (HBB) training: what happens to knowledge and skills over time?. BMC Pregnancy Childbirth, 2016, 16(1): 364.
55. Arlington L, Kairuki AK, Isangula KG, et al. Implementation of “helping babies breathe”: a 3-year experience in Tanzania. Pediatrics, 2017, 139(5): e20162132.

West China Medical Journal

Interpretation of the updated 2020 American Heart Association Guidelines for Pediatric Basic and Advanced Life Support and Neonatal Resuscitation

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