ILCOR updates

Question 1

Discuss changes to paediatric ALS chart for children

Answer 1

Very similar to adults flow charts. Key differences

1) ABC in children rather than CAB
2) nil role for compression only CPR as adds no survival benefit
3) changes from rate of chest compression of approx 100 to between 100-120
4) for children 1/3 of chest depth for compression this equates to more than the 5cm in adults – should be approx 5cm in children and 4 cm in infants - in adults more than 6cm depth is associated with detriment

Question 2

Discuss changes in newborn guidelines 2021

Answer 2

1) For infants born at less than 34 weeks gestational age who do not require immediate resus delay cord clamping at least 30 seconds
2) For infants >34 weeks or term cord clamping at 60 seconds or greater
3) do not milk cord
4) For all newborns with mec stained amniotic fluid ANZCOR suggest against routine direct laryngoscopy and suction
5) For preterm infants born at less than 35 weeks gestation ANZCOR suggest commencing resus either using room air or blended air and o2 up to an o2 of .3 rather than higher
6) ANZCOR suggest that a reasonable time frame to consider a change in goals of care (cessation) at around 20 minutes

Question 3

Discuss changes to the neonatal resus guideline

Answer 3

1) greater emphasis on maintaining a normal body temp during resus of all newborns
2) Assessing temp on admission for neonatal ICU or special care as a measure of quality of care
3) consideration of deferred cord clamping in preterm infants who do not require resusu
4) do not do cord milking
5) ECG can be used as an adjunct to ausculatation and saturation to provide a more rapid and accurate measure of heart rate during resus
6) insufficient data to suggest routine use of ET intubation to suction meconium from the trachea
7) Greater focus on commencing insertion of Umbicual venous catheter as soon as it is determined that chest compressions are required. Early IC admin of adrenaline is suggested over ET administration

Question 4

Discuss BSL changes in adults

Answer 4

In the current COVID climate out of hospital resus focusses on compression only CPR - this is in the presence of active community spread

Question 5

Discuss changes to ALS from 2015 ILCOR

Answer 5

1) if the first shock is not successful and the defib is capable of delivering shocks of higher energy it is reasonable to increase the energy for subsequent shocks
2) There is equipose between the choice of an advanced airway or a BVM for airway management during CPR and for the choice between SGD and ETT.

3) The role of waveform capnography during ALS is further emphasized including its use to
- confirm and continually monitor for tracheal tube position
- quality of CPR
- provide early recognition of ROSC

4) The routine use of automated mechanical chest compression devices is not recommended but they are suggested as a reasonable alternative in situations where sustained high quality chest compression are not feasible
5) ECMO CPR is suggest as a reasonable rescure therapy for patients with cardiac arrest when conventional CPR is failing
6) Cardiac ultrasound is recommended as a tool to identify reversible causes during resus
7) Selecting and maintaining a constant target temperature between 32-36 degrees for patient in whom targeted temperature management is used