Part 10: Paediatric basic and advanced life support
2010; Elsevier BV; Volume: 81; Issue: 1 Linguagem: Inglês
10.1016/j.resuscitation.2010.08.028
ISSN1873-1570
AutoresAllan R. de Caen, Monica E. Kleinman, Leon Chameides, Dianne L. Atkins, Robert A. Berg, Marc Berg, Farhan Bhanji, Dominique Biarent, Robert Bingham, Ashraf Coovadia, Mary Fran Hazinski, Robert W. Hickey, Vinay Nadkarni, Amélia G. Reis, Antonio Rodrı́guez-Núñez, James Tibballs, Arno Zaritsky, David Zideman,
Tópico(s)Neonatal Respiratory Health Research
ResumoThe 2010 ILCOR Paediatric Task Force experts developed 55 questions related to paediatric resuscitation. Topics were selected based on the 2005 Consensus on Science and Treatment Recommendations (CoSTR) document,12005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 6: paediatric basic and advanced life support.Resuscitation. 2005; 67: 271-291Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar, 22005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 6: pediatric basic and advanced life support.Circulation. 2005; 112 (III-73–90)Google Scholar emerging science, and newly identified issues. Not every topic reviewed for the 2005 International Consensus on Science was reviewed in the 2010 evidence evaluation process. In general, evidence-based worksheets were assigned to at least two authors for each topic. The literature search strategy was first reviewed by a “worksheet expert” for completeness. The expert also approved the final worksheet to ensure that the levels of evidence were correctly assigned according to the established criteria. Worksheet authors were requested to draft CoSTR statements (see Part 3: Evidence Evaluation Process). Each worksheet author or pair of authors presented their topic to the Task Force in person or via a webinar conference, and Task Force members discussed the available science and revised the CoSTR draft accordingly. These draft CoSTR summaries were recirculated to the International Liaison Committee on Resuscitation (ILCOR) Paediatric Task Force for further refinement until consensus was reached. Selected controversial and critical topics were presented at the 2010 ILCOR International Evidence Evaluation conference in Dallas, Texas, for further discussion to obtain additional input and feedback. This document presents the 2010 international consensus on the science, treatment, and knowledge gaps for each paediatric question. The most important changes or points of emphasis in the recommendations for paediatric resuscitation since the publication of the 2005 ILCOR International Consensus on CPR and ECC Science with Treatment Recommendations12005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 6: paediatric basic and advanced life support.Resuscitation. 2005; 67: 271-291Abstract Full Text Full Text PDF PubMed Scopus (53) Google Scholar, 22005 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Part 6: pediatric basic and advanced life support.Circulation. 2005; 112 (III-73–90)Google Scholar are summarised in the following list. The scientific evidence supporting these changes is detailed in this document.•Additional evidence shows that healthcare providers do not reliably determine the presence or absence of a pulse in infants or children.•New evidence documents the important role of ventilations in CPR for infants and children. However, rescuers who are unable or unwilling to provide ventilations should be encouraged to perform compression-only CPR.•To achieve effective chest compressions, rescuers should compress at least one-third the anterior–posterior dimension of the chest. This corresponds to approximately 4 cm (1.5 in.) in most infants and 5 cm (2 in.) in most children.•When shocks are indicated for ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) in infants and children, an initial energy dose of 2–4 J kg−1 is reasonable; doses higher than 4 J kg−1, especially if delivered with a biphasic defibrillator, may be safe and effective.•More data support the safety and effectiveness of cuffed tracheal tubes in infants and young children, and the formula for selecting the appropriately sized cuffed tube was updated.•The safety and value of using cricoid pressure during emergency intubation are not clear. Therefore, the application of cricoid pressure should be modified or discontinued if it impedes ventilation or the speed or ease of intubation.•Monitoring capnography/capnometry is recommended to confirm proper tracheal tube position.•Monitoring capnography/capnometry may be helpful during CPR to help assess and optimise quality of chest compressions.•On the basis of increasing evidence of potential harm from exposure to high-concentration oxygen after cardiac arrest, once spontaneous circulation is restored, inspired oxygen concentration should be titrated to limit the risk of hyperoxaemia.•Use of a rapid response system in a paediatric inpatient setting may be beneficial to reduce rates of cardiac and respiratory arrest and in-hospital mortality.•Use of a bundled approach to management of paediatric septic shock is recommended.•The young victim of a sudden, unexpected cardiac arrest should have an unrestricted, complete autopsy, if possible, with special attention to the possibility of an underlying condition that predisposes to a fatal arrhythmia. Appropriate preservation and genetic analysis of tissue should be considered; detailed testing may reveal an inherited “channelopathy” that may also be present in surviving family members. Medical emergency teams (METs) or rapid response teams (RRTs) have been shown to be effective in preventing respiratory and cardiac arrests in selected paediatric inpatient settings. Family presence during resuscitations has been shown to be beneficial for the grieving process and in general was not found to be disruptive. Thus, family presence is supported if it does not interfere with the resuscitative effort. Download .pdf (.05 MB) Help with pdf files Peds-025A Download .pdf (.05 MB) Help with pdf files Peds-025B The introduction of METs or RRTs was associated with a decrease in paediatric hospital mortality in one LOE 3 meta-analysis3Chan P.S. Jain R. Nallmothu B.K. Berg R.A. Sasson C. Rapid response teams: a systematic review and meta-analysis.Arch Intern Med. 2010; 170: 18-26Crossref PubMed Scopus (155) Google Scholar and three paediatric LOE 3 studies with historical controls.4Sharek P.J. Parast L.M. Leong K. et al.Effect of a rapid response team on hospital-wide mortality and code rates outside the ICU in a Children's Hospital.JAMA. 2007; 298: 2267-2274Crossref PubMed Scopus (124) Google Scholar, 5Tibballs J. Kinney S. Duke T. Oakley E. Hennessy M. Reduction of paediatric in-patient cardiac arrest and death with a medical emergency team: preliminary results.Arch Dis Child. 2005; 90: 1148-1152Crossref PubMed Scopus (95) Google Scholar, 6Tibballs J. Kinney S. Reduction of hospital mortality and of preventable cardiac arrest and death on introduction of a pediatric medical emergency team.Pediatr Crit Care Med. 2009; 10: 306-312Crossref PubMed Scopus (57) Google Scholar The introduction of a MET or RRT was associated witha decrease in respiratory but not cardiac arrest in one LOE 37Hunt E.A. Zimmer K.P. Rinke M.L. et al.Transition from a traditional code team to a medical emergency team and categorization of cardiopulmonary arrests in a children's center.Arch Pediatr Adolesc Med. 2008; 162: 117-122Crossref Scopus (48) Google Scholar study with historical controls;a decrease in preventable total number of arrests in one LOE 3 study compared with a retrospective chart review8Brilli R.J. Gibson R. Luria J.W. et al.Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit.Pediatr Crit Care Med. 2007; 8 (quiz 47): 236-246Crossref PubMed Scopus (90) Google Scholar;a decrease in total number of arrests in two LOE 34Sharek P.J. Parast L.M. Leong K. et al.Effect of a rapid response team on hospital-wide mortality and code rates outside the ICU in a Children's Hospital.JAMA. 2007; 298: 2267-2274Crossref PubMed Scopus (124) Google Scholar, 8Brilli R.J. Gibson R. Luria J.W. et al.Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit.Pediatr Crit Care Med. 2007; 8 (quiz 47): 236-246Crossref PubMed Scopus (90) Google Scholar studies;a decrease in preventable cardiac arrests in one LOE 36Tibballs J. Kinney S. Reduction of hospital mortality and of preventable cardiac arrest and death on introduction of a pediatric medical emergency team.Pediatr Crit Care Med. 2009; 10: 306-312Crossref PubMed Scopus (57) Google Scholar study anda decrease in cardiac arrest and non-paediatric intensive care unit (PICU) mortality in one LOE 39Mistry K.P. Turi J. Hueckel R. Mericle J.M. Meliones J.N. Pediatric rapid response teams in the academic medical center.Clin Pediatr Emerg Med. 2006; 7: 241-247Abstract Full Text Full Text PDF Scopus (10) Google Scholar paediatric cohort study using historical controls. Paediatric RRT or MET systems may be beneficial to reduce the risk of respiratory and/or cardiac arrest in hospitalised paediatric patients outside an intensively monitored environment. Is it the team or the staff education associated with MET or RRT implementation that leads to improved patient outcomes? Is the team effectiveness due to validated team activation criteria or specific team composition? Do the benefits attributed to these teams extend to children in a community hospital setting? Download .pdf (.1 MB) Help with pdf files Peds-003 Ten studies (LOE 210Dudley N.C. Hansen K.W. Furnival R.A. Donaldson A.E. Van Wagenen K.L. Scaife E.R. The effect of family presence on the efficiency of pediatric trauma resuscitations.Ann Emerg Med. 2009; 53 (e3): 777-784Abstract Full Text Full Text PDF Scopus (23) Google Scholar; LOE 311Tinsley C. Hill J.B. Shah J. et al.Experience of families during cardiopulmonary resuscitation in a pediatric intensive care unit.Pediatrics. 2008; 122: e799-804Crossref PubMed Scopus (24) Google Scholar; LOE 412Mangurten J. Scott S.H. Guzzetta C.E. et al.Effects of family presence during resuscitation and invasive procedures in a pediatric emergency department.J Emerg Nurs. 2006; 32: 225-233Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar, 13McGahey-Oakland P.R. Lieder H.S. Young A. et al.Family experiences during resuscitation at a children's hospital emergency department.J Pediatr Health Care. 2007; 21: 217-225Abstract Full Text Full Text PDF Scopus (20) Google Scholar, 14Jones M. Qazi M. Young K.D. Ethnic differences in parent preference to be present for painful medical procedures.Pediatrics. 2005; 116: e191-e197Crossref PubMed Scopus (23) Google Scholar, 15Boie E.T. Moore G.P. Brummett C. Nelson D.R. Do parents want to be present during invasive procedures performed on their children in the emergency department? A survey of 400 parents.Ann Emerg Med. 1999; 34: 70-74Abstract Full Text Full Text PDF PubMed Scopus (124) Google Scholar, 16Andrews R. Andrews R. Family presence during a failed major trauma resuscitation attempt of a 15-year-old boy: lessons learned.J Emerg Nurs. 2004; 30 ([see comment]): 556-558Abstract Full Text Full Text PDF Scopus (10) Google Scholar, 17Dill K. Gance-Cleveland B. Dill K. Gance-Cleveland B. With you until the end: family presence during failed resuscitation.J Spec Pediatr Nurs: JSPN. 2005; 10: 204-207Crossref Google Scholar, 18Gold K.J. Gorenflo D.W. Schwenk T.L. et al.Physician experience with family presence during cardiopulmonary resuscitation in children.Pediatr Crit Care Med. 2006; 7 ([see comment]): 428-433Crossref PubMed Scopus (37) Google Scholar, 19Duran C.R. Oman K.S. Abel J.J. Koziel V.M. Szymanski D. Attitudes toward and beliefs about family presence: a survey of healthcare providers, patients’ families, and patients.Am J Crit Care. 2007; 16: 270-279PubMed Google Scholar) documented that parents wish to be given the option of being present during the resuscitation of their children. One LOE 2,10Dudley N.C. Hansen K.W. Furnival R.A. Donaldson A.E. Van Wagenen K.L. Scaife E.R. The effect of family presence on the efficiency of pediatric trauma resuscitations.Ann Emerg Med. 2009; 53 (e3): 777-784Abstract Full Text Full Text PDF Scopus (23) Google Scholar one LOE 3,11Tinsley C. Hill J.B. Shah J. et al.Experience of families during cardiopulmonary resuscitation in a pediatric intensive care unit.Pediatrics. 2008; 122: e799-804Crossref PubMed Scopus (24) Google Scholar two LOE 4,13McGahey-Oakland P.R. Lieder H.S. Young A. et al.Family experiences during resuscitation at a children's hospital emergency department.J Pediatr Health Care. 2007; 21: 217-225Abstract Full Text Full Text PDF Scopus (20) Google Scholar, 19Duran C.R. Oman K.S. Abel J.J. Koziel V.M. Szymanski D. Attitudes toward and beliefs about family presence: a survey of healthcare providers, patients’ families, and patients.Am J Crit Care. 2007; 16: 270-279PubMed Google Scholar and one LOE 520Doyle C.J. Post H. Burney R.E. Maino J. Keefe M. Rhee K.J. Family participation during resuscitation: an option.Ann Emerg Med. 1987; 16: 673-675Abstract Full Text PDF PubMed Google Scholar studies confirmed that most parents would recommend parent presence during resuscitation to others. One LOE 2,10Dudley N.C. Hansen K.W. Furnival R.A. Donaldson A.E. Van Wagenen K.L. Scaife E.R. The effect of family presence on the efficiency of pediatric trauma resuscitations.Ann Emerg Med. 2009; 53 (e3): 777-784Abstract Full Text Full Text PDF Scopus (23) Google Scholar one LOE 3,11Tinsley C. Hill J.B. Shah J. et al.Experience of families during cardiopulmonary resuscitation in a pediatric intensive care unit.Pediatrics. 2008; 122: e799-804Crossref PubMed Scopus (24) Google Scholar six LOE 4,12Mangurten J. Scott S.H. Guzzetta C.E. et al.Effects of family presence during resuscitation and invasive procedures in a pediatric emergency department.J Emerg Nurs. 2006; 32: 225-233Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar, 14Jones M. Qazi M. Young K.D. Ethnic differences in parent preference to be present for painful medical procedures.Pediatrics. 2005; 116: e191-e197Crossref PubMed Scopus (23) Google Scholar, 19Duran C.R. Oman K.S. Abel J.J. Koziel V.M. Szymanski D. Attitudes toward and beliefs about family presence: a survey of healthcare providers, patients’ families, and patients.Am J Crit Care. 2007; 16: 270-279PubMed Google Scholar, 21Hanson C. Strawser D. Family presence during cardiopulmonary resuscitation: Foote Hospital emergency department's nine-year perspective.J Emerg Nurs. 1992; 18: 104-106PubMed Google Scholar, 22Meyers T.A. Eichhorn D.J. Guzzetta C.E. Do families want to be present during CPR? A retrospective survey.J Emerg Nurs. 1998; 24: 400-405Abstract Full Text Full Text PDF PubMed Google Scholar, 23Meyers T.A. Eichhorn D.J. Guzzetta C.E. et al.Family presence during invasive procedures and resuscitation.Am J Nurs. 2000; 100 (quiz 3): 32-42PubMed Google Scholar and two LOE 520Doyle C.J. Post H. Burney R.E. Maino J. Keefe M. Rhee K.J. Family participation during resuscitation: an option.Ann Emerg Med. 1987; 16: 673-675Abstract Full Text PDF PubMed Google Scholar, 24Holzhauser K. Finucane J. De Vries S. Family presence during resuscitation: a randomised controlled trial of the impact of family presence.Aust Emerg Nurs J. 2005; 8: 139-147Abstract Full Text Full Text PDF Scopus (23) Google Scholar studies of relatives present during the resuscitation of a family member reported that they believed their presence was beneficial to the patient. One LOE 2,10Dudley N.C. Hansen K.W. Furnival R.A. Donaldson A.E. Van Wagenen K.L. Scaife E.R. The effect of family presence on the efficiency of pediatric trauma resuscitations.Ann Emerg Med. 2009; 53 (e3): 777-784Abstract Full Text Full Text PDF Scopus (23) Google Scholar one LOE 3,11Tinsley C. Hill J.B. Shah J. et al.Experience of families during cardiopulmonary resuscitation in a pediatric intensive care unit.Pediatrics. 2008; 122: e799-804Crossref PubMed Scopus (24) Google Scholar six LOE 4,12Mangurten J. Scott S.H. Guzzetta C.E. et al.Effects of family presence during resuscitation and invasive procedures in a pediatric emergency department.J Emerg Nurs. 2006; 32: 225-233Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar, 13McGahey-Oakland P.R. Lieder H.S. Young A. et al.Family experiences during resuscitation at a children's hospital emergency department.J Pediatr Health Care. 2007; 21: 217-225Abstract Full Text Full Text PDF Scopus (20) Google Scholar, 16Andrews R. Andrews R. Family presence during a failed major trauma resuscitation attempt of a 15-year-old boy: lessons learned.J Emerg Nurs. 2004; 30 ([see comment]): 556-558Abstract Full Text Full Text PDF Scopus (10) Google Scholar, 17Dill K. Gance-Cleveland B. Dill K. Gance-Cleveland B. With you until the end: family presence during failed resuscitation.J Spec Pediatr Nurs: JSPN. 2005; 10: 204-207Crossref Google Scholar, 18Gold K.J. Gorenflo D.W. Schwenk T.L. et al.Physician experience with family presence during cardiopulmonary resuscitation in children.Pediatr Crit Care Med. 2006; 7 ([see comment]): 428-433Crossref PubMed Scopus (37) Google Scholar, 19Duran C.R. Oman K.S. Abel J.J. Koziel V.M. Szymanski D. Attitudes toward and beliefs about family presence: a survey of healthcare providers, patients’ families, and patients.Am J Crit Care. 2007; 16: 270-279PubMed Google Scholar and one LOE 524Holzhauser K. Finucane J. De Vries S. Family presence during resuscitation: a randomised controlled trial of the impact of family presence.Aust Emerg Nurs J. 2005; 8: 139-147Abstract Full Text Full Text PDF Scopus (23) Google Scholar studies reported that most relatives present during the resuscitation of a family member benefited from the experience. One LOE 3,11Tinsley C. Hill J.B. Shah J. et al.Experience of families during cardiopulmonary resuscitation in a pediatric intensive care unit.Pediatrics. 2008; 122: e799-804Crossref PubMed Scopus (24) Google Scholar four LOE 4,12Mangurten J. Scott S.H. Guzzetta C.E. et al.Effects of family presence during resuscitation and invasive procedures in a pediatric emergency department.J Emerg Nurs. 2006; 32: 225-233Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar, 13McGahey-Oakland P.R. Lieder H.S. Young A. et al.Family experiences during resuscitation at a children's hospital emergency department.J Pediatr Health Care. 2007; 21: 217-225Abstract Full Text Full Text PDF Scopus (20) Google Scholar, 20Doyle C.J. Post H. Burney R.E. Maino J. Keefe M. Rhee K.J. Family participation during resuscitation: an option.Ann Emerg Med. 1987; 16: 673-675Abstract Full Text PDF PubMed Google Scholar, 21Hanson C. Strawser D. Family presence during cardiopulmonary resuscitation: Foote Hospital emergency department's nine-year perspective.J Emerg Nurs. 1992; 18: 104-106PubMed Google Scholar and two LOE 524Holzhauser K. Finucane J. De Vries S. Family presence during resuscitation: a randomised controlled trial of the impact of family presence.Aust Emerg Nurs J. 2005; 8: 139-147Abstract Full Text Full Text PDF Scopus (23) Google Scholar, 25Robinson S.M. Mackenzie-Ross S. Campbell Hewson G.L. Egleston C.V. Prevost A.T. Psychological effect of witnessed resuscitation on bereaved relatives.Lancet. 1998; 352: 614-617Abstract Full Text Full Text PDF PubMed Scopus (201) Google Scholar studies reported that being present during the resuscitation helped their adjustment to the family member's death. One LOE 210Dudley N.C. Hansen K.W. Furnival R.A. Donaldson A.E. Van Wagenen K.L. Scaife E.R. The effect of family presence on the efficiency of pediatric trauma resuscitations.Ann Emerg Med. 2009; 53 (e3): 777-784Abstract Full Text Full Text PDF Scopus (23) Google Scholar and two LOE 412Mangurten J. Scott S.H. Guzzetta C.E. et al.Effects of family presence during resuscitation and invasive procedures in a pediatric emergency department.J Emerg Nurs. 2006; 32: 225-233Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar, 13McGahey-Oakland P.R. Lieder H.S. Young A. et al.Family experiences during resuscitation at a children's hospital emergency department.J Pediatr Health Care. 2007; 21: 217-225Abstract Full Text Full Text PDF Scopus (20) Google Scholar studies observed that allowing family members to be present during a resuscitation in a hospital setting did them no harm, whereas one LOE 426van der Woning M. Relatives in the resuscitation area: a phenomenological study.Nurs Crit Care. 1999; 4: 186-192Google Scholar study suggested that some relatives present for the resuscitation of a family member experienced short-term emotional difficulty. One LOE 2,10Dudley N.C. Hansen K.W. Furnival R.A. Donaldson A.E. Van Wagenen K.L. Scaife E.R. The effect of family presence on the efficiency of pediatric trauma resuscitations.Ann Emerg Med. 2009; 53 (e3): 777-784Abstract Full Text Full Text PDF Scopus (23) Google Scholar one LOE 3,27O’Connell K.J. Farah M.M. Spandorfer P. et al.Family presence during pediatric trauma team activation: an assessment of a structured program.Pediatrics. 2007; 120: e565-e574Crossref PubMed Scopus (27) Google Scholar three LOE 4,12Mangurten J. Scott S.H. Guzzetta C.E. et al.Effects of family presence during resuscitation and invasive procedures in a pediatric emergency department.J Emerg Nurs. 2006; 32: 225-233Abstract Full Text Full Text PDF PubMed Scopus (55) Google Scholar, 23Meyers T.A. Eichhorn D.J. Guzzetta C.E. et al.Family presence during invasive procedures and resuscitation.Am J Nurs. 2000; 100 (quiz 3): 32-42PubMed Google Scholar, 28Engel K.G. Barnosky A.R. Berry-Bovia M. et al.Provider experience and attitudes toward family presence during resuscitation procedures.J Palliat Med. 2007; 10: 1007-1009Crossref Scopus (10) Google Scholar and three LOE 520Doyle C.J. Post H. Burney R.E. Maino J. Keefe M. Rhee K.J. Family participation during resuscitation: an option.Ann Emerg Med. 1987; 16: 673-675Abstract Full Text PDF PubMed Google Scholar, 24Holzhauser K. Finucane J. De Vries S. Family presence during resuscitation: a randomised controlled trial of the impact of family presence.Aust Emerg Nurs J. 2005; 8: 139-147Abstract Full Text Full Text PDF Scopus (23) Google Scholar, 29Boyd R. White S. Does witnessed cardiopulmonary resuscitation alter perceived stress in accident and emergency staff?.Eur J Emerg Med. 2000; 7: 51-53Crossref PubMed Google Scholar studies showed that family presence during resuscitation was not perceived as being stressful to staff or to have negatively affected staff performance. However, one survey (LOE 430Compton S. Madgy A. Goldstein M. et al.Emergency medical service providers’ experience with family presence during cardiopulmonary resuscitation.Resuscitation. 2006; 70: 223-228Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar) found that 39–66% of emergency medical services (EMS) providers reported feeling threatened by family members during an out-of-hospital resuscitation and that family presence interfered with their ability to perform resuscitations. In general, family members should be offered the opportunity to be present during the resuscitation of an infant or child. When deciding whether to allow family members to be present during an out-of-hospital resuscitation, the potential negative impact on EMS provider performance must be considered. How does the presence of a dedicated support person help family members and, potentially, healthcare providers during the resuscitation of an infant or child? What training is appropriate for staff who may serve as support persons for family members during resuscitation of an infant or child? Why is family presence during resuscitation perceived more negatively by out-of-hospital care providers than by in-hospital staff? Many healthcare providers find it difficult to rapidly and accurately determine the presence or absence of a pulse. On the basis of available evidence, the Task Force decided to deemphasise but not eliminate the pulse check as part of the healthcare provider assessment. The Task Force members recognised that healthcare providers who work in specialised settings may have enhanced skills in accurate and rapid pulse checks, although this has not been studied. There are considerable data regarding use of end-tidal carbon dioxide (Petco2) measurement, capnography and capnometry, during cardiopulmonary resuscitation (CPR) as an indicator of CPR quality and as a predictive measure of outcome. Although capnography/capnometry may reflect the quality of CPR, there is insufficient evidence of its reliability in predicting resuscitation success in infants and children. Download .pdf (.07 MB) Help with pdf files Peds-002A Thirteen LOE 5 studies31Bahr J. Klingler H. Panzer W. Rode H. Kettler D. Skills of lay people in checking the carotid pulse.Resuscitation. 1997; 35: 23-26Abstract Full Text Full Text PDF PubMed Scopus (112) Google Scholar, 32Brearley S. Shearman C.P. Simms M.H. Peripheral pulse palpation: an unreliable physical sign.Ann Roy Coll Surg Engl. 1992; 74: 169-171Google Scholar, 33Cavallaro D.L. Melker R.J. Comparison of two techniques for detecting cardiac activity in infants.Crit Care Med. 1983; 11: 189-190Crossref PubMed Google Scholar, 34Inagawa G. Morimura N. Miwa T. Okuda K. Hirata M. Hiroki K. A comparison of five techniques for detecting cardiac activity in infants.Paediatr Anaesth. 2003; 13: 141-146Crossref PubMed Scopus (26) Google Scholar, 35Kamlin C.O. 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Heartbeat assessment in infants: a comparison of four clinical methods.Pediatr Crit Care Med. 2005; 6: 212-215Crossref PubMed Scopus (17) Google Scholar, 41Sarti A. Savron F. Ronfani L. Pelizzo G. Barbi E. Comparison of three sites to check the pulse and count heart rate in hypotensive infants.Paediatr Anaesth. 2006; 16: 394-398Crossref Scopus (17) Google Scholar, 42Tanner M. Nagy S. Peat J.K. Detection of infant's heart beat/pulse by caregivers: a comparison of 4 methods.J Pediatr. 2000; 137: 429-430Crossref PubMed Scopus (18) Google Scholar, 43Whitelaw C.C. Goldsmith L.J. Comparison of two techniques for determining the presence of a pulse in an infant.Acad Emerg Med. 1997; 4: 153-154Crossref PubMed Google Scholar observed that neither laypersons nor healthcare providers are able to perform an accurate pulse check in healthy adults or infants within 10 s. In two LOE 5 studies in adults44Dick W.F. Eberle B. Wisser G. Schneider T. The carotid pulse check revisited: what if there is no pulse?.Crit Care Med. 2000; 28: N183-N185Crossref PubMed Google Scholar, 45Eberle B. Dick W.F. Schneider T. Wisser G. Doetsch S. Tzanova I. Checking the carotid pulse check: diagnostic accuracy of first responders in patients with and without a pulse.Resuscitation. 1996; 33: 107-116Abstract Full Text PDF PubMed Scopus (198) Google Scholar and two LOE 3 studies in children with nonpulsatile circulation,46Tibballs J. Russell P. Reliability of pulse palpation by healthcare personnel to diagnose paediatric cardiac arrest.Resuscitation. 2009; 80: 61-64Abstract Full Text Full Text PDF PubMed Scopus (36) Google Scholar, 47Tibballs J. Weeranatna C. The influence of time on the accuracy of healthcare personnel to diagnose paediatric cardiac arrest by pulse palpation.Resuscitation. 2010; 81: 671-675Abstract Full Text Full Text PDF PubMed Scopus (15) Google Scholar blinded healthcare providers commonly assessed pulse status inaccurately and their assessment often took >10 s. In the paediatric studies, healthcare professionals were able to accurately detect a pulse by palpation only 80% of the time. They mistakenly perceived a pulse when it was nonexistent 14–24% of the time and failed to detect a pulse when present in 21–36% of the assessments. The average time to detect an actual pulse was approximately 15 s, whereas the average time to confirm the absence of a pulse was 30 s. Because the pulseless patients were receiving extracorporeal membrane oxygenation (ECMO) support, one must b
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