Evidence Base Medicine Newborn and Child Dominique Biarent Hôpital Universitaire des Enfants Urgences et Soins Intensifs http://www.c2005.org/presenter.jhtml?identifier=3022512 Your Guide to the 2005 International CoSTR Conference
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Newborn and Child
Hôpital Universitaire des Enfants
Urgences et Soins Intensifs
Your Guide to the 2005 International CoSTR Conference
What is the purpose of the evidence evaluation process?The endpointof this process is the preparation of the International Consensus on CPR and ECC Science with Treatment Recommendations.
Consensus on Sciences and Treatment Recommendations
ILCOR is conducting systematic reviews and updates of scientific evidence supporting ECC treatment recommendations.
More than 300 CPR and ECC scientific topics will undergo evidence-based review
This process represents the most comprehensive, systematic review of the resuscitation literature to date
Who's in charge?ILCOR - the International Liaison Committee on Resuscitation.
includes 7 international resuscitation organizations
American Heart Association (AHA),
European Resuscitation Council (ERC),
Heart and Stroke Foundation of Canada (HSFC),
Resuscitation Council of Southern Africa (RCSA),
Australia and New Zealand Council on Resuscitation (ANZCOR),
InterAmerican Heart Foundation (IAHF).
Japan Resuscitation Council JRC : international observer to ILCOR.
China (Ministry of Health) : international observer to the C2005 Conference.
Wenzel V, Krismer AC, Arntz HR, Sitter H, Stadlbauer KH, Lindner KH. A comparison of vasopressin and epinephrine for out-of-hospital cardiopulmonary resuscitation. N Engl J Med 2004;350(2):105-13.
Voelckel WG, Lurie KG, McKnite S, et al. Comparison of epinephrine and vasopressin in a pediatric porcine model of asphyxial cardiac arrest. Crit Care Med 2000;28(12):3777-83.
Voelckel WG, Lurie KG, McKnite S, et al. Effects of epinephrine and vasopressin in a piglet model of prolonged ventricular fibrillation and cardiopulmonary resuscitation. Crit Care Med 2002;30(5):957-62.
Mann K, Berg RA, Nadkarni V. Beneficial effects of vasopressin in prolonged pediatric cardiac arrest: a case series. Resuscitation 2002;52(2):149-56.
« High dose of adrenaline is harmful in children with in-hospital and out-of-hospital cardiac arrest »
209 articles excluded
40 articles analysed : 25 human and 15 animal model studies
« The recommended resuscitation dose of adrenaline for children (0.01 mg/kg) should be increased
Age less than 18 years
5 articles met full criteriaHigh dose versus low dose adrenaline
A universal compression-ventilation ratio should be used for infants and children irrespective of their age, etiology of arrest and number of rescuers
Scientific evidence supports the superiority of a 5:1 CV ratio in children rather than the 15:2 CV ratio recommended for adults
20 articles used for discussion
9 articles in gridCompression / Ventilation Ratio
Kinney SB, Tibballs J. An analysis of the efficacy of bag-valve-mask ventilation and chest compression during different compression–ventilation ratios in manikin-simulated paediatric resuscitation. Resuscitation 2000;43:115-120.
J. L. Greingor. Quality of cardiac massage with ratio compression–ventilation 5/1 and 15/2.
Resuscitation 2002; 55:263-267
Babbs CF, Nadkarni V. Optimizing chest compression to rescue ventilation ratios during one-rescuer CPR by professionals and lay persons: children are not just little adults. Resuscitation 2004;61:173-81.
Optimum C/V ratios in pediatric basic life support
5 + AGE for Pro
5 + AGE/2 for LAY
Babbs CF, Kern KB. Optimum compression to ventilation ratios in CPR under realistic, practical conditions: a physiological and mathematical analysis. Resuscitation. 2002 Aug;54(2):147-57.
OPTIMAL RATIO between 30:2 and 50:2
Number of shocks that failed to terminate the initial VF episode for monophasic weight-based and attenuated adult biphasic shocks in the 4, 14 and 24 kg weight categories. *P<0.01.
Berg RA, Chapman FW et al Attenuated adult biphasic shocks compared with weight-based monophasic shocks in a swine model of prolonged pediatric ventricular fibrillation.Resuscitation 2004, 61:189-197