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General Cardiac Arrest Care

Date Last Search Run: Feb 01, 2022
Table last updated: Apr 02, 2022
Data last added: Apr 27, 2022

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)  
2 (fair evidence exists)  
3 (weak evidence exists)  


Interventions

ACDC
Level Direction Primary Outcome Patient/Process Setting Reference

ACLS
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Procedural skills Process PH-Paramedic Baker TW., King W., Soto W., Asher C., Stolfi A., Rowin ME. The efficacy of pediatric ALS training in EMS providers. Ped Emerg Care 2009; 25:508-12. Medline

Bystander CPR
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Survival-to-hospital-discharge Patient PH-Bystander Albargi H, Mallett S, Berhane S, Booth S, Hawkes C, Perkins GD, et al. Bystander cardiopulmonary resuscitation for paediatric out-of-hospital cardiac arrest in England: An observational registry cohort study. Resuscitation 2021; 170:17–25. Medline
II Supportive (Green) Neurological status at 1 month Patient PH-Paramedic & MD Goto Y, Funada A, Maeda T. Temporal trends in neurologically intact survival after paediatric bystander-witnessed out-of-hospital cardiac arrest: A nationwide population-based observational study. Resusc Plus 2021; 6:100104. Medline
II Supportive (Green) Survival Patient Naim MY., Burke RV., McNally BF., Song L., Griffis HM., Berg RA., et al. Association of Bystander Cardiopulmonary Resuscitation With Overall and Neurologically Favorable Survival After Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Report From the Cardiac Arrest Registry to Enhance Survival Surveillance Regis. JAMA Pediatrics 2016; 171(2):133-41. Medline

Chest Compression devices
Level Direction Primary Outcome Patient/Process Setting Reference

Compression-only CPR
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) 1-month favorable neurological status Patient Fukuda T., Ohashi-Fukuda N., Kobayashi H., Gunshin M., Sera T., Kondo Y., et al. Conventional Versus Compression-Only Versus No-Bystander Cardiopulmonary Resuscitation for Pediatric Out-of-Hospital Cardiac Arrest. Circulation 2016; 134(25):2060-70. Medline
II Neutral (Yellow) 1-month neurologically intact survival, defined as a CPC score of 1 or 2 Patient PH-Bystander Goto Y, Funada A, Maeda T. Temporal trends in neurologically intact survival after paediatric bystander-witnessed out-of-hospital cardiac arrest: A nationwide population-based observational study. Resusc Plus 2021; 6:100104. Medline
II Neutral (Yellow) 30 Day Neurologically Intact Survival Patient Goto Y., Funada A., Goto Y. Conventional versus chest-compression-only cardiopulmonary resuscitation by bystanders for children with out-of-hospital cardiac arrest. Resuscitation 2018; 122:126-34. Medline
II Neutral (Yellow) Neurological function at 1 month Patient PH-Paramedic Kitamura T., Iwami T., Kawamura T., et al. Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: A prospective, nationwide, population-based cohort study. Lancet 2010; 375(9723):1347-54. Medline

CPR feedback device
Level Direction Primary Outcome Patient/Process Setting Reference

CPR-Finger technique
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Blood Pressure Process SIM Dorfsman ML., Menegazzi JJ., Wadas RJ., Auble TE. Two-thumb vs. two-finger chest compression in an infant model of prolonged cardiopulmonary resuscitation. Acad Emerg Med 2000; 7(10):1077-82. Medline
III Supportive (Green) Adequacy Process Smereka J., Bielski K., Ladny JR., Ruetzler K., Szarpak L. Evaluation of a newly developed infant chest compression technique: A randomized crossover manikin trial. Medicine 2017; 96(14):e5915. Medline
III Supportive (Green) Compression efficacy Patient SIM Whitelaw CC., Slywka B., Goldsmith LJ. Comparison of a two-finger versus two-thumb method for chest compressions by healthcare providers in an infant mechanical model. Resuscitation 2000; 43(3):213-216. Medline
III Neutral (Yellow) Chest compression quality Process Smereka J., Kasiński M., Smereka A., Aadny J.R, Szarpak Ł. The quality of a newly developed infant chest compression method applied by paramedics: a randomised crossover manikin trial. Kardiol Pol 2017; 75(6):589-595. Medline
III Neutral (Yellow) Improved perfusion Patient Smereka J., Szarpak L., Rodreguez A., Ladny JR., Leung S., Ruetzler K. A randomized comparison of three chest compression techniques and associated hemodynamic effect during infant CPR: A randomized manikin study. Am J Emerg Med 2017; 35(10):1420-5. Medline
X Not Yet Graded (White) - Cioccari G, Sica da Rocha T, Piva JP. Two-Thumb Technique Is Superior to Two-Finger Technique in Cardiopulmonary Resuscitation of Simulated Out-of-Hospital Cardiac Arrest in Infants. J Am Hear Assoc 2021; 10(20):e018050. Medline

CPR-Thumb technique
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Blood Pressure Process SIM Dorfsman ML., Menegazzi JJ., Wadas RJ., Auble TE. Two-thumb vs. two-finger chest compression in an infant model of prolonged cardiopulmonary resuscitation. Acad Emerg Med 2000; 7(10):1077-82. Medline
III Supportive (Green) Mean hands-off time. Process Jo CH., Cho GC., Lee CH. Two-Thumb Encircling Technique Over the Head of Patients in the Setting of Lone Rescuer Infant CPR Occurred During Ambulance Transfer: A Crossover Simulation Study. Pediatr Emerg Care 2017; 33(7):462-6. Medline
III Supportive (Green) Chest compression quality Process Smereka J., Kasiński M., Smereka A., Aadny J.R, Szarpak Ł. The quality of a newly developed infant chest compression method applied by paramedics: a randomised crossover manikin trial. Kardiol Pol 2017; 75(6):589-595. Medline
III Supportive (Green) Adequacy Process Smereka J., Bielski K., Ladny JR., Ruetzler K., Szarpak L. Evaluation of a newly developed infant chest compression technique: A randomized crossover manikin trial. Medicine 2017; 96(14):e5915. Medline
III Supportive (Green) Improved perfusion Patient Smereka J., Szarpak L., Rodreguez A., Ladny JR., Leung S., Ruetzler K. A randomized comparison of three chest compression techniques and associated hemodynamic effect during infant CPR: A randomized manikin study. Am J Emerg Med 2017; 35(10):1420-5. Medline
III Supportive (Green) Compression efficacy Patient SIM Whitelaw CC., Slywka B., Goldsmith LJ. Comparison of a two-finger versus two-thumb method for chest compressions by healthcare providers in an infant mechanical model. Resuscitation 2000; 43(3):213-216. Medline
X Not Yet Graded (White) - Cioccari G, Sica da Rocha T, Piva JP. Two-Thumb Technique Is Superior to Two-Finger Technique in Cardiopulmonary Resuscitation of Simulated Out-of-Hospital Cardiac Arrest in Infants. J Am Hear Assoc 2021; 10(20):e018050. Medline

Early epinephrine
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) short-term survival with favorable neurological outcomes Patient Other Ohshige K., et al. Evaluation of OOHCA resuscitation with resuscitative drugs: a prospective comparative study in Japan. Resus 2005; 66:53-61. Medline

Epinephrine
Level Direction Primary Outcome Patient/Process Setting Reference
I Neutral (Yellow) 24-hour survival rate Patient ED-MD Perondi M., Reis A., Palva E., Nadkarni V., Berg R. A Comparison of High-Dose and Standard-Dose Epinephrine in Children with Cardiac Arrest. N Engl J Med 2004; 350:1722-30. Medline
II Supportive (Green) Survival to hospital discharge Patient Hansen M., Schmicker RH., Newgard CD., Grunau B., Scheuermeyer F., Cheskes S., et al. Time to Epinephrine Administration and Survival from Non-Shockable Out-of-Hospital Cardiac Arrest Among Children and Adults. Circulation 2018; 137(19):2032-40. Medline
II Neutral (Yellow) Return of spontaneous circulation Patient PH-Paramedic Dieckmann RA., Vardis R. High-dose epinephrine in pediatric out-of-hospital cardiopulmonary arrest. Pediatrics 1995; 95:901-13. Medline
II Neutral (Yellow) ROSC Process PH-Paramedic Goetting MG., Paradis NA. High-dose epinephrine improves outcome from pediatric cardiac arrest. Ann Emerg Med 1991; 20:22-6. Medline
II Neutral (Yellow) Post resuscitative Hemodynamics Patient Lin YR., Syue YJ., Buddhakosai W., et al. Impact of different initial epinephrine treatment time points on the early postresuscitative hemodynamic status of children with traumatic out-of-hospital cardiac arrest. Medicine. 2016;95(12):e3195. Medline
II Neutral (Yellow) Survival Patient PH-Paramedic Moler FW., Donaldson AE., Meert K., et al. Multicenter cohort study of out-of-hospital pediatric cardiac arrest. Crit Care Med 2011; 39(1):141-9. Medline
III Supportive (Green) ROSC Process ED-MD Carpenter T., Stenmark K. High-dose epinephrine is not superior to standard-dose epinephrine in pediatric in-hospital cardiopulmonary arrest. Pediatrics 1997; 99:403-8. Medline
III Supportive (Green) Survival to discharge Patient PH-Paramedic Lienhart HG., John W., Wenzel V. Cardiopulmonary resuscitation of a near-drowned child with a combination of epinephrine and vasopressin. Pediatr Crit Care Med 2005;.6(4):486-488. Medline
III Neutral (Yellow) Survival to discharge, Survival with good neuro outcome Patient Lin YR., Syue YJ., Buddhakosai W., Lu HE., Chang CF., Chang CY., et al. Impact of Different Initial Epinephrine Treatment Time Points on the Early Postresuscitative Hemodynamic Status of Children With Traumatic Out-of-hospital Cardiac Arrest. Medicine 2016; 95(12):e3195. Medline

ETCO2
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Mortality Patient ICU Berg RA, Reeder RW, Meert KL, Yates AR, Berger JT, Newth CJ, Carcillo JA, McQuillen PS, Harrison RE, Moler FW, Pollack MM, Carpenter TC, Notterman DA, Holubkov R, Dean JM, Nadkarni VM, Sutton RM; Eunice Kennedy Shriver National Institute of Child Health and Human Development Collaborative Pediatric Critical Care Research Network (CPCCRN) Pediatric Intensive Care Quality of Cardio-Pulmonary Resuscitation (PICqCPR) investigators. End-tidal carbon dioxide during pediatric in-hospital cardiopulmonary resuscitation. Resuscitation. 2018 Dec;133:173-179. doi: 10.1016/j.resuscitation.2018.08.013. Epub 2018 Aug 15. PMID: 30118812; PMCID: PMC6258346. Medline
III Supportive (Green) Prediction of recovery Process ICU Stine CN, Koch J, Brown LS, Chalak L, Kapadia V, Wyckoff MH. Quantitative end-tidal CO2 can predict increase in heart rate during infant cardiopulmonary resuscitation. Heliyon. 2019 Jun 12;5(6):e01871. doi: 10.1016/j.heliyon.2019.e01871. PMID: 31245640; PMCID: PMC6581839. Medline

HEMS
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Survival Patient Moors XRJ., Rijs K., Den HD, Stolker RJ. Pediatric out-of-hospital cardiopulmonary resuscitation by helicopter emergency medical service, does it has added value compared to regular emergency medical service? European journal of trauma and emergency surgery 2018; 44(3) 407-10. Medline

High Dose Epi.
Level Direction Primary Outcome Patient/Process Setting Reference
I Opposes (Red) 24-hour survival rate Patient ED-MD Perondi M., Reis A., Palva E., Nadkarni V., Berg R. A Comparison of High-Dose and Standard-Dose Epinephrine in Children with Cardiac Arrest. N Engl J Med 2004; 350:1722-30. Medline
II Supportive (Green) ROSC Process PH-Paramedic Goetting MG., Paradis NA. High-dose epinephrine improves outcome from pediatric cardiac arrest. Ann Emerg Med 1991; 20:22-6. Medline
II Neutral (Yellow) Return of spontaneous circulation Patient PH-Paramedic Dieckmann RA., Vardis R. High-dose epinephrine in pediatric out-of-hospital cardiopulmonary arrest. Pediatrics 1995; 95:901-13. Medline
III Neutral (Yellow) ROSC Patient PH-Paramedic Patterson MD., Boenning DA., Klein BL., et al. The use of high-dose epinephrine for patients with out-of-hospital cardiopulmonary arrest refractory to prehospital interventions. Pediatr Emerg Care 2005; 21(4):227-37. Medline
III Opposes (Red) ROSC Process ED-MD Carpenter T., Stenmark K. High-dose epinephrine is not superior to standard-dose epinephrine in pediatric in-hospital cardiopulmonary arrest. Pediatrics 1997; 99:403-8. Medline

IV access
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Survival Patient PH-Paramedic Recher M, Baert V, Escutnaire J, Le Bastard Q, Javaudin F, Hubert H, et al. Intraosseous or Peripheral IV Access in Pediatric Cardiac Arrest? Results From the French National Cardiac Arrest Registry. Pediatr Crit Care Med 2021; 22(3):286-96. Medline

Manual Intraosseous Insertion
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) First attempt success Patient Sunde G., Heradstveit B., Vikenes B., HeltneJ. Emergency intraosseous access in a helicopter emergency medical service: a retrospective study. Scan J Trauma, Resus and Emerg Med 2010; 18:52. Medline

Mechanical Intraosseous Insertion
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) First attempt success Patient Sunde G., Heradstveit B., Vikenes B., HeltneJ. Emergency intraosseous access in a helicopter emergency medical service: a retrospective study. Scan J Trauma, Resus and Emerg Med 2010; 18:52. Medline
II Neutral (Yellow) Survival Patient PH-Paramedic Recher M, Baert V, Escutnaire J, Le Bastard Q, Javaudin F, Hubert H, et al. Intraosseous or Peripheral IV Access in Pediatric Cardiac Arrest? Results From the French National Cardiac Arrest Registry. Pediatr Crit Care Med 2021; 22(3):286-96. Medline
III Supportive (Green) Overall placement success Process PH-Paramedic Schalk R., Schweigkofler U., Lotz G., Zacharowski K., Latasch L., Byhahn C. Efficacy of the EZ-IO needle driver for out-of-hospital intraosseous access--a preliminary, observational, multicenter study. Scand J Trauma Resusc Emerg Med 2011; 19:65-7241-19-65. Medline
X Not Yet Graded (White) - Besserer F, Kawano T, Dirk J, Meckler G, Tijssen JA, DeCaen A, et al. The association of intraosseous vascular access and survival among pediatric patients with out-of-hospital cardiac arrest. Resuscitation 2021; 167:49–57. Medline

NaHCO3
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Survival Patient PH-Paramedic Moler FW., Donaldson AE., Meert K., et al. Multicenter cohort study of out-of-hospital pediatric cardiac arrest. Crit Care Med 2011; 39(1):141-9. Medline

NaHCO3 in special cases
Level Direction Primary Outcome Patient/Process Setting Reference

NaHCO3-after long arrest
Level Direction Primary Outcome Patient/Process Setting Reference

One-handed CPR
Level Direction Primary Outcome Patient/Process Setting Reference
III Neutral (Yellow) Average Compression Depth Process Jung GH., Oh JH., Kim CW., Kim SE., Lee DH. Out-of-hospital cardiopulmonary resuscitation strategies using one-handed chest compression technique for children suffering a cardiac arrest. European Journal of Emergency Medicine 2017; 24(4):255-61. Medline

Passive Oxygen Administration
Level Direction Primary Outcome Patient/Process Setting Reference

Pre-Arrival Instructions
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Survival from pediatric OHCA with advisory assisted full CPR Process Other Goto Y, Funada A, Maeda T. Dispatcher-assisted conventional cardiopulmonary resuscitation and outcomes for paediatric out-of-hospital cardiac arrests. Resuscitation 2021. Medline
II Supportive (Green) Survival to discharge Patient Ro YS., Shin SD., Lee YJ., Lee SC., Song KJ., Ryoo HW., et al. Effect of Dispatcher-Assisted Cardiopulmonary Resuscitation Program and Location of Out-of-Hospital Cardiac Arrest on Survival and Neurologic Outcome. Ann Emerg Med 2017; 69(1):52-61.e1. Medline

Precordial Thump
Level Direction Primary Outcome Patient/Process Setting Reference

Standard CPR
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) ROSC Process PH-Paramedic Donoghue AJ, et al. Out-of-hospital pediatric cardiac arrest: an epidemiologic review and assessment of current knowledge. Ann Emerg Med 2005; 46:512-22. Medline
II Supportive (Green) 1-month favorable neurological status Patient Fukuda T., Ohashi-Fukuda N., Kobayashi H., Gunshin M., Sera T., Kondo Y., et al. Conventional Versus Compression-Only Versus No-Bystander Cardiopulmonary Resuscitation for Pediatric Out-of-Hospital Cardiac Arrest. Circulation 2016; 134(25):2060-70. Medline
II Supportive (Green) 30 day neurologically intact survival Patient Goto Y., Funada A., Goto Y. Conventional versus chest-compression-only cardiopulmonary resuscitation by bystanders for children with out-of-hospital cardiac arrest. Resuscitation 2018; 122:126-34. Medline
II Supportive (Green) Neurological function at 1 month Patient PH-Paramedic Kitamura T., Iwami T., Kawamura T., et al. Conventional and chest-compression-only cardiopulmonary resuscitation by bystanders for children who have out-of-hospital cardiac arrests: A prospective, nationwide, population-based cohort study. Lancet 2010; 375(9723):1347-54. Medline
II Supportive (Green) Detection factors related to ROSC Process PH-Paramedic Lin YR., Wu HP., Huang CY., Chang YJ., Lin CY., Chou CC. Significant factors in predicting sustained ROSC in paediatric patients with traumatic OOHCA admitted to ED. Resus 2007; 74:83-9. Medline
III Supportive (Green) Survival Patient PH-Paramedic Khoury A., Shavit I. OOH VF in 3 adolescents. Arch Dis Child 2009; 94:153-5. Medline
III Supportive (Green) Survival to discharge Patient PH-Paramedic Lienhart HG., John W., Wenzel V. Cardiopulmonary resuscitation of a near-drowned child with a combination of epinephrine and vasopressin. Pediatr Crit Care Med 2005;.6(4):486-488. Medline
III Supportive (Green) Survival to discharge Patient ED-MD Tham LP., Chan I.. Paediatric OOHCA epidemiology and outcome. Singapore Med 2007; 46:289-96. Medline

Termination Resuscitation
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) 30-day neurologically intact Patient Goto Y., Funada A., Goto Y. Duration of Prehospital Cardiopulmonary Resuscitation and Favorable Neurological Outcomes for Pediatric Out-of-Hospital Cardiac Arrests: A Nationwide, Population-Based Cohort Study. Circulation 2016;134(25):2046-59. Medline
III Supportive (Green) False prediction of death. Process Rotering VM., Trepels-Kottek S., Heimann K., Brokmann JC., Orlikowsky T., Schoberer M. Adult "termination-of-resuscitation" (TOR)-criteria may not be suitable for children - a retrospective analysis. Scand J Trauma Resusc Emerg Med 2016; 24(1):144. Medline
III Opposes (Red) Analgesic effect Patient In-Patient Hall WL., Myers JH., Pepe PE., Larkin GL., Sirbaugh PE., Persse DE. The perspective of paramedics about on-scene termination of resuscitation efforts for ped patients. Resus 2004; 60:175-87. Medline

Vasopressin
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Survival Patient PH-Paramedic Moler FW., Donaldson AE., Meert K., et al. Multicenter cohort study of out-of-hospital pediatric cardiac arrest. Crit Care Med 2011; 39(1):141-9. Medline
III Supportive (Green) Survival to Discharge Patient PH-Paramedic Lienhart HG., John W., Wenzel V. Cardiopulmonary resuscitation of a near-drowned child with a combination of epinephrine and vasopressin. Pediatr Crit Care Med 2005;.6(4):486-488. Medline
III Supportive (Green) ROSC Patient ED-MD Mann K., Berg RA., Nadkarni V. Beneficial effects of vasopressin in prolonged pediatric cardiac arrest: A case series. Resuscitation 2002; 52(2):149-56. Medline


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