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The American Heart Association’s cardiopulmonary resuscitation guidelines recommend against the routine administration of IV calcium during pediatric cardiopulmonary arrest; however, IV calcium is routinely used. Learn more in this discussion of “Calcium Administration During Cardiopulmonary Resuscitation for In-Hospital Cardiac Arrest in Children With Heart Disease is Associated With Worse Survival—A Report From the American Heart Association’s Get With the Guidelines-Resuscitation (GWTG-R) Registry."
Pediatric advanced life support (PALS) guidelines include weight-based epinephrine dosing recommendations of 0.01 mg/kg with a maximum of 1 mg, which corresponds to a weight of 100 kg. But what are the actual practice patterns? This podcast discusses the Pediatric Critical Care Medicine article “Weight-Based Versus Flat Dosing of Epinephrine During Cardiac Arrest in the PICU: A Multicenter Survey.”
Common causes of death in hospitals, such as sepsis and respiratory failure, are treatable and benefit from early intervention. Machine learning algorithms or early warning scores can be used for early identification and recognition to potentially help accelerate interventions and limit morbidity and mortality. This Concise Critical Appraisal explores an article published in Critical Care Medicine that looked at the impact of one of these early warning scores—electronic cardiac arrest risk triage (eCART)—on mortality for elevated-risk adult inpatients.
Sudden cardiac arrest remains a leading cause of premature death worldwide and survival with favorable neurologic function is less than 10%. Review a practical, attainable roadmap for enhancing the likelihood of neurologically intact survival in this podcast.
Although several trials have examined in-hospital cardiac arrest (IHCA), only two trials in the past decade have examined the use of vasopressin and glucocorticoids for IHCA. Both trials found improved survival and favorable neurologic outcome with a vasopressin-epinephrine-methylprednisolone combination. Because of a lack of additional supporting evidence, neither the American nor European international guidelines have recommended this combination for IHCA. This Concise Critical Appraisal examines an article by Andersen et al that attempted to validate the results of these trials.
The average annual incidence of pediatric in-hospital cardiac arrest (IHCA) has recently been estimated at more than 15,000 cases.1 Survival rates for pediatric patients who have had pulseless cardiac arrest have remained below 50% for the past decade.2,3 The American Heart Association currently recommends epinephrine, the cornerstone medication for cardiac arrest, dosed every 3 to 5 minutes in adult and pediatric cardiac arrest, although there is conflicting evidence about whether this is the best interval.4,5 Epinephrine is believed to acutely increase coronary perfusion pressure by increasing diastolic blood pressure (DBP).
The ARREST Trial compared extracorporeal membrane oxygenation (ECMO)-facilitated resuscitation to advanced cardiac life support (ACLS) treatment in patients with out-of-hospital cardiac arrest (OHCA). This month’s Concise Critical Appraisal takes a deep dive into the trial, published in The Lancet.
Lascarrou et al (N Engl J Med. 2019. Epub ahead of print) set out to test the effectiveness of moderate therapeutic hypothermia (MTH) in patients with nonshockable rhythms.
Moskowitz et al (Resuscitation. 2019. Epub ahead of print) set out to investigate the preventability of ICU-CAs and identify targets for future intervention.
Perkins et al (N Engl J Med. 2018;379:711-721) set out to examine the effects of epinephrine during OHCA.
Ruemmler et al (Resuscitation. 2018;132:56-62) set out to compare intermittent positive pressure ventilation to passive oxygenation (continuous positive airway pressure) and a novel ultra-low tidal volume ventilation (ULTVV) regimen.