Critical Care Pediatrics - Stabilization of Child in the Emergency

Ashok Aralihond

FRCPCH, MRCPCH, MBBS, MSc (PEM)
Assistant Professor of Clinical Pediatrics 
Weill Cornell Medicine-Qatar

Pediatric emergency medicine continues to grow throughout the world. For general physicians, who manages both adult and children, pediatric patients, account for a smaller proportion of the daily workload, but, the anxiety is always associated with providing effective and safe quality care. Hence this group of population ensures a keen interest in updating skills and knowledge. The principles in managing children are the same as adults; however, there are notable differences in patterns of diseases and cardiopulmonary arrest. Besides, the modality of treatment available varies widely between paediatric and pediatrics clinical practice. For the last few decades have seen a significant improvement in research supporting guidelines for the management of paediatric emergencies and resuscitation of children.

While survival from critical illness in children has improved significantly in recent years, improvements in survival rates from cardiorespiratory arrest have been exceptional. Except in some part of the world, the survival from paediatric cardiac arrest continues to improve in many parts of the world, particularly for in-hospital events. Previous studies of paediatric cardiac arrest have reported reduced survival rates with severe neurological sequelae compared with adults. Therefore, the emphasis of resuscitation training is on early recognition and treatment of the critically ill child before respiratory or cardiac arrest occurs. The resuscitation organizations have developed guidelines, and current recommendations are to simplify the resuscitation approach.

The American Heart Association (AHA) in association with several other major medical organizations has reported interim guidance on advanced life support for children with suspected or confirmed COVID-19. There is an ongoing emphasis on the quality of care provided to children with cardiopulmonary arrest from arrival to hospital and discharge to home.

References

1. American Heart Association. Web-based Integrated Guidelines for Cardiopulmonary and Emergency Cardiovascular Care - Part 12. Pediatric advanced life support.https://eccguidelines.heart.org/index.php/circulation/cpr-ecc-guidelines-2/part-12-pediatric-advanced-life-support.

2. Characterization of Pediatric In-Hospital Cardiopulmonary Resuscitation Quality Metrics Across an International Resuscitation Collaborative. Pediatric critical care medicine: a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies. 2018;19(5):421–32