Session 10S6: Critical emergency medicine in children

Session 10S6: Critical emergency medicine in children

 

Sunday 3 June, 1400-1530H, Turquoise room

This three-part session will be opened by Dr Barney Scholefield, University Hospital Birmingham and University of Birmingham, UK, who will present the talk “The Tough Challenge: Cardiac Arrest in Children”.

“In 2018, too many infants and children have cardiac arrests and the survival and importantly neurodevelopmental outcome (when we know this outcome) remains poor,” says Dr Scholefield.  “I don’t want ANY child to have a cardiac arrest, but if they do, I want them to have the BEST possible outcome, AND for us to continually improve in the care we provide.”

His presentation will cover the current field of paediatric cardiac arrest research and how it is coming out of the shadows of adult focused research and the importance of focusing on QUALITY in both management of CPR and individualised care. Later, he will discuss the increased use and impact of extra-corporeal life support in resourced areas and the latest insight into cardiac arrest guidelines specifically for our most challenging population; infants and children with congenital heart disease.

Dr Scholefield concludes: “If we are to continually improve, we must identify good practice, evidenced based interventions and come together as a community to collect and learn from these infrequent, but potentially devastating events.”

The final part of the session, on how to anaesthetise a child in shock, will be presented by Professor Christoph Eich, Department of Anaesthesia, Paediatric Intensive Care and Emergency Medicine, Auf der Bult Children’s Hospital, Hannover, Germany.

“A short answer to the question ‘how to anaesthetise a child in shock’ could be: don’t anaesthetise a child in shock at all!” explains Professor Eich. “Shock means profound haemodynamic instability that is not suited to receiving an anaesthetic.  All anaesthetics aggravate haemodynamical instability by their negative impact on myocardial contractility, peripheral resistance, heart rate and preload.”

He will explain that, additionally, transient hypoxaemia during apnoea and intubation may occur and further worsen haemodynamic instability, through bradycardia and hypoxic myocardial depression. He says: “So if you really need to anaesthetise a child in shock based on a robust risk-benefit decision (for example for intubation and ventilation to prevent or treat respiratory and/or myocardial decompensation) you should carefully anticipate all negative haemodynamic and respiratory effects of your anaesthetics.”

Professor Eich will go through a number of  considerations that may provide some guidance: use of decreased doses of slowly titrated anaesthetics, avoidance of propofol , opioid- or (es)ketamine-based anaesthesia, use of muscle relaxants, avoidance of bradycardia, vasopressor (e.g. noradrenaline) and inotrope (e.g. adrenaline or dobutamine) stand-by or their proactive infusion, consideration of an arterial line before induction of anaesthesia, and finally avoidance of but preparation for cardiac arrest (including resuscitation manpower and skills, drugs, difficult airway equipment,  and defibrillator use).  He concludes: “The ultimate objective for a child in shock receiving anaesthesia should be a better cardiocirculatory and respiratory stability than before.”

The other talk in this session will be given by Dr Karl-Christian Thies, University Hospital Göttingen, Germany, who will present on damage control resuscitation in children.