Advance Pediatric

Resuscitation in
COVID-19

Irene Yuniar

UKK ERIA
TABLE OF CONTENTS

01 High Quality CPR

02 Advanced Pediatric Life Support

General Principles for Resuscitation in

03 Suspected and Confirmed COVID-19 Patients

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Case 1

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Resuscitation Room
5 y.o boy, 40 kg
WD/ Enchepalitis, suspect COVID-19
GCS 7, fever, HR < 60/min, Saturation 84% with NRM 15 LPM
Plan : CPR, intubation

Isolation Room (negative pressure) ; PPE level 3

- Intubation : bacterial filter, video laringoscope,
ETT with cuff, manually bagging
- CPR 15:2, evaluation every 2 min
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Case 2

5
PICU Kiara Ultimate
10 mo, 8 kg
WD/ Hypovolemic shock ec diarrhea
Confirmed COVID-19
HR< 60/min, desaturation
Plan : CPR, intubation

PPE level 3
- Intubation : bacterial filter, video laringoscope,
ETT with cuff, Mechanical Ventilation
- CPR 15:2, evaluation every 2 min 6
 Ventilator
Monitor

Airway Assitant

Airway
Doctor

Medical Team
Leader + Drugs

Runner

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INTRODUCTION
> 20 000 infants and children :
a cardiac arrest/year (USA)

In 2015, EMS–documented :
- OHCA : 7000 infants and children
Survived : 11.4%
- IHCA : 12.66 events per 1000

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Basic Life Support
Algorithm

Scene assessment
Initial apporoach
Basic Airway Management
Identifying Cardiac Arrest
CPR

HIGH QUALITY CPR

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10
 Basic Life Support
Algorithm

Advanced Airway
Defibrillation Management
No interruption > 10 seconds

Pediatric Advanced
Life Support

IV/IO Drugs
Cannulation Administration
Reversible Causes and timings
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 General Principles for
Resuscitation in Suspected
and Confirmed COVID-19
Patients

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Reduce provider exposure to COVID-19

1. All rescuers should don PPE
2. Limit personnel in the room
3. Consider replacing manual chest
compressions with mechanical CPR
devices
4. Clearly communicate COVID-19
status
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Hazard and Risk
Management
COVID-19 patients

Isolation room
Negative pressure
High Efficiency Particulate Air
Cubic meter hour

SOP
Zone
Work hour

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Prioritize oxygenation and ventilation
strategies with lower aerosolization risk
5.Attach a HEPA filter securely
6.After assess the rhythm and defibrillate any ventricular
arrhythmias — intubated with a cuffed tube
7.Minimize the likelihood of failed intubation attempts by
a) Assigning the provider and approach with the best
chance of first-pass success to intubate 

b) Pausing chest compressions to intubate
8.Video laryngoscopy may reduce intubator exposure to
aerosolized particles and should be considered, if
available.
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Prioritize oxygenation and ventilation
strategies with lower aerosolization risk

9. Use a bag-mask device with a HEPA

filter and a tight seal
10.If intubation is delayed, consider manual
ventilation with a supraglottic airway or
bag-mask device with a HEPA filter
11.Once on a closed circuit, minimize
disconnections to reduce aerosolization
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17
Consider the appropriateness of starting and
continuing resuscitation

12. Address goals of care with COVID-19 patients

13.Healthcare systems and EMS agencies : guide
front-line providers in determining the
appropriateness of starting and terminating CPR
for patients with COVID-19
14.There is insufficient data to support
extracorporeal cardiopulmonary resuscitation
(E- CPR) for COVID-19 patients.
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19
The components of
post–cardiac arrest
syndrome 1 2

brain injury myocardial dysfunction

systemic ischemia persistent

and reperfusion precipitating
3 4

response pathophysiology 20
Take Home Message Advanced Pediatric
Resuscitation:
Defibrillation
Advanced Airway Management
IV/IO canullation
Drug admnistration and timings
High-quality CPR
is the
foundation of
resuscitation

Reduced Providers
Exposure to
COVID-19

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 Consider the
Take Home Message appropriateness of
starting and
continuing
Prioritize resuscitation
oxygenation and
ventilation strategies
with lower
aerosolization risk

Resuscitation goal:
achieving the best
patient outcomes

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Special thanks to:
Tim DPJP ERIA FKUI RSCM
PPDS Sp1 dan Sp2 ERIA FKUI RSCM
Ns Erida dan Tim perawat ERIA
Bp. Ngadimun

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THANK YOU
Does anyone have any questions?

irene.tambunan@yahoo.co.id

irene yuniar

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