[Paediatric Life Support]. / Lebensrettende Maßnahmen bei Kindern (Paediatric Life Support, PLS): Leitlinien des European Resuscitation Council 2021.

The European Resuscitation Council (ERC) Paediatric Life Support (PLS) guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR). This section provides guidelines on the management of critically ill or injured infants, children and adolescents before, during and after respiratory/cardiac arrest.

European Resuscitation Council Guidelines 2021: Paediatric Life Support.

These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.

[Current international recommendations for pediatric cardiopulmonary resuscitation: the European guidelines]. / Actualización de las recomendaciones internacionales de reanimación cardiopulmonar pediátrica (RCP): recomendaciones europeas de RCP pediátrica.

OBJECTIVES: This summary of the European guidelines for pediatric cardiopulmonary resuscitation (CPR) emphasizes the main changes and encourages health care professionals to keep their pediatric CPR knowledge and skills up to date. Basic and advanced pediatric CPR follow the same algorithm in the 2015 guidelines. The main changes affect the prevention of cardiac arrest and the use of fluids. Fluid expansion should not be used routinely in children with fever in the abuse of signs of shock because too high a volume can worsen prognosis. Rescue breaths should last around 1 second in basic CPR, making pediatric recommendations consistent with those for adults. Chest compressions should be at least as deep as one-third the anteroposterior diameter of the thorax. Most children in cardiac arrest lack a shockable rhythm, and in such cases a coordinated sequence of breaths, chest compressions, and administration of adrenalin is essential. An intraosseous canula may be the first choice for introducing fluids and medications, especially in young infants. In treating supraventricular tachycardia with cardioversion, an initial dose of 1 J/kg is currently recommended (vs the dose of 0.5 J/kg previously recommended). After spontaneous circulation is recovered, measures to control fever should be taken. The goal is to reach a normal temperature even before arrival to the hospital.

OBJETIVO: Este artículo resume las recomendaciones europeas de reanimación cardiopulmonar (RCP) pediátricas, destacando los principales cambios e intenta animar a los profesionales a actualizar y mantener sus conocimientos y habilidades en RCP pediátrica. Las recomendaciones europeas del año 2015 mantienen el mismo algoritmo de actuación en la RCP básica y avanzada pediátrica. Los cambios más significativos son: en la prevención de la parada cardiaca (PC), los niños con enfermedad febril sin signos de shock no deben recibir de forma rutinaria expansiones de fluidos porque un volumen excesivo puede empeorar el pronóstico. En la RCP básica se recomienda que la administración de la respiración dure alrededor de 1 segundo, para unificar las recomendaciones con las del adulto. En las compresiones torácicas el esternón debe deprimirse por lo menos un tercio del diámetro torácico anteroposterior. En el niño, la mayoría de las PC tienen ritmos no desfibrilables y en ellos la secuencia coordinada de ventilación y compresiones torácicas y administración de adrenalina es el tratamiento esencial. La vía intraósea, sobre todo en los lactantes, puede ser el acceso vascular de primera elección. En el tratamiento de la taquicardia supraventricular, cuando se realice cardioversión como tratamiento, se recomienda utilizar una dosis inicial de 1 J/kg (antes se recomendaba 0,5 J/kg). En los cuidados postresucitación tras la recuperación de la circulación espontánea, se deben tomar medidas para evitar la fiebre, teniendo como objetivo conseguir la normotermia ya desde el ámbito extrahospitalario.

[The latest in paediatric resuscitation recommendations]. / Novedades en las recomendaciones de reanimación cardiopulmonar pediátrica.

Cardiac arrest has a high mortality in children. To improve the performance of cardiopulmonary resuscitation, it is essential to disseminate the international recommendations and the training of health professionals and the general population in resuscitation. This article summarises the 2015 European Paediatric Cardiopulmonary Resuscitation recommendations, which are based on a review of the advances in cardiopulmonary resuscitation and consensus in the science and treatment by the International Council on Resuscitation. The Spanish Paediatric Cardiopulmonary Resuscitation recommendations, developed by the Spanish Group of Paediatric and Neonatal Resuscitation, are an adaptation of the European recommendations, and will be used for training health professionals and the general population in resuscitation. This article highlights the main changes from the previous 2010 recommendations on prevention of cardiac arrest, the diagnosis of cardiac arrest, basic life support, advanced life support and post-resuscitation care, as well as reviewing the algorithms of treatment of basic life support, obstruction of the airway and advanced life support.

[Aetiology and outcomes of potentially serious infections in febrile infants less than 3 months old]. / Etiología y evolución de las infecciones potencialmente graves en lactantes menores de 3 meses febriles.

BACKGROUND: Recent studies have shown changes in the aetiology of serious bacterial infections in febrile infants ≤ 90 days of age. The aim of this study was to describe the current microbiology and outcomes of these infections in Spain. MATERIAL AND METHODS: Sub-analysis of a prospective multicentre study focusing on febrile infants of less than 91 days of life, admitted between October 2011 and September 2013 to Emergency Departments of 19 Spanish hospitals, members of the Spanish Paediatric Emergency Research Group of the Spanish Society of Paediatric Emergencies (RISeuP/SPERG). RESULTS: The analysis included 3,401 febrile infants ≤90 days of age with fever without source. There were 896 positive cultures: 766 urine (85.5%), 100 blood (11.2%), 18 cerebrospinal fluid (2%), 10 stool, and 2 umbilical cultures. Among the 3,401 infants included, 784 (23%) were diagnosed with a serious bacterial infection, and 107 of them (3.1%) with an invasive infection. E. coli was the most common pathogen isolated from urine (628; 82%), blood (46; 46%), and cerebrospinal fluid cultures (7; 38.9%), followed by S. agalactiae that was isolated from 24 (24%) blood cultures and 3 (16.7%) cerebrospinal fluid cultures. There were only 2 L. monocytogenes infections. Four children died, and seven had severe complications. CONCLUSIONS: Among infants ≤ 90 days of age with fever without source, E. coli was the most common pathogen isolated from urine, blood, and cerebrospinal fluid cultures.

Lipid peroxidation, occupational stress and aging in workers of a prehospital emergency service.

BACKGROUND: Stressful conditions lead to formation of excessive free radicals, and lipid peroxidation is one of the major outcomes of free radical-mediated injury that directly damages membranes and generates a number of secondary products. OBJECTIVES: To determine the levels of malondialdehyde, an end product of lipid peroxidation, according to demographic and occupational variables in workers of a prehospital emergency service and to analyse the relationship between malondialdehyde levels and burnout. MATERIAL AND METHODS: One hundred and eleven healthy workers of a prehospital emergency service and eighty aged-matched healthy individuals of both sexes as a control group were surveyed. Malondialdehyde levels were measured by the Bull and Marnett method. To measure burnout, the Maslach Burnout Inventory was used. RESULTS: Professional category is associated with lipid peroxidation and burnout levels (Malondialdehyde levels were: physicians 338.10+/-14.47, nurses 329.17+/-12.62 and technicians 296.74+/-14.28; burnout levels were: physicians 41.29+/-3.59, nurses 37.38+/-6.05 and technicians 35.33+/-5.87). Working at night and in the evening increased malondialdehyde and burnout levels. Malondialdehyde levels increase with age. No significant variations with respect to sex were detected. Significant variations in malondialdehyde levels were detected between singles (303.13+/-12.74) and married people (344.43+/-13.43) but not with respect to divorcees (326.44+/-11.74). Significant differences were detected in erythrocyte malondialdehyde levels between smokers (341.37+/-17.09) and nonsmokers (302.21+/-12.38), but not for alcohol consumption. CONCLUSIONS: These findings suggest a positive correlation between malondialdehyde, a biomarker of lipid peroxidation and occupational stress, as estimated by elements of the Maslach Burnout Inventory, and oxidative stress.

Magnesium metabolism after cardiac surgery in children.

OBJECTIVE: To analyze magnesium metabolism in children after cardiac surgery. DESIGN: Prospective observational study. SETTING: Pediatric intensive care unit (PICU) of a university hospital. PATIENTS: A total of 42 children in the perioperative period of cardiac surgery. MEASUREMENTS AND MAIN RESULTS: Determinations of serum magnesium (MgS), ultrafiltrable magnesium (MgU), intraerythrocytic magnesium, urinary magnesium, blood and urinary calcium, phosphorus, sodium, and blood and urinary creatinine were made in the operating room before surgery, at admission to the PICU, at 24 hrs, and at 3 and 5 days after surgery. The relationship with age, sex, diagnosis, type of surgery, arrhythmias, complications, length of stay in the PICU, and mortality was analyzed. MgS and MgU levels decreased after cardiac surgery (MgS before surgery, 0.74 +/- 0.09 mmol/L; MgS at admission to the PICU, 0.66 +/- 0.11 mmol/L; MgU before surgery, 0.56 +/- 0.06 mmol/L; MgU at admission to the PICU, 0.50 +/- 0.07 mmol/L; p <.0001 for both values). At admission to the PICU, 61.5% of the patients had MgS of <0.63 mmol/L, and 47.2% of the patients had an MgU of <0.46 mmol/L. MgS and MgU had increased by 24 hrs and showed further increases over the first 5 days after surgery. There were no significant changes in the intraerythrocytic magnesium levels in the postoperative period. Changes of MgS and MgU were greater after extracorporeal circulation than after closed surgery (p <.001). There was no correlation between MgS, MgU, or intraerythrocytic magnesium and other analytic and clinical parameters. No patient presented arrhythmias and none died. CONCLUSIONS: After cardiac surgery, and particularly after extracorporeal circulation surgery, children present with low MgS and MgU levels at admission to the PICU. MgS and MgU levels increase over the first 5 days after cardiac surgery. No relationship was found between magnesium levels and the postoperative course.