October SNACK: 2020 PALS Update

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No me gusta!

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James P. -

I have always been confused about what to do without advanced airway in place. It seems that at least prehospital it makes no difference having an advanced airway so does that mean that we do not need to prioritize it when they’re in the emergency department and focus on other things like high-quality CPR? Also, are we doing 15 compressions with two breaths the entire time until we get that advanced airway? It seems like when we have the entire crew we always revert back to continuous compressions and asynchronous bag masking to maintain perfusion. Thanks for the update!

Jason Woods -

Thanks for the comment James!

As far as the PALS algorithm goes in the ED, continuous compressions is only recommended once an advanced airway is in place. At my shop we do not change to continuous until an advanced airway is in place. This has been the PALS recommendation previously as well.

The general paradigm regarding advanced airways is that unless the airway is the primary cause of arrest (which is rare in kids), placement of advanced airways should not interfere with compressions. However, given the ease of placement and effectiveness of supraglottic airways, these are usually the preferred method of quickly establishing an advanced airway and would get you to continuous compressions quickly. I usually teach that rarely is an ETT the thing that saves pediatric patients in arrest, so strongly prefer supraglottic airway placement as soon as I have someone free to do it.

I'm not aware of much comparative research in kids, but there was a study published this year looking at this exact issue in adults.

I hope that helps!
- Jason Woods

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EM:RAP 2021 October SNACK: 2020 PALS Update Full episode audio for MD edition 22:20 min - 25 MB - M4A