Major changes from previous guideline:

No major changes to the clinical aspects of the guideline. Updating of review evidence, references, and terminology to increase consistency with GRADE terminology.

Major changes from previous guideline:

Anaphylaxis update to include initial and refractory management algorithms. Emphasis on advanced airway management when required.

Endorsement of Australasian Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and Australian and New Zealand Intensive Care Society (ANZICS) guidelines on cardiothoracic advanced life support (CALS-ANZ).

Hypothermia section included.

Tension pneumothorax included.

Trauma now covered by Guideline 11.10.1 Management of cardiac arrest due to trauma.

Major changes from previous guideline:

Amendment

If ingestion of a button battery is suspected in a person under the age of one:

·       Encourage a person under the age of one to swallow 10 mL (2 teaspoons) of jam every 10 minutes until they reach higher level of care. Do not use honey.

Major changes from previous guideline:

Major changes from previous guideline:

The main changes made in this latest update to the ANZCOR Guideline 12.4 include:

 Section 2.0:

• Updated Guidance: Added a new section on children with cardiac arrest due to hypovolaemia.
• Previous Guidance: Nil

 Section 4.0:

• Updated Guidance: Added a new section on children with cardiac arrest due to electrolyte or metabolic disorders.
• Previous Guidance: Some advice previously covered in 12.2

 Section 7.0:

• Updated Guidance: Added a new section on children with cardiac arrest due to pulmonary embolism.
• Previous Guidance: Nil

 Section 9.0:

• Updated Guidance: Added new guidance on management of children with LVADs.
• Previous Guidance: Nil

 Section 9.0:

• Updated Guidance: Added new ILCOR Good Practice Statement: In children who develop signs of pulmonary hypertensive crisis, low cardiac output, or right ventricular failure despite optimal medical therapy, extracorporeal membrane oxygenation (ECMO) may be considered before cardiac arrest or for refractory cardiac arrest as a bridge to recovery or as a bridge to the evaluation for organ replacement and transplantation in very select cases.
• Previous Guidance: Nil

Major changes from previous guideline:

The main changes made in this latest update to the ANZCOR Guideline 12.5 include:

Section: 1.0

• Updated Guidance: ANZCOR suggests that infants and children with ROSC who have been resuscitated after cardiorespiratory arrest should be admitted to a facility with the necessary resources for post cardiac arrest care.
• Previous Guidance: ANZCOR suggests that infants and children with ROSC who have been resuscitated after cardiorespiratory arrest should be admitted to a facility with the necessary resources for proper post-ROSC neuroprotective care, organ- and/or life supporting treatments, comprehensive neurological assessment and psychosocial support.

Section 2.0: 

• Updated Guidance: ANZCOR recommends that for infants and children after ROSC, a systolic or mean arterial blood pressure >10th percentile for age should be targeted.
• Previous Guidance: ANZCOR recommends that for infants and children after ROSC, parenteral fluids and/or inotropes or vasopressors should be used to maintain a systolic blood pressure of at least greater than the fifth percentile for age.

Section 3.0

• Updated Guidance: 

  ANZCOR suggests that rescuers measure partial pressure of arterial carbon dioxide (PaCO₂) after ROSC and target normocapnia. Consider adjustments to the target PaCO₂ for specific patient populations where normocapnia may not be desirable (e.g. chronic lung disease, congenital heart disease, increased intracranial pressure).

  ANZCOR suggests that rescuers measure partial pressure of arterial oxygen (PaO₂) after ROSC and target a value appropriate to the specific patient condition and suggest rescuers target normoxemia after ROSC.

  ANZCOR suggests that, to achieve normoxia, targeting an oxygen saturation of 94 to 99% may be a reasonable alternative to measuring PaO₂.

• Previous Guidance: 

  ANZCOR suggests that rescuers measure PaCO₂ after ROSC and target normocapnia. Consider adjustments to the target PaCO₂ for specific patient populations where normocapnia may not be desirable (e.g. chronic lung disease with chronic hypercapnia, congenital heart disease with single-ventricle physiology, increased intracranial pressure with impending herniation).

  ANZCOR suggests that rescuers measure PaO₂ after ROSC and target a value appropriate to the specific patient condition. In the absence of specific patient data, we suggest rescuers target normoxemia after ROSC. Given the availability of continuous pulse oximetry, targeting an oxygen saturation of 94% to 99% may be a reasonable alternative to measuring PaO₂ and titrating oxygen when feasible to achieve normoxia.

Section 6.0 

• Updated Guidance: ANZCOR suggests continuous electroencephalogram (EEG) monitoring should be considered post-arrest within the first 24 hours and the treatment of seizures is suggested for children post–cardiac arrest. Routine use of prophylactic anti-seizure medication is not advised.
• Previous Guidance: Nil

Section 7.0

• Updated Guidance: 

  ANZCOR recommends that no single test be used in isolation to predict good neurological outcome in children after cardiac arrest. Clinicians should use multiple tests in combination for good neurological outcome prediction.

  ANZCOR recommends that no single test be used in isolation to predict poor neurological outcome in children after cardiac arrest. Clinicians should use multiple tests in combination for poor neurological outcome.

• Previous Guidance: ANZCOR suggests that practitioners use multimodal tools to predict neurologic outcomes for infants and children after cardiac arrest.

Section 9.0

• Updated Guidance: ANZCOR suggests performing post-event debriefing after paediatric cardiac arrest in all settings.
• Previous Guidance: NZCOR suggests data-driven, performance-focused debriefing of rescuers after IHCA or OHCA in children.

Major changes from previous guideline:

The main changes made in this latest update to the ANZCOR Guideline 12.1 include:

Section 8.0 

• Updated Guidance: Addition of statement: ANZCOR suggest that external cardiac compression should be started while rescuers wait for a bag-mask ventilation (BMV) device to arrive. If a BMV device is immediately available, 2 initial ventilations should be provided before commencement of external cardiac compression. 
• Previous Guidance: Always suggested 2 rescue breaths.

Section 9.0

• Updated Guidance:

  Palpation of a pulse (or its absence) is not reliable as the sole determinant of cardiac arrest and need for chest compressions.

  ANZCOR suggest that, in infants and children who are unresponsive and breathing is absent (or agonal), healthcare providers should begin cardiopulmonary resuscitation (CPR

   
• Previous Guidance: ANZCOR suggest that in infants and children who are unresponsive and not breathing normally, healthcare providers should begin CPR unless they can definitely palpate a pulse within 10 seconds.

Section 9.2 

• Updated Guidance: 

  ANZCOR suggest that chest compression for an infant be performed with the two-thumb encircling technique as it results in consistently greater chest compression depth and less fatigue.

  Chest compression for an infant using the heel of one hand may be considered if the rescuer is unable to achieve optimal compression depth using the two-thumb encircling technique.

• Previous Guidance: Chest compression for an infant can be performed with two-thumb technique or two finger technique. The two-thumb technique is the strongly preferred technique for healthcare rescuers.

Section 10.0

• Updated Guidance: CPR providers using manual defibrillation in infants and children, should place pads in an anterior-posterior position.
• Previous Guidance: Nil 

Section 13.0

• Updated Guidance: Addition of section on management of Foreign Body Airway Obstruction (FBAO) in children.
• Previous Guidance: Refer to ANZCOR Guideline 4