Advanced pediatric life support: state of the art.

Cardiopulmonary resuscitation in children is not well studied; many of the current recommendations for advanced pediatric life support (APLS) are based on anecdotal experience rather than scientific study. The following are unique issues in APLS requiring a consensus decision: What are the best methods of vascular access and of drug delivery and dosages? What constitutes minimal paramedic training and equipment? There are also many shared controversies between APLS and ACLS, including the use of calcium, epinephrine vs isoproterenol, methoxamine, and bicarbonate. This article presents the scientific basis for these controversial issues and highlights areas where information is lacking. A discussion of these questions generated a consensus on some issues and hopefully will stimulate further study to answer the questions that were raised.