Interim Singapore guidelines for basic and advanced life support for paediatric patients with suspected or confirmed COVID-19.

The COVID-19 pandemic has resulted in significant challenges for the resuscitation of paediatric patients, especially for infants and children who are suspected or confirmed to be infected. Thus, the paediatric subcommittee of the Singapore Resuscitation and First Aid Council developed interim modifications to the current Singapore paediatric guidelines using extrapolated data from the available literature, local multidisciplinary expert consensus and institutional best practices. It is hoped that this it will provide a framework during the pandemic for improved outcomes in paediatric cardiac arrest patients in the local context, while taking into consideration the safety of all community first responders, medical frontline providers and healthcare workers.

A unique case of acute brain haemorrhage with left ventricular systolic failure requiring ECMO.

Background: Acute left ventricular (LV) systolic failure as a consequence of acute severe brain injury with status epilepticus in a young infant is not common; managing such a patient on extracorporeal membrane oxygenation (ECMO), which requires proper anticoagulation adds further substrate to a particularly intriguing and novel case worthy of reporting. Takotsubo syndrome and its peculiar clinical presentation is not commonly reported in the paediatric population, yet the high likelihood of this diagnosis joining the dots up for this case invites our curiosity and reflection through the clinical management of this case.

Case Presentation: A previously healthy 9-month-old local Chinese boy presented with generalised seizures secondary to acute severe brain injury, with signs of sympathetic overdrive, followed by rapidly progressive cardiogenic shock and respiratory failure, eventually requiring ECMO support.