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Gausche-Hill M, Kerrey BT. Challenges in the Design of Pediatric Out-of-Hospital Cardiac Arrest Trials. Ann Emerg Med 2024; 83:196-197. [PMID: 38180401 DOI: 10.1016/j.annemergmed.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 12/01/2023] [Accepted: 12/04/2023] [Indexed: 01/06/2024]
Affiliation(s)
- Marianne Gausche-Hill
- David Geffen School of Medicine at University of California, Los Angeles, CA; Harbor-UCLA Medical Center, CA; Lundquist Institute at Harbor-UCLA, Torrance, CA.
| | - Benjamin T Kerrey
- College of Medicine, the University of Cincinnati, Cincinnati, OH; Division of Emergency Medicine and Center for Simulation and Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Kiyohara K, Matsui S, Ayusawa M, Sudo T, Nitta M, Iwami T, Nakata K, Kitamura Y, Sobue T, Kitamura T. Basic life support for non-traumatic out-of-hospital cardiac arrests during school-supervised sports activities in children: A nationwide observational study in Japan. Resusc Plus 2024; 17:100531. [PMID: 38155977 PMCID: PMC10753082 DOI: 10.1016/j.resplu.2023.100531] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 11/16/2023] [Accepted: 12/03/2023] [Indexed: 12/30/2023] Open
Abstract
Objective To investigate the prognostic impact of bystander-initiated cardiopulmonary resuscitation (CPR) and public-access automated external defibrillator (AED) use on non-traumatic out-of-hospital cardiac arrest (OHCA) occurring during school-supervised sports activities in children. Methods From a nationwide database of pediatric OHCAs occurring under school supervision in Japan, data between April 2008 and December 2020 were obtained. We analyzed non-traumatic OHCAs that occurred during school-supervised sports activities among schoolchildren from elementary, junior high, high, and technical colleges. A multivariable logistic regression model was used to evaluate the effect of basic life support (BLS) on 1-month survival with favorable neurological outcomes after OHCA. Results In total, 318 OHCA cases were analyzed. The 1-month survival with favorable neurological outcomes was 64.8% (164/253) in cases receiving both bystander-CPR and AED application, 40.7% (11/27) in cases receiving CPR only, 38.5% (5/13) in patients receiving AED application only, and 28.0% (7/25) in cases receiving no bystander intervention. Compared with cases receiving no BLS, cases receiving both CPR and AED had a significantly higher proportion of 1-month survival with favorable neurological outcomes (adjusted odds ratio [AOR]: 3.97, 95% confidence interval [CI]: 1.32-11.90, p = 0.014). However, compared to cases receiving no BLS, there was no significant difference in the outcome in the cases receiving CPR only (AOR: 1.35, 95% CI: 0.34-5.29, p = 0.671) and the cases receiving AED application only (AOR: 1.26, 95% CI: 0.25-6.38, p = 0.778). Conclusion The combination of CPR and AED as BLS performed by bystanders for non-traumatic OHCA during school-supervised sports activities improved the outcomes.
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Affiliation(s)
- Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women’s University, Tokyo, Japan
| | - Satoshi Matsui
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Mamoru Ayusawa
- Department of Nutrition and Health Science, Faculty of Health and Medical Science, Kanagawa Institute of Technology, Atsugi, Japan
| | - Takeichiro Sudo
- Institute of Human Culture Studies, Otsuma Women’s University, Tokyo, Japan
| | - Masahiko Nitta
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Osaka, Japan
- Division of Patient Safety, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
| | - Taku Iwami
- Kyoto University Health Service, Kyoto, Japan
| | - Ken Nakata
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yuri Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
| | - the SPIRITS investigators
- Department of Food Science, Faculty of Home Economics, Otsuma Women’s University, Tokyo, Japan
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, Suita, Japan
- Department of Nutrition and Health Science, Faculty of Health and Medical Science, Kanagawa Institute of Technology, Atsugi, Japan
- Institute of Human Culture Studies, Otsuma Women’s University, Tokyo, Japan
- Department of Emergency Medicine, Osaka Medical and Pharmaceutical University, Osaka, Japan
- Department of Pediatrics, Osaka Medical and Pharmaceutical University, Osaka, Japan
- Division of Patient Safety, Osaka Medical and Pharmaceutical University Hospital, Osaka, Japan
- Kyoto University Health Service, Kyoto, Japan
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, Suita, Japan
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3
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Amagasa S, Iwamoto S, Kashiura M, Yasuda H, Kishihara Y, Uematsu S. Early Versus Late Advanced Airway Management for Pediatric Patients With Out-of-Hospital Cardiac Arrest. Ann Emerg Med 2024; 83:185-195. [PMID: 37999654 DOI: 10.1016/j.annemergmed.2023.09.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 11/25/2023]
Abstract
STUDY OBJECTIVE To determine the association between early versus late advanced airway management and improved outcomes in pediatric out-of-hospital cardiac arrest. METHODS We performed a retrospective cohort study using data from the out-of-hospital cardiac arrest registry in Japan. We included pediatric patients (<18 years) with out-of-hospital cardiac arrest who had received advanced airway management (tracheal intubation, supraglottic airway, and esophageal obturator). The main exposure was early (≤20 minutes) versus late (>20 minutes) advanced airway management. The primary and secondary outcome measurements were survival and favorable neurologic outcomes at 1 month, respectively. To address resuscitation time bias, we performed risk-set matching analyses using time-dependent propensity scores. RESULTS Out of the 864 pediatric patients with both out-of-hospital cardiac arrest and advanced airway management over 67 months (2014 to 2019), we included 667 patients with adequate data (77%). Of these 667 patients, advanced airway management was early for 354 (53%) and late for 313 (47%) patients. In the risk-set matching analysis, the risk of both survival (risk ratio 0.98 for early versus late [95% confidence interval 0.95 to 1.02]) and favorable 1-month neurologic outcomes (risk ratio 0.99 [95% confidence interval 0.97 to 1.00]) was similar between early and late advanced airway management groups. In sensitivity analyses, with time to early advanced airway management defined as ≤10 minutes and ≤30 minutes, both outcomes were again similar. CONCLUSION In pediatric out-of-hospital cardiac arrest, the timing of advanced airway management may not affect patient outcomes, but randomized controlled trials are needed to address this question further.
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Affiliation(s)
- Shunsuke Amagasa
- Department of Emergency and Transport Medicine, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan.
| | - Shintaro Iwamoto
- Department of Data Science, Clinical Research Center, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
| | - Masahiro Kashiura
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Saitama, Japan
| | - Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Saitama, Japan
| | - Yuki Kishihara
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama City, Saitama, Japan
| | - Satoko Uematsu
- Department of Emergency and Transport Medicine, National Center for Child Health and Development, Setagaya-ku, Tokyo, Japan
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4
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Albrecht M, de Jonge RCJ, Dulfer K, Van Gils-Frijters APJM, de Hoog M, Hunfeld M, Kammeraad JAE, Moors XRJ, Nadkarni VM, Buysse CMP. Trends in community response and long-term outcomes from pediatric cardiac arrest: A retrospective observational study. Resuscitation 2024; 194:110045. [PMID: 37952576 DOI: 10.1016/j.resuscitation.2023.110045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/07/2023] [Accepted: 11/07/2023] [Indexed: 11/14/2023]
Abstract
AIM This study aimed to investigate trends over time in pre-hospital factors for pediatric out-of-hospital cardiac arrest (pOHCA) and long-term neurological and neuropsychological outcomes. These have not been described before in large populations. METHODS Non-traumatic arrest patients, 1 day-17 years old, presented to the Sophia Children's Hospital from January 2002 to December 2020, were eligible for inclusion. Favorable neurological outcome was defined as Pediatric Cerebral Performance Categories (PCPC) 1-2 or no difference with pre-arrest baseline. The trend over time was tested with multivariable logistic and linear regression models with year of event as independent variable. FINDINGS Over a nineteen-year study period, the annual rate of long-term favorable neurological outcome, assessed at a median 2.5 years follow-up, increased significantly (OR 1.10, 95%-CI 1.03-1.19), adjusted for confounders. Concurrently, annual automated external defibrillator (AED) use and, among adolescents, initial shockable rhythm increased significantly (OR 1.21, 95% CI 1.10-1.33 and OR 1.15, 95% CI 1.02-1.29, respectively), adjusted for confounders. For generalizability purposes, only the total intelligence quotient (IQ) was considered for trend analysis of all tested domains. Total IQ scores and bystander basic life support (BLS) rate did not change significantly over time. INTERPRETATION Long-term favorable neurological outcome, assessed at a median 2.5 years follow-up, improved significantly over the study period. Total IQ scores did not significantly change over time. Furthermore, AED use (OR 1.21, 95%CI 1.10-1.33) and shockable rhythms among adolescents (OR1.15, 95%CI 1.02-1.29) increased over time.
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Affiliation(s)
- M Albrecht
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - R C J de Jonge
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - K Dulfer
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - A P J M Van Gils-Frijters
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - M de Hoog
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - M Hunfeld
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands; Department of Pediatric Neurology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - J A E Kammeraad
- Department of Pediatric Cardiology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - X R J Moors
- Department of Pediatric Anesthesiology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands; Helicopter Emergency Medical Services, Erasmus MC, Rotterdam, the Netherlands
| | - V M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA., United States
| | - C M P Buysse
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands.
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Bakker AM, Albrecht M, Verkaik BJ, de Jonge RCJ, Buysse CMP, Blom NA, Rammeloo LAJ, Verhagen JMA, Riedijk MA, Yap SC, Tan HL, Kammeraad JAE. Sudden cardiac arrest in infants and children: proposal for a diagnostic workup to identify the etiology. An 18-year multicenter evaluation in the Netherlands. Eur J Pediatr 2024; 183:335-344. [PMID: 37889292 PMCID: PMC10858117 DOI: 10.1007/s00431-023-05301-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/17/2023] [Accepted: 10/21/2023] [Indexed: 10/28/2023]
Abstract
Sudden cardiac arrest (SCA) studies are often population-based, limited to sudden cardiac death, and excluding infants. To guide prevention opportunities, it is essential to be informed of pediatric SCA etiologies. Unfortunately, etiologies frequently remain unresolved. The objectives of this study were to determine paediatric SCA etiology, and to evaluate the extent of post-SCA investigations and to assess the performance of previous cardiac evaluation in detecting conditions predisposing to SCA. In a retrospective cohort (2002-2019), all children 0-18 years with out-of-hospital cardiac arrest (OHCA) referred to Erasmus MC Sophia Children's Hospital or the Amsterdam UMC (tertiary-care university hospitals), with cardiac or unresolved etiologies were eligible for inclusion. SCA etiologies, cardiac and family history and etiologic investigations in unresolved cases were assessed. The etiology of arrest could be determined in 52% of 172 cases. Predominant etiologies in children ≥ 1 year (n = 99) were primary arrhythmogenic disorders (34%), cardiomyopathies (22%) and unresolved (32%). Events in children < 1 year (n = 73) were largely unresolved (70%) or caused by cardiomyopathy (8%), congenital heart anomaly (8%) or myocarditis (7%). Of 83 children with unresolved etiology a family history was performed in 51%, an autopsy in 51% and genetic testing in 15%. Pre-existing cardiac conditions presumably causative for SCA were diagnosed in 9%, and remained unrecognized despite prior evaluation in 13%. CONCLUSION SCA etiology remained unresolved in 83 of 172 cases (48%) and essential diagnostic investigations were often not performed. Over one-fifth of SCA patients underwent prior cardiac evaluation, which did not lead to recognition of a cardiac condition predisposing to SCA in all of them. The diagnostic post-SCA approach should be improved and the proposed standardized pediatric post-SCA diagnostics protocol may ensure a consistent and systematic evaluation process increasing the diagnostic yield. WHAT IS KNOWN • Arrests in infants remain unresolved in most cases. In children > 1 year, predominant etiologies are primary arrhythmia disorders, cardiomyopathy and myocarditis. • Studies investigating sudden cardiac arrest are often limited to sudden cardiac death (SCD) in 1 to 40 year old persons, excluding infants and successfully resuscitated children. WHAT IS NEW • In patients with unresolved SCA events, the diagnostic work up was often incompletely performed. • Over one fifth of victims had prior cardiac evaluation before the arrest, with either a diagnosed cardiac condition (9%) or an unrecognized cardiac condition (13%).
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Affiliation(s)
- Ashley M Bakker
- Department of Pediatric Cardiology, Erasmus MC Sophia Children's Hospital, Postbus 2060, 3000 CB, Rotterdam, The Netherlands
| | - Marijn Albrecht
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Bas J Verkaik
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Rogier C J de Jonge
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Corinne M P Buysse
- Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nico A Blom
- The Center for Congenital Heart Disease Amsterdam-Leiden, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Lukas A J Rammeloo
- The Center for Congenital Heart Disease Amsterdam-Leiden, Amsterdam, The Netherlands
- Department of Pediatric Cardiology, Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Judith M A Verhagen
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maaike A Riedijk
- Department of Pediatric Intensive Care, Emma Children's Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Sing C Yap
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
| | - Hanno L Tan
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Janneke A E Kammeraad
- Department of Pediatric Cardiology, Erasmus MC Sophia Children's Hospital, Postbus 2060, 3000 CB, Rotterdam, The Netherlands.
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Burns KM. Pediatric out-of-hospital cardiac arrest: Robust dataset shows sobering reality but provides clues to improvement. Heart Rhythm 2023; 20:1532-1533. [PMID: 37597600 DOI: 10.1016/j.hrthm.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 08/15/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Kristin M Burns
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland; Children's National Hospital, Washington, DC.
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Gupte D, Assaf M, Miller MR, McKenzie K, Loosley J, Tijssen JA. Evaluation of hospital management of paediatric out-of-hospital cardiac arrest. Resusc Plus 2023; 15:100433. [PMID: 37555196 PMCID: PMC10405089 DOI: 10.1016/j.resplu.2023.100433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/22/2023] [Accepted: 07/11/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Pediatric out of hospital cardiac arrest (POHCA) is rare, with high mortality and neurological morbidity. Adherence to Pediatric Advanced Life Support guidelines standardizes in-hospital care and improves outcomes. We hypothesized that in-hospital care of POHCA patients was variable and deviations from guidelines were associated with higher mortality. METHODS POHCA patients in the London-Middlesex region between January 2012 and June 2020 were included. The care of children with ongoing arrest (intra-arrest) and post-arrest outcomes were reviewed using the Children's Hospital, London Health Sciences Centre (LHSC) patient database and the Adverse Event Management System. RESULTS 50 POHCA patients arrived to hospital, with 15 (30%) patients admitted and 2 (4.0%) surviving to discharge, both with poor neurological outcomes and no improvement at 90 days. Deviations occurred at every event with intra-arrest care deviations occurring mostly in medication delivery and defibrillation (98%). Post-arrest deviations occurred mostly in temperature monitoring (60%). Data missingness was 15.9% in the intra-arrest and 1.7% in the post-arrest group. DISCUSSION Deviations commonly occurred in both in-hospital arrest and post-arrest care. The study was under-powered to identify associations between DEVs and outcomes. Future work includes addressing specific deviations in intra-arrest and post-arrest care of POHCA patients and standardizing electronic documentation.
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Affiliation(s)
- Dhruv Gupte
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - Maysaa Assaf
- Department of Paediatrics, London Health Sciences Centre, 800 Commissioners Rd. E., London, ON N6A 5W9, Canada
| | - Michael R. Miller
- Department of Paediatrics, London Health Sciences Centre, 800 Commissioners Rd. E., London, ON N6A 5W9, Canada
- Children’s Health Research Institute, 800 Commissioners Rd. E., London, ON N6C 2V5, Canada
| | - Kate McKenzie
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
| | - Jay Loosley
- Middlesex-London Paramedic Service, 1035 Adelaide St. S., London, ON N6E 1R4, Canada
| | - Janice A. Tijssen
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON N6A 5C1, Canada
- Department of Paediatrics, London Health Sciences Centre, 800 Commissioners Rd. E., London, ON N6A 5W9, Canada
- Children’s Health Research Institute, 800 Commissioners Rd. E., London, ON N6C 2V5, Canada
- Lawson Health Research Institute, 750 Base Line Rd. E., London, ON N6C 2R5, Canada
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Amagasa S, Utsumi S, Moriwaki T, Yasuda H, Kashiura M, Uematsu S, Kubota M. Advanced airway management for pediatric out-of-hospital cardiac arrest: A systematic review and network meta-analysis. Am J Emerg Med 2023; 68:161-169. [PMID: 37027937 DOI: 10.1016/j.ajem.2023.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES Although airway management is important in pediatric resuscitation, the effectiveness of bag-mask ventilation (BMV) and advanced airway management (AAM), such as endotracheal intubation (ETI) and supraglottic airway (SGA) devices, for prehospital resuscitation of pediatric out-of-hospital cardiac arrest (OHCA) remains unclear. We aimed to determine the efficacy of AAM during prehospital resuscitation of pediatric OHCA cases. METHODS We searched four databases from their inception to November 2022 and included randomized controlled trials and observational studies with appropriate adjustments for confounders that evaluated prehospital AAM for OHCA in children aged <18 years in quantitative synthesis. We compared three interventions (BMV, ETI, and SGA) via network meta-analysis using the GRADE Working Group approach. The outcome measures were survival and favorable neurological outcomes at hospital discharge or 1 month after cardiac arrest. RESULTS Five studies (including one clinical trial and four cohort studies with rigorous confounding adjustment) involving 4852 patients were analyzed in our quantitative synthesis. Compared with ETI, BMV was associated with survival (relative risk [RR] 0.44 [95% confidence intervals (CI) 0.25-0.77]) (very low certainty). There were no significant association with survival in the other comparisons (SGA vs. BMV: RR 0.62 [95% CI 0.33-1.15] [low certainty], ETI vs. SGA: RR 0.71 [95% CI 0.39-1.32] [very low certainty]). There was no significant association with favorable neurological outcomes in any comparison (ETI vs. BMV: RR 0.33 [95% CI 0.11-1.02]; SGA vs. BMV: RR 0.50 [95% CI 0.14-1.80]; ETI vs. SGA: RR 0.66 [95% CI 0.18-2.46]) (all very low certainty). In the ranking analysis, the hierarches for efficacy for survival and favorable neurological outcome were BMV > SGA > ETI. CONCLUSION Although the available evidence is from observational studies and its certainty is low to very low, prehospital AAM for pediatric OHCA did not improve outcomes.
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Global burden of out-of-hospital cardiac arrest in children: a systematic review, meta-analysis, and meta-regression. Pediatr Res 2023:10.1038/s41390-022-02462-5. [PMID: 36646884 DOI: 10.1038/s41390-022-02462-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 11/18/2022] [Accepted: 12/15/2022] [Indexed: 01/18/2023]
Abstract
The incidence of out-of-hospital cardiac arrest (OHCA) and its mortality among children decreased globally over the years. However, the incidence, mortality, and its determinants are heterogeneous globally. The current study was designed to investigate the incidence of OHCA, mortality, and its determinants based on a systematic review of published literature. A comprehensive search was conducted in PubMed/Medline; Science Direct, Cochrane Library, Hinari, and LILACS without language and date restrictions. The data were extracted with two independent authors in a customized format. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa appraisal tool. A total of 2526 articles were identified from different databases with an initial search. Forty-eight articles with 138.3 million participants were included in the systematic review. The meta-analysis showed that the pooled rate of mortality was found to be 70% (95% CI: 57-81%, 42 studies, 28,345 participants). The incidence of OHCA and mortality among children was very high among children with significant regional disparity. Those children with cardiovascular causes of arrest, and initial nonshockable rhythm were independent predictors of OHCA-related mortality. This systematic review and meta-analysis is registered in Prospero (CRD42022316602). IMPACT: This systematic review addresses a significant health problem in a global context from 1995 to 2022. The meta-regression revealed that the incidence of OHCA and mortality of children decline over the years in high-income countries despite regional dispraises among individual studies. Body of evidence on the incidence of OHCA and mortality is lacking in low- and middle-income countries.
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Liang LD, Leung KHB, Chan TCY, Deakin J, Heidet M, Meckler G, Scheuermeyer F, Sanatani S, Christenson J, Grunau B. Pediatric and adult Out-of-Hospital cardiac arrest incidence within and near public schools in British Columbia: Missed opportunities for Systematic AED deployment strategies. Resuscitation 2022; 181:20-25. [PMID: 36208861 DOI: 10.1016/j.resuscitation.2022.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 09/15/2022] [Accepted: 09/27/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Systematic automated external defibrillator(AED) placement in schools may improve pediatric out-of-hospital cardiac arrest(OHCA) survival. To estimate their utility, we identified school-located pediatric and adult OHCAs to estimate the potential utilization of school-located AEDs. Further, we identified all OHCAs within an AED-retrievable distance of the school by walking, biking, and driving. METHODS We used prospectively collected data from the British Columbia(BC) Cardiac Arrest Registry(2013-2020), and geo-plotted all OHCAs and schools(n = 824) in BC. We identified adult and pediatric(age < 18 years) OHCAs occurring in schools, as well as nearby OHCAs for which a school-based externally-placed AED could be retrieved by a bystander prior to emergency medical system(EMS) arrival. RESULTS Of 16,409 OHCAs overall in the study period, 28.6 % occurred during school hours. There were 301 pediatric OHCAs. 5(1.7 %) occurred in schools, of whom 2(40 %) survived to hospital discharge. Among both children and adults, 28(0.17 %) occurred in schools(0.0042/school/year), of whom 21(75 %) received bystander resuscitation, 4(14 %) had a bystander AED applied, and 14(50 %) survived to hospital discharge. For each AED, an average of 0.29 OHCAs/year(95 % CI 0.21-0.37), 0.93 OHCAs/year(95 % CI 0.69-1.56) and 1.69 OHCAs/year(95 % CI 1.21-2.89) would be within the potential retrieval distance of a school-located AED by pedestrian, cyclist and automobile retrieval, respectively, using the median EMS response times. CONCLUSION While school-located OHCAs were uncommon, outcomes were favourable. 11.1% to 60.9% of all OHCAs occur within an AED-retrievable distance to a school, depending on retrieval method. Accessible external school-located AEDs may improve OHCA outcomes of school children and in the surrounding community.
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Affiliation(s)
- Li Danny Liang
- Department of Emergency Medicine, University of Calgary, Calgary, Canada
| | - K H Benjamin Leung
- Department of Mechanical and Industrial Engineering University of Toronto, Canada
| | - Timothy C Y Chan
- Department of Mechanical and Industrial Engineering University of Toronto, Canada
| | - Jonathan Deakin
- British Columbia Emergency Health Services, Vancouver, Canada
| | - Matthieu Heidet
- Assistance Publique-Hôpitaux de Paris (AP-HP), SAMU 94 and Emergency Department, University Hospital Henri Mondor, Créteil, France
| | - Garth Meckler
- British Columbia Emergency Health Services, Vancouver, Canada; Division of Emergency Medicine, Department of Pediatrics, University of British Columbia, Canada; Departments of Emergency Medicine, St Paul's Hospital and University of British Columbia, Canada
| | - Frank Scheuermeyer
- Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada; Departments of Emergency Medicine, St Paul's Hospital and University of British Columbia, Canada
| | - Shubhayan Sanatani
- Division of Cardiology, Department of Pediatrics, University of British Columbia, Canada
| | - Jim Christenson
- Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada; Departments of Emergency Medicine, St Paul's Hospital and University of British Columbia, Canada
| | - Brian Grunau
- Centre for Health Evaluation and Outcome Sciences, Vancouver, Canada; British Columbia Emergency Health Services, Vancouver, Canada; Departments of Emergency Medicine, St Paul's Hospital and University of British Columbia, Canada
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11
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Holgersen MG, Jensen TW, Breindahl N, Kjerulff JLB, Breindahl SH, Blomberg SNF, Wolthers SA, Andersen LB, Torp-Pedersen C, Mikkelsen S, Lippert F, Christensen HC. Pediatric out-of-hospital cardiac arrest in Denmark. Scand J Trauma Resusc Emerg Med 2022; 30:58. [DOI: 10.1186/s13049-022-01045-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 10/20/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
Pediatric out-of-hospital cardiac arrest (POHCA) has received limited attention. All causes of POHCA and outcomes were examined during a 4-year period in a Danish nationwide register and prehospital medical records. The aim was to describe the incidence, reversible causes, and survival rates for POHCA in Denmark.
Methods
This is a registry-based follow-up cohort study. All POHCA for a 4-year period (2016–2019) in Denmark were included. All prehospital medical records for the included subjects were reviewed manually by five independent raters establishing whether a presumed reversible cause could be assigned.
Results
We identified 173 cases within the study period. The median incidence of POHCA in the population below 17 years of age was 4.2 per 100,000 persons at risk. We found a presumed reversible cause in 48.6% of cases, with hypoxia being the predominant cause of POHCA (42.2%). The thirty-day survival was 40%. Variations were seen across age groups, with the lowest survival rate in cases below 1 year of age. Defibrillators were used more frequently among survivors, with 16% of survivors defibrillated bystanders as opposed to 1.9% in non-survivors and 24% by EMS personnel as opposed to 7.8% in non-survivors. The differences in initial rhythm being shockable was 34% for survivors and 16% for non-survivors.
Conclusion
We found pediatric out-of-hospital cardiac arrests was a rare event, with higher incidence and mortality in infants compared to other age groups of children. Use of defibrillators was disproportionally higher among survivors. Hypoxia was the most common presumed cause among all age groups.
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12
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Long-Term Outcomes after Non-Traumatic Out-of-Hospital Cardiac Arrest in Pediatric Patients: A Systematic Review. J Clin Med 2022; 11:jcm11175003. [PMID: 36078931 PMCID: PMC9457161 DOI: 10.3390/jcm11175003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/12/2022] [Accepted: 08/15/2022] [Indexed: 11/17/2022] Open
Abstract
Long-term outcomes after non-traumatic pediatric out-of-hospital cardiac arrest (OHCA) are not well understood. This systematic review aimed to summarize long-term outcomes (1 year and beyond), including overall survival, survival with favorable neurological outcomes, and health-related quality of life (HRQoL) outcomes) amongst pediatric OHCA patients who survived to discharge. Embase, Medline, and The Cochrane Library were searched from inception to October 6, 2021. Studies were included if they reported outcomes at 1 year or beyond after pediatric OHCA. Data abstraction and quality assessment was conducted by three authors independently. Qualitative outcomes were reported systematically. Seven studies were included, and amongst patients that survived to hospital discharge or to 30 days, longer-term survival was at least 95% at 24 months of follow up. A highly variable proportion (range 10–71%) of patients had favorable neurological outcomes at 24 months of follow up. With regard to health-related quality of life outcomes, at a time point distal to 1 year, at least 60% of pediatric non-traumatic OHCA patients were reported to have good outcomes. Our study found that at least 95% of pediatric OHCA patients, who survived to discharge, survived to a time point distal to 1 year. There is a general paucity of data surrounding the pediatric OHCA population.
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13
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Kiyohara K, Kitamura Y, Ayusawa M, Nitta M, Iwami T, Nakata K, Sobue T, Kitamura T. Dissemination of Chest Compression-Only Cardiopulmonary Resuscitation by Bystanders for Out-of-Hospital Cardiac Arrest in Students: A Nationwide Investigation in Japan. J Clin Med 2022; 11:jcm11040928. [PMID: 35207201 PMCID: PMC8876364 DOI: 10.3390/jcm11040928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/04/2022] [Accepted: 02/09/2022] [Indexed: 12/10/2022] Open
Abstract
We aimed to investigate how the types of bystander-initiated cardiopulmonary resuscitation (CPR) for out-of-hospital cardiac arrest (OHCA) among students have changed recently. We also determined the association between two types of bystander-CPRs (i.e., chest compression-only CPR [CCCPR] and conventional CPR with rescue breathing [CCRB]) and survival after OHCA. From a nationwide registry of pediatric OHCAs occurring in school settings in Japan, the data of 253 non-traumatic OHCA patients (elementary, junior high, and high school/technical college students) receiving bystander-CPR between April 2008 and December 2017 were analyzed. Multivariable logistic regression analysis was conducted to assess the impact of different types of bystander-CPR on 30-day survival with favorable neurological outcomes. The proportion of patients receiving CCCPR increased from 25.0% during 2008–2009 to 55.3% during 2016–2017 (p for trend < 0.001). Overall, 53.2% (50/94) of patients receiving CCCPR and 46.5% (74/159) of those receiving CCRB survived for 30 days with favorable neurological outcomes. Multivariable analysis showed no significant difference in outcomes between the two groups (adjusted odds ratio: 1.23, 95% confidence interval: 0.67–2.28). In this setting, CCCPR is a common type of bystander-CPR for OHCA in students, and the effectiveness of CCCPR and CCRB on survival outcomes seems comparable.
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Affiliation(s)
- Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women’s University, 12 Sanbancho Chiyoda-ku, Tokyo 102-8357, Japan
- Correspondence: ; Tel.: +81-3-5275-6954
| | - Yuri Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita 565-0871, Japan; (Y.K.); (T.S.); (T.K.)
| | - Mamoru Ayusawa
- Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo 173-8610, Japan;
| | - Masahiko Nitta
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigakumachi, Takatsuki 569-8686, Japan;
- Department of Pediatrics, Osaka Medical College, 2-7 Daigakumachi, Takatsuki 569-8686, Japan
| | - Taku Iwami
- Kyoto University Health Service, Yoshida-Honmachi, Sakyo-ku, Kyoto 606-8501, Japan;
| | - Ken Nakata
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita 565-0871, Japan;
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita 565-0871, Japan; (Y.K.); (T.S.); (T.K.)
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita 565-0871, Japan; (Y.K.); (T.S.); (T.K.)
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Prakash O, Held M, McCormick LF, Gupta N, Lian LY, Antonyuk S, Haynes LP, Thomas NL, Helassa N. CPVT-associated calmodulin variants N53I and A102V dysregulate Ca2+ signalling via different mechanisms. J Cell Sci 2022; 135:274029. [PMID: 34888671 PMCID: PMC8917356 DOI: 10.1242/jcs.258796] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 11/29/2021] [Indexed: 12/26/2022] Open
Abstract
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited condition that can cause fatal cardiac arrhythmia. Human mutations in the Ca2+ sensor calmodulin (CaM) have been associated with CPVT susceptibility, suggesting that CaM dysfunction is a key driver of the disease. However, the detailed molecular mechanism remains unclear. Focusing on the interaction with the cardiac ryanodine receptor (RyR2), we determined the effect of CPVT-associated variants N53I and A102V on the structural characteristics of CaM and on Ca2+ fluxes in live cells. We provide novel data showing that interaction of both Ca2+/CaM-N53I and Ca2+/CaM-A102V with the RyR2 binding domain is decreased. Ca2+/CaM-RyR23583-3603 high-resolution crystal structures highlight subtle conformational changes for the N53I variant, with A102V being similar to wild type (WT). We show that co-expression of CaM-N53I or CaM-A102V with RyR2 in HEK293 cells significantly increased the duration of Ca2+ events; CaM-A102V exhibited a lower frequency of Ca2+ oscillations. In addition, we show that CaMKIIδ (also known as CAMK2D) phosphorylation activity is increased for A102V, compared to CaM-WT. This paper provides novel insight into the molecular mechanisms of CPVT-associated CaM variants and will facilitate the development of strategies for future therapies.
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Affiliation(s)
- Ohm Prakash
- Liverpool Centre for Cardiovascular Science, Department of Cardiovascular Science and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Marie Held
- Liverpool Centre for Cardiovascular Science, Department of Cardiovascular Science and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Liam F. McCormick
- Liverpool Centre for Cardiovascular Science, Department of Cardiovascular Science and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Nitika Gupta
- Department of Molecular Physiology and Cell Signalling, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - Lu-Yun Lian
- Nuclear Magnetic Resonance Centre for Structural Biology, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZB, UK
| | - Svetlana Antonyuk
- Molecular Biophysics Group, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 7ZB, UK
| | - Lee P. Haynes
- Department of Molecular Physiology and Cell Signalling, Institute of Systems, Molecular and Integrative Biology, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3BX, UK
| | - N. Lowri Thomas
- School of Pharmacy & Pharmaceutical Sciences, Cardiff University, Cardiff, Redwood Building, CF10 3NB, UK
| | - Nordine Helassa
- Liverpool Centre for Cardiovascular Science, Department of Cardiovascular Science and Metabolic Medicine, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool L69 3BX, UK,Author for correspondence ()
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15
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Salcido DD, Koller AC, Genbrugge C, Fink EL, Berg RA, Menegazzi JJ. Injury characteristics and hemodynamics associated with guideline-compliant CPR in a pediatric porcine cardiac arrest model. Am J Emerg Med 2022; 51:176-183. [PMID: 34763236 PMCID: PMC8982633 DOI: 10.1016/j.ajem.2021.10.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/08/2021] [Accepted: 10/16/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Guidelines for depth of chest compressions in pediatric cardiopulmonary resuscitation (CPR) are based on sparse evidence. OBJECTIVE We sought to evaluate the performance of the two most widely recommended chest compression depth levels for pediatric CPR (1.5 in. and 1/3 the anterior-posterior diameter- APd) in a controlled swine model of asphyxial cardiac arrest. METHODS We executed a 2-group, randomized laboratory study with an adaptive design allowing early termination for overwhelming injury or benefit. Forty mixed-breed domestic swine (mean weight = 26 kg) were sedated, anesthetized and paralyzed along with endotracheal intubation and mechanical ventilation. Asphyxial cardiac arrest was induced with fentanyl overdose. Animals were untreated for 9 min followed by mechanical CPR with a target depth of 1.5 in. or 1/3 the APd. Advanced life support drugs were administered IV after 4 min of basic resuscitation followed by defibrillation at 14 min. The primary outcomes were return of spontaneous circulation (ROSC), hemodynamics and CPR-related injury severity. RESULTS Enrollment in the 1/3 APd group was stopped early due to overwhelming differences in injury. Twenty-three animals were assigned to the 1.5 in. group and 15 assigned to the 1/3 APd group, per an adaptive group design. The 1/3 APd group had increased frequency of rib fracture (6.7 vs 1.7, p < 0.001) and higher proportions of several anatomic injury markers than the 1.5 in. group, including sternal fracture, hemothorax and blood in the endotracheal tube (p < 0.001). ROSC and hemodynamic measures were similar between groups. CONCLUSION In this pediatric model of cardiac arrest, chest compressions to 1/3APd were more harmful without a concurrent benefit for resuscitation outcomes compared to the 1.5 in. compression group.
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Affiliation(s)
- David D. Salcido
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Allison C. Koller
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | | | - Ericka L. Fink
- Department of Critical Care Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Robert A. Berg
- Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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16
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Binkhorst M, Hogeveen M, Benthem Y, van de Pol EM, van Heijst AFJ, Draaisma JMT. Validation of an Assessment Instrument for Pediatric Basic Life Support. Pediatr Emerg Care 2021; 37:e1057-e1064. [PMID: 31318831 DOI: 10.1097/pec.0000000000001899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To develop a valid and reliable instrument for the assessment of pediatric basic life support (PBLS). METHODS An assessment instrument for PBLS was developed, based on 3 existing scoring systems and the European Resuscitation Council PBLS guideline. We tested if experienced PBLS instructors performed better than medical students on a standard PBLS examination on a low-fidelity pediatric manikin (construct validity). To pass the examination, 15 penalty points or less were required. The examinations were videotaped. One researcher assessed all videos once, and approximately half of them twice (intrarater reliability). A second researcher independently assessed part of the videos (interrater reliability). The time needed to assess 1 examination was determined. RESULTS Face and content validity were established, because PBLS experts reached consensus on the instrument and because the instrument incorporated all items of the European Resuscitation Council algorithm. Of the 157 medical students that were scored, 98 (62.4%) passed the examination. Fourteen PBLS instructors were scored; all passed (100%). Pass rate (62.4% vs 100%) and median penalty points (15 [interquartile range, 10-22.5] vs 7.5 [interquartile range, 1.25-10]) were significantly different between students and instructors (P = 0.005 and <0.001, respectively). Reassessment demonstrated a κ for intrarater reliability of 0.62 (95% confidence interval, 0.45-0.81) (substantial agreement); κ for interrater reliability was 0.51 (95% confidence interval, 0.09-0.93) (moderate agreement). It took approximately 3 minutes to assess 1 videotaped examination. CONCLUSIONS Our instrument for the (video-based) assessment of PBLS is valid and sufficiently reliable. It is also designed to be practical, time-efficient, and applicable in various settings, including resource limited.
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Affiliation(s)
| | | | - Yvet Benthem
- Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Eva M van de Pol
- Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, the Netherlands
| | | | - Jos M Th Draaisma
- Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, the Netherlands
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17
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Moors XRJ, Alink MO, Bouman S, Schober P, De Leeuw M, Hoogerwerf N, Bergsma M, Hartog DD, Houmes RJ, Stolker RJ. A Nationwide Retrospective Analysis of Out-of-Hospital Pediatric Cardiopulmonary Resuscitation Treated by Helicopter Emergency Medical Service in the Netherlands. Air Med J 2021; 40:410-414. [PMID: 34794780 DOI: 10.1016/j.amj.2021.08.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/28/2021] [Accepted: 08/06/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE There is generally limited but conflicting literature on the incidence, causes, and outcomes of pediatric out-of-hospital cardiac arrest. This study was performed to determine the incidence and outcome of pediatric out-of-hospital cardiac arrest reported by all helicopter emergency medical services in the Netherlands and to provide a description of causes and treatments and, in particular, a description of the specific interventions that can be performed by a physician-staffed helicopter emergency medical service. METHODS A retrospective analysis was performed of all documented pediatric (0 < 18 years of age) out-of-hospital cardiac arrests from July 2015 to July 2017, attended by all 4 Dutch helicopter emergency medical service teams. RESULTS Two hundred two out-of-hospital cardiac arrests were identified. The overall incidence in the Netherlands is 3.5 out-of-hospital cardiac arrests in children per 100,000 pediatric inhabitants. The overall survival rate for out-of-hospital cardiac arrest was 11.4%. Eleven (52%) of the survivors were in the drowning group and between 12 and 96 months of age. CONCLUSION Helicopter emergency medical services are frequently called to pediatric out-of-hospital cardiac arrests in the Netherlands. The survival rate is normal to high compared with other countries. The 12- to 96-month age group and drowning seem to have a relatively favorable outcome.
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Affiliation(s)
- Xavier R J Moors
- Department of Anesthesiology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands; HEMS Lifeliner 2, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Michelle Oude Alink
- Department of Anesthesiology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Stef Bouman
- Department of Anesthesiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Patrick Schober
- Department of Anesthesiology, Amsterdam University Medical Center, VU Medical Center, Amsterdam, The Netherlands; HEMS Lifeliner 1, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Marcel De Leeuw
- Department of Anesthesiology, Amsterdam University Medical Center, VU Medical Center, Amsterdam, The Netherlands; HEMS Lifeliner 1, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Nico Hoogerwerf
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands; HEMS Lifeliner 3, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Margot Bergsma
- Department of Anesthesiology, University Medical Center Groningen, Groningen, The Netherlands; HEMS Lifeliner 4, University Medical Center Groningen, Groningen, The Netherlands
| | - Dennis Den Hartog
- Trauma Research Unit Department of Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robert Jan Houmes
- HEMS Lifeliner 2, Erasmus University Medical Center, Rotterdam, The Netherlands; Department of Pediatric Intensive Care, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Robert Jan Stolker
- Department of Anesthesiology, Erasmus University Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
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18
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Yin J, Zhou J, Chen J, Xu T, Zhang Z, Zhang H, Yuan C, Cheng X, Qin Y, Zheng B, Wang C, Yang S, Jia Z. Case Report: A Novel Variant c.2262+3A>T of the SCN5A Gene Results in Intron Retention Associated With Incessant Ventricular Tachycardias. Front Med (Lausanne) 2021; 8:659119. [PMID: 34422849 PMCID: PMC8371685 DOI: 10.3389/fmed.2021.659119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: Voltage-gated sodium channel Nav1.5 encoded by the SCN5A gene plays crucial roles in cardiac electrophysiology. Previous genetic studies have shown that mutations in SCN5A are associated with multiple inherited cardiac arrhythmias. Here, we investigated the molecular defect in a Chinese boy with clinical manifestations of arrhythmias. Methods: Gene variations were screened using whole-exome sequencing and validated by direct Sanger sequencing. A minigene assay and reverse transcription PCR (RT-PCR) were performed to confirm the effects of splice variants in vitro. Western blot analysis was carried out to determine whether the c.2262+3A>T variant produced a truncated protein. Results: By genetic analysis, we identified a novel splice variant c.2262+3A>T in SCN5A gene in a Chinese boy with incessant ventricular tachycardias (VT). This variant was predicted to activate a new cryptic splice donor site and was identified by in silico analysis. The variant retained 79 bp at the 5′ end of intron 14 in the mature mRNA. Furthermore, the mutant transcript that created a premature stop codon at 818 amino acids [p.(R818*)] could be produced as a truncated protein. Conclusion: We verified the pathogenic effect of splicing variant c.2262+3A>T, which disturbed the normal mRNA splicing and caused a truncated protein, suggesting that splice variants play an important role in the molecular basis of early onset incessant ventricular tachycardias, and careful molecular profiling of these patients will be essential for future effective personalized treatment options.
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Affiliation(s)
- Jie Yin
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jia Zhou
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jinlong Chen
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ting Xu
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Zhongman Zhang
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Han Zhang
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Chang Yuan
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xueying Cheng
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Yuming Qin
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Bixia Zheng
- Nanjing Key Laboratory of Pediatrics, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Chunli Wang
- Nanjing Key Laboratory of Pediatrics, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Shiwei Yang
- Department of Cardiology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Zhanjun Jia
- Nanjing Key Laboratory of Pediatrics, Children's Hospital of Nanjing Medical University, Nanjing, China
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Hunfeld M, Dulfer K, Rietman A, Pangalila R, van Gils-Frijters A, Catsman-Berrevoets C, Tibboel D, Buysse C. Longitudinal two years evaluation of neuropsychological outcome in children after out of hospital cardiac arrest. Resuscitation 2021; 167:29-37. [PMID: 34389455 DOI: 10.1016/j.resuscitation.2021.07.043] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/21/2021] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Abstract
AIM To investigate longitudinal functional and neuropsychological outcomes 3-6 and 24 months after paediatric out-of-hospital cardiac arrest (OHCA). Further, to explore the association between paediatric cerebral performance category (PCPC) and intelligence. METHODS Prospective longitudinal single center study including children (0-17 years) with OHCA, admitted to the PICU of a tertiary care hospital between 2012 and 2017. Survivors were assessed during an outpatient multidisciplinary follow-up program 3-6 and 24 months post-OHCA. Functional and neuropsychological outcomes were assessed through interviews, neurological exam, and validated neuropsychological testing. RESULTS The total eligible cohort consisted of 49 paediatric OHCA survivors. The most common cause of OHCA was arrhythmia (33%). Median age at time of OHCA was 48 months, 67% were males. At 3-6 and 24 months post-OHCA, respectively 74 and 73% had a good PCPC score, defined as 1-2. Compared with normative data, OHCA children obtained worse sustained attention and processing speed scores 3-6 (n = 26) and 24 (n = 27) months post-OHCA. At 24 months, they also obtained worse intelligence, selective attention and cognitive flexibility scores. In children tested at both time-points (n = 19), no significant changes in neuropsychological outcomes were found over time. Intelligence scores did not correlate with PCPC. CONCLUSION Although paediatric OHCA survivors had a good PCPC score 3-6 and 24 months post-OHCA, they obtained worse scores on important neuropsychological domains such as intelligence and executive functioning (attention and cognitive flexibility). Follow-up should continue over a longer life span in order to fully understand the long-term impact of OHCA in childhood.
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Affiliation(s)
- Maayke Hunfeld
- Intensive Care and Department of Paediatric Surgery, Erasmus MC, Sophia Children's Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands; Department of Paediatric Neurology, Erasmus MC, Sophia Children's Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
| | - Karolijn Dulfer
- Intensive Care and Department of Paediatric Surgery, Erasmus MC, Sophia Children's Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Andre Rietman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, Sophia Children's Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Robert Pangalila
- Rijndam Rehabilitation - Paediatric Rehabilitation, Westersingel 300, 3015 LJ Rotterdam, the Netherlands
| | - Annabel van Gils-Frijters
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, Sophia Children's Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Coriene Catsman-Berrevoets
- Department of Paediatric Neurology, Erasmus MC, Sophia Children's Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Dick Tibboel
- Intensive Care and Department of Paediatric Surgery, Erasmus MC, Sophia Children's Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Corinne Buysse
- Intensive Care and Department of Paediatric Surgery, Erasmus MC, Sophia Children's Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
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20
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Riva G, Hollenberg J. Different forms of bystander cardiopulmonary resuscitation in out-of-hospital cardiac arrest. J Intern Med 2021; 290:57-72. [PMID: 33527546 DOI: 10.1111/joim.13260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/24/2020] [Accepted: 11/23/2020] [Indexed: 11/29/2022]
Abstract
Out-of-hospital cardiac arrest (OHCA) is a major cause of death in the Western world with an estimated number of 275 000 treated with resuscitation attempts by the Emergency Medical Services (EMS) in Europe each year. Overall survival rates remain low, and most studies indicate that around 1 out 10 will survive to 30 days. Amongst the strongest factors associated with survival in OHCA is first recorded rhythm amendable to defibrillation, early defibrillation and prompt initiation of cardiopulmonary resuscitation (CPR). Overall, CPR started prior to EMS arrival has repeatedly been shown to be associated with survival rates 2-3 times higher compared with no such initiation. The primary goal of CPR is to generate sufficient blood flow to vital organs, mainly the brain and heart, until restoration of spontaneous circulation can be achieved. Barriers to the initiation of CPR by bystanders in OHCA include fear of being incapable, causing harm, and transmission of infectious diseases. Partly due to these barriers, and low rates of CPR, the concept of CPR with compression only was proposed as a simpler form of resuscitation with the aim to be more widely accepted by the public in the 1990s. But how reliable is the evidence supporting this simpler form of CPR, and are the outcomes after CO-CPR comparable to standard CPR?
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Affiliation(s)
- G Riva
- From the, Department of Cardiology, Karolinska Institutet, Solna, Sweden
| | - J Hollenberg
- From the, Department of Cardiology, Karolinska Institutet, Solna, Sweden
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Albrecht M, de Jonge RCJ, Nadkarni VM, de Hoog M, Hunfeld M, Kammeraad JAE, Moors XRJ, van Zellem L, Buysse CMP. Association between shockable rhythms and long-term outcome after pediatric out-of-hospital cardiac arrest in Rotterdam, the Netherlands: An 18-year observational study. Resuscitation 2021; 166:110-120. [PMID: 34082030 DOI: 10.1016/j.resuscitation.2021.05.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/06/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Shockable rhythm following pediatric out-of-hospital cardiac arrest (pOHCA) is consistently associated with hospital and short-term survival. Little is known about the relationship between shockable rhythm and long-term outcomes (>1 year) after pOHCA. The aim was to investigate the association between first documented rhythm and long-term outcomes in a pOHCA cohort over 18 years. METHODS All children aged 1 day-18 years who experienced non-traumatic pOHCA between 2002-2019 and were subsequently admitted to the emergency department (ED) or pediatric intensive care unit (PICU) of Erasmus MC-Sophia Children's Hospital were included. Data was abstracted retrospectively from patient files, (ground) ambulance and Helicopter Emergency Medical Service (HEMS) records, and follow-up clinics. Long-term outcome was determined using a Pediatric Cerebral Performance Category (PCPC) score at the longest available follow-up interval through august 2020. The primary outcome measure was survival with favorable neurologic outcome, defined as PCPC 1-2 or no difference between pre- and post-arrest PCPC. The association between first documented rhythm and the primary outcome was calculated in a multivariable regression model. RESULTS 369 children were admitted, nine children were lost to follow-up. Median age at arrest was age 3.4 (IQR 0.8-9.9) years, 63% were male and 14% had a shockable rhythm (66% non-shockable, 20% unknown or return of spontaneous circulation (ROSC) before emergency medical service (EMS) arrival). In adolescents (aged 12-18 years), 39% had shockable rhythm. 142 (39%) of children survived to hospital discharge. On median follow-up interval of 25 months (IQR 5.1-49.6), 115/142 (81%) of hospital survivors had favorable neurologic outcome. In multivariable analysis, shockable rhythm was associated with survival with favorable long-term neurologic outcome (OR 8.9 [95%CI 3.1-25.9]). CONCLUSION In children with pOHCA admitted to ED or PICU shockable rhythm had significantly higher odds of survival with long-term favorable neurologic outcome compared to non-shockable rhythm. Survival to hospital discharge after pOHCA was 39% over the 18-year study period. Of survivors to discharge, 81% had favorable long-term (median 25 months, IQR 5.1-49.6) neurologic outcome. Efforts for improving outcome of pOHCA should focus on early recognition and treatment of shockable pOHCA at scene.
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Affiliation(s)
- M Albrecht
- Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - R C J de Jonge
- Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - V M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - M de Hoog
- Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M Hunfeld
- Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Pediatric Neurology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - J A E Kammeraad
- Department of Pediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - X R J Moors
- Department of Pediatric Anesthesiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Helicopter Emergency Medical Services, Erasmus MC, Rotterdam, The Netherlands
| | - L van Zellem
- Department of Youth Health Care, Public Health Service (GGD), Amsterdam, The Netherlands
| | - C M P Buysse
- Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
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Abstract
In this section of the European Resuscitation Council Guidelines 2021, key information on the epidemiology and outcome of in and out of hospital cardiac arrest are presented. Key contributions from the European Registry of Cardiac Arrest (EuReCa) collaboration are highlighted. Recommendations are presented to enable health systems to develop registries as a platform for quality improvement and to inform health system planning and responses to cardiac arrest.
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de Graaf C, Beesems SG, Oud S, Stickney RE, Piraino DW, Chapman FW, Koster RW. Analyzing the heart rhythm during chest compressions: Performance and clinical value of a new AED algorithm. Resuscitation 2021; 162:320-328. [PMID: 33460749 DOI: 10.1016/j.resuscitation.2021.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/26/2020] [Accepted: 01/01/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE Automated external defibrillators (AED) prompt the rescuer to stop chest compressions (CC) for ECG analysis during out-of-hospital cardiac arrest (OHCA). We assessed the diagnostic accuracy and clinical benefit of a new AED algorithm (cprINSIGHT), which analyzes ECG and impedance signals during CC, allowing rhythm analysis with ongoing chest compressions. METHODS Amsterdam Police and Fire Fighters used a conventional AED in 2016-2017 (control) and an AED with cprINSIGHT in 2018-2019 (intervention). In the intervention AED, cprINSIGHT was activated after the first (conventional) analysis. This algorithm classified the rhythm as "shockable" (S) and "non-shockable" (NS), or "pause needed". Sensitivity for S, specificity for NS with 90% lower confidence limit (LCL), chest compression fractions (CCF) and pre-shock pause were compared between control and intervention cases accounting for multiple observations per patient. RESULTS Data from 465 control and 425 intervention cases were analyzed. cprINSIGHT reached a decision during CC in 70% of analyses. Sensitivity of the intervention AED was 96%, (LCL 93%) and specificity was 98% (LCL 97%), both not significantly different from control. Intervention cases had a shorter median pre-shock pause compared to control cases (8 s vs 22 s, p < 0.001) and higher median CCF (86% vs 80%, P < 0.001). CONCLUSION AEDs with cprINSIGHT analyzed the ECG during chest compressions in 70% of analyses with 96% sensitivity and 98% specificity when it made a S or a NS decision. Compared to conventional AEDs, cprINSIGHT leads to a significantly shorter pre-shock pause and a significant increase in CCF.
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Affiliation(s)
- Corina de Graaf
- Amsterdam UMC, Academic Medical Center (AMC), Heart Center, Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
| | - Stefanie G Beesems
- Amsterdam UMC, Academic Medical Center (AMC), Heart Center, Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Sharon Oud
- Amsterdam UMC, Academic Medical Center (AMC), Heart Center, Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | | | | | | | - Rudolph W Koster
- Amsterdam UMC, Academic Medical Center (AMC), Heart Center, Department of Cardiology, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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Hunfeld M, Nadkarni VM, Topjian A, Harpman J, Tibboel D, van Rosmalen J, de Hoog M, Catsman-Berrevoets CE, Buysse CMP. Timing and Cause of Death in Children Following Return of Circulation After Out-of-Hospital Cardiac Arrest: A Single-Center Retrospective Cohort Study. Pediatr Crit Care Med 2021; 22:101-113. [PMID: 33027241 DOI: 10.1097/pcc.0000000000002577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine timing and cause of death in children admitted to the PICU following return of circulation after out-of-hospital cardiac arrest. DESIGN Retrospective observational study. SETTING Single-center observational cohort study at the PICU of a tertiary-care hospital (Erasmus MC-Sophia, Rotterdam, The Netherlands) between 2012 and 2017. PATIENTS Children younger than 18 years old with out-of-hospital cardiac arrest and return of circulation admitted to the PICU. MEASUREMENTS AND RESULTS Data included general, cardiopulmonary resuscitation and postreturn of circulation characteristics. The primary outcome was defined as survival to hospital discharge. Modes of death were classified as brain death, withdrawal of life-sustaining therapies due to poor neurologic prognosis, withdrawal of life-sustaining therapies due to refractory circulatory and/or respiratory failure, and recurrent cardiac arrest without return of circulation. One hundred thirteen children with out-of-hospital cardiac arrest were admitted to the PICU following return of circulation (median age 53 months, 64% male, most common cause of out-of-hospital cardiac arrest drowning [21%]). In these 113 children, there was 44% survival to hospital discharge and 56% nonsurvival to hospital discharge (brain death 29%, withdrawal of life-sustaining therapies due to poor neurologic prognosis 67%, withdrawal of life-sustaining therapies due to refractory circulatory and/or respiratory failure 2%, and recurrent cardiac arrest 2%). Compared with nonsurvivors, more survivors had witnessed arrest (p = 0.007), initial shockable rhythm (p < 0.001), shorter cardiopulmonary resuscitation duration (p < 0.001), and more favorable clinical neurologic examination within 24 hours after admission. Basic cardiopulmonary resuscitation event and postreturn of circulation (except for the number of extracorporeal membrane oxygenation) characteristics did not significantly differ between the withdrawal of life-sustaining therapies due to poor neurologic prognosis and brain death patients. Timing of decision-making to withdrawal of life-sustaining therapies due to poor neurologic prognosis ranged from 0 to 18 days (median: 0 d; interquartile range, 0-3) after cardiopulmonary resuscitation. The decision to withdrawal of life-sustaining therapies was based on neurologic examination (100%), electroencephalography (44%), and/or brain imaging (35%). CONCLUSIONS More than half of children who achieve return of circulation after out-of-hospital cardiac arrest died after PICU admission. Of these deaths, two thirds (67%) underwent withdrawal of life-sustaining therapies based on an expected poor neurologic prognosis and did so early after return of circulation. There is a need for international guidelines for accurate neuroprognostication in children after cardiac arrest.
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Affiliation(s)
- Maayke Hunfeld
- Department of Pediatric Neurology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Pediatric Surgery and Intensive Care, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Alexis Topjian
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jasmijn Harpman
- Department of Pediatric Surgery and Intensive Care, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Dick Tibboel
- Department of Pediatric Surgery and Intensive Care, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Matthijs de Hoog
- Department of Pediatric Surgery and Intensive Care, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Corinne M P Buysse
- Department of Pediatric Surgery and Intensive Care, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
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Binkhorst M, Draaisma JMT, Benthem Y, van de Pol EMR, Hogeveen M, Tan ECTH. Peer-led pediatric resuscitation training: effects on self-efficacy and skill performance. BMC MEDICAL EDUCATION 2020; 20:427. [PMID: 33187502 PMCID: PMC7666463 DOI: 10.1186/s12909-020-02359-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 11/04/2020] [Indexed: 05/04/2023]
Abstract
BACKGROUND Peer-led basic life support training in medical school may be an effective and valued way of teaching medical students, yet no research has been conducted to evaluate the effect on the self-efficacy of medical students. High self-efficacy stimulates healthcare professionals to initiate and continue basic life support despite challenges. METHODS A randomized controlled trial, in which medical students received pediatric basic life support (PBLS) training, provided by either near-peer instructors or expert instructors. The students were randomly assigned to the near-peer instructor group (n = 105) or expert instructor group (n = 108). All students received two hours of PBLS training in groups of approximately 15 students. Directly after this training, self-efficacy was assessed with a newly developed questionnaire, based on a validated scoring tool. A week after each training session, students performed a practical PBLS exam and completed another questionnaire to evaluate skill performance and self-efficacy, respectively. RESULTS Students trained by near-peers scored significantly higher on self-efficacy regarding all aspects of PBLS. Theoretical education and instructor feedback were equally valued in both groups. The scores for the practical PBLS exam and the percentage of students passing the exam were similar in both groups. CONCLUSIONS Our findings point towards the fact that near-peer-trained medical students can develop a higher level of PBLS-related self-efficacy than expert-trained students, with comparable PBLS skills in both training groups. The exact relationship between peer teaching and self-efficacy and between self-efficacy and the quality of real-life pediatric resuscitation should be further explored. TRIAL REGISTRATION ISRCTN, ISRCTN69038759 . Registered December 12th, 2019 - Retrospectively registered.
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Affiliation(s)
- M. Binkhorst
- Radboud Institute for Health Sciences (RIHS), Department of Neonatology, Radboud University Medical Center Amalia Children’s Hospital, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - J M Th Draaisma
- Department of Pediatrics, Radboud University Medical Center Amalia Children’s Hospital, Nijmegen, The Netherlands
| | - Y. Benthem
- Department of Pediatrics, Radboud University Medical Center Amalia Children’s Hospital, Nijmegen, The Netherlands
| | - E. M. R. van de Pol
- Department of Pediatrics, Radboud University Medical Center Amalia Children’s Hospital, Nijmegen, The Netherlands
| | - M. Hogeveen
- Radboud Institute for Health Sciences (RIHS), Department of Neonatology, Radboud University Medical Center Amalia Children’s Hospital, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - E. C. T. H. Tan
- Department of General Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
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Kiyohara K, Sado J, Kitamura T, Ayusawa M, Nitta M, Iwami T, Nakata K, Sobue T, Kitamura Y. Public-access automated external defibrillation and bystander-initiated cardiopulmonary resuscitation in schools: a nationwide investigation in Japan. Europace 2020; 21:451-458. [PMID: 30500911 DOI: 10.1093/europace/euy261] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/11/2018] [Indexed: 11/12/2022] Open
Abstract
AIMS We aimed to reveal the effects of application of public-access automated external defibrillators (AEDs) and bystander-initiated cardiopulmonary resuscitation (CPR) on survival of paediatric patients with out-of-hospital cardiac arrest (OHCA) occurring on school campuses in Japan. METHODS AND RESULTS Data were obtained from a nationwide prospective observational study of paediatric OHCAs in school settings in Japan, termed Stop and Prevent cardIac aRrest, Injury, and Trauma in Schools (SPIRITS). Non-traumatic OHCA patients from elementary school, junior high school, and high school/technical college between April 2008 and December 2015 were enrolled. A multivariable logistic regression analysis was conducted to assess the effect of bystander interventions (i.e. public-access AED application and bystander-CPR) on 30-day survival with favourable neurological outcome. In total, 232 OHCA cases were analysed. The proportion of 30-day survival with favourable neurological outcome was significantly higher among the patients receiving both public-access AED application and bystander-CPR than those without any bystander intervention (50.9% vs. 20.0%, adjusted odds ratio 4.08, 95% confidence interval 1.25-13.31; P = 0.020). During the study period, the proportion of patients to whom public-access AEDs were applied increased significantly (from 61.9% in 2008 to 87.0% in 2015, P-for trend = 0.014). Accordingly, the proportion of 30-day survival with favourable neurological outcome improved significantly (from 38.1% in 2005 to 56.5% in 2015, P-for trend = 0.026). CONCLUSION The combination of public-access AED application and bystander-CPR increased the chance of survival approximately four-fold in schools. The nationwide efforts towards disseminating public-access defibrillation systems in school settings may reduce the risk of sudden cardiac death among school children.
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Affiliation(s)
- Kosuke Kiyohara
- Department of Food Science, Otsuma Women's University, 12 Sanbancho Chiyoda-ku, Tokyo, Japan
| | - Junya Sado
- Department of Health and Sport Sciences, Medicine for Sports and Performing Arts, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita, Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita, Japan
| | - Mamoru Ayusawa
- Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1, Ooyaguchikamichou, Itabashi-ku, Tokyo, Japan
| | - Masahiko Nitta
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, Japan.,Department of Pediatrics, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki City, Osaka, Japan
| | - Taku Iwami
- Kyoto University Health Service, Yoshida Honmachi, Sakyo-ku, Kyoto, Japan
| | - Ken Nakata
- Department of Health and Sport Sciences, Medicine for Sports and Performing Arts, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita, Japan
| | - Yuri Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita, Japan
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The current practice regarding neuro-prognostication for comatose children after cardiac arrest differs between and within European PICUs: A survey. Eur J Paediatr Neurol 2020; 28:44-51. [PMID: 32669214 DOI: 10.1016/j.ejpn.2020.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 06/19/2020] [Accepted: 06/30/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE To describe current practices in European Paediatric Intensive Care Units (PICUs) regarding neuro-prognostication in comatose children after cardiac arrest (CA). METHODS An anonymous online survey was conducted among members of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) and the European Paediatric Neurology Society (EPNS) throughout January and February 2019. The survey consisted of 49 questions divided into 4 sections: general information, cardiac arrest, neuro-prognostication and follow-up. RESULTS The survey was sent to 1310 EPNS and 611 ESPNIC members. Of the 108 respondents, 71 (66%) (23 countries, 45 PICUs) completed the "neuro-prognostication" section. Eight PICUs (20%) had a local neuro-prognostication guideline. The 3 methods considered as most useful were neurological examination (92%), magnetic resonance imaging (MRI) (82%) and continuous electroencephalography (cEEG) (45%). In 50% a Pediatric Cerebral Performance Category (PCPC) score ≥ 4 was considered as poor neurological outcome. In 63% timing of determining neurological prognosis was based on the individual patient. Once decided that neurological prognosis was futile, 55% indicated that withdrawing life-sustaining therapy (WLST) was (one of) the options, whereas 44% continued PICU treatment (with or without restrictions). In 28 PICUs (68%) CA-survivors were scheduled for follow-up visits. CONCLUSION Local guidelines for neuro-prognostication in comatose children after CA are uncommon. Methods to assess neurological outcome were mainly neurological examination, MRI and cEEG. Consequences of poor outcome differed between respondents. Inaccuracies in neuro-prognostication can result in premature WLST, thereby biasing outcome research and creating a self-fulfilling cycle. Further research is needed to develop scientifically based international guidelines for neuro-prognostication in comatose children after CA.
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Huang WC, Huang HT, Chen PY, Wang WC, Ko TM, Shrestha S, Yang CD, Tai CS, Chiew MY, Chou YP, Hu YF, Huang HD. SVAD: A genetic database curates non-ischemic sudden cardiac death-associated variants. PLoS One 2020; 15:e0237731. [PMID: 32813752 PMCID: PMC7437891 DOI: 10.1371/journal.pone.0237731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/31/2020] [Indexed: 11/19/2022] Open
Abstract
Sudden cardiac death (SCD) is an important cause of mortality worldwide. It accounts for approximately half of all deaths from cardiovascular disease. While coronary artery disease and acute myocardial infarction account for the majority of SCD in the elderly population, inherited cardiac diseases (inherited CDs) comprise a substantial proportion of younger SCD victims with a significant genetic component. Currently, the use of next-generation sequencing enables the rapid analysis to investigate relationships between genetic variants and inherited CDs causing SCD. Genetic contribution to risk has been considered an alternate predictor of SCD. In the past years, large numbers of SCD susceptibility variants were reported, but these results are scattered in numerous publications. Here, we present the SCD-associated Variants Annotation Database (SVAD) to facilitate the interpretation of variants and to meet the needs of data integration. SVAD contains data from a broad screening of scientific literature. It was constructed to provide a comprehensive collection of genetic variants along with integrated information regarding their effects. At present, SVAD has accumulated 2,292 entries within 1,239 variants by manually surveying pertinent literature, and approximately one-third of the collected variants are pathogenic/likely-pathogenic following the ACMG guidelines. To the best of our knowledge, SVAD is the most comprehensive database that can provide integrated information on the associated variants in various types of inherited CDs. SVAD represents a valuable source of variant information based on scientific literature and benefits clinicians and researchers, and it is now available on http://svad.mbc.nctu.edu.tw/.
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Affiliation(s)
- Wei-Chih Huang
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
| | - Hsin-Tzu Huang
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
- Industrial Development Graduate Program of College of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
| | - Po-Yuan Chen
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
| | - Wei-Chi Wang
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
| | - Tai-Ming Ko
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan, R.O.C
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan, R.O.C
| | - Sirjana Shrestha
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
| | - Chi-Dung Yang
- Warshel Institute for Computational Biology, The Chinese University of Hong Kong, Shenzhen, China
- School of Life and Health Sciences, The Chinese University of Hong Kong, Shenzhen, China
| | - Chun-San Tai
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
- Institute of Molecular Medicine and Bioengineering, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
| | - Men-Yee Chiew
- Department of Biological Science and Technology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
| | - Yu-Pao Chou
- Institute of Bioinformatics and Systems Biology, National Chiao Tung University, Hsinchu, Taiwan, R.O.C
| | - Yu-Feng Hu
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan, R.O.C
- * E-mail: (HDH); (YFH)
| | - Hsien-Da Huang
- Warshel Institute for Computational Biology, The Chinese University of Hong Kong, Shenzhen, China
- School of Life and Health Sciences, The Chinese University of Hong Kong, Shenzhen, China
- * E-mail: (HDH); (YFH)
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Okubo M, Chan HK, Callaway CW, Mann NC, Wang HE. Characteristics of paediatric out-of-hospital cardiac arrest in the United States. Resuscitation 2020; 153:227-233. [DOI: 10.1016/j.resuscitation.2020.04.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/24/2020] [Accepted: 04/12/2020] [Indexed: 10/24/2022]
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Cardiopulmonary Resuscitation in Interfacility Transport: An International Report Using the Ground Air Medical Quality in Transport (GAMUT) Database. Crit Care Res Pract 2020; 2020:4647958. [PMID: 32695507 PMCID: PMC7368958 DOI: 10.1155/2020/4647958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 06/14/2020] [Accepted: 06/24/2020] [Indexed: 11/25/2022] Open
Abstract
Background With the regionalization of specialty care, there is an increasing need for interfacility transport from local to regional hospitals. There are very limited data on rates of cardiopulmonary resuscitation (CPR) during medical transport and relationship between transport-specific factors, such as transport program type and need of CPR during transport of critically ill patients. We present the first, multicenter, international report of CPR during medical transport using the large Ground and Air Medical qUality Transport (GAMUT) database. Methods We retrospectively reviewed the GAMUT database from January 2014 to March 2017 for CPR during transport. We determined the overall CPR rate and CPR rates for adult, pediatric, and neonatal transport programs. The rate of CPR per total transports was expressed as percentage, and then, Spearman's rho nonparametric associations were determined between CPR and other quality metrics tracked in the GAMUT database. Examples include advanced airway presence, waveform capnography usage, average mobilization time from the start of referral until en route, 1st attempt intubation success rate, and DASH1A intubation success (definitive airway sans hypoxia/hypotension on 1st attempt). Data were analyzed using chi-square tests, and in the presence of overall significance, post hoc Bonferroni adjusted z tests were performed. Results There were 72 programs that had at least one CPR event during the study period. The overall CPR rate was 0.42% (777 CPR episodes/184,272 patient contacts) from 115 programs reporting transport volume and CPR events from the GAMUT database during the study period. Adult, pediatric, and neonatal transport programs (n = 57, 40 and 16, respectively) had significantly different CPR rates (P < 0.001) i.e., 0.68% (555/82,094), 0.18% (138/76,430), and 0.33% (73/21,823), respectively. Presence of an advanced airway and mobilization time was significantly associated with CPR episodes (P < 0.001) (Rs = +0.41 and Rs = −0.60, respectively). Other transport quality metrics such as waveform capnography, first attempt intubation, and DASH1A success rate were not significantly associated with CPR episodes. Conclusion The overall CPR rate during medical transport is 0.42%. Adult, pediatric, and neonatal program types have significantly different overall rates of CPR. Presence of advanced airway and mobilization time had an association with the rate of CPR during transport.
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Abstract
The main inherited cardiac arrhythmias are long QT syndrome, short QT syndrome, catecholaminergic polymorphic ventricular tachycardia and Brugada syndrome. These rare diseases are often the underlying cause of sudden cardiac death in young individuals and result from mutations in several genes encoding ion channels or proteins involved in their regulation. The genetic defects lead to alterations in the ionic currents that determine the morphology and duration of the cardiac action potential, and individuals with these disorders often present with syncope or a life-threatening arrhythmic episode. The diagnosis is based on clinical presentation and history, the characteristics of the electrocardiographic recording at rest and during exercise and genetic analyses. Management relies on pharmacological therapy, mostly β-adrenergic receptor blockers (specifically, propranolol and nadolol) and sodium and transient outward current blockers (such as quinidine), or surgical interventions, including left cardiac sympathetic denervation and implantation of a cardioverter-defibrillator. All these arrhythmias are potentially life-threatening and have substantial negative effects on the quality of life of patients. Future research should focus on the identification of genes associated with the diseases and other risk factors, improved risk stratification and, in particular for Brugada syndrome, effective therapies.
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Incidence, characteristics, and outcomes of pediatric out-of-hospital cardiac arrest in nursery schools and kindergartens in Japan. J Cardiol 2020; 76:549-556. [PMID: 32616330 DOI: 10.1016/j.jjcc.2020.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/16/2020] [Accepted: 05/29/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND A better understanding of the epidemiology of pediatric out-of-hospital cardiac arrest (OHCA) occurring in nursery schools and kindergartens is indispensable to establish an evidence-based strategy for prevention and improved outcomes. This study aimed to describe the incidence, characteristics, and outcomes of pediatric OHCAs that occurred in certified nursery schools and kindergartens. METHODS Stop and Prevent cardIac aRrest, Injury, and Trauma in Schools (SPIRITS) is a study to construct and analyze a nationwide registry of pediatric OHCAs occurring in school settings in Japan. Using data from the SPIRITS registry, we assessed the incidence, characteristics, and outcomes of pediatric OHCAs that occurred in certified nursery schools/kindergartens between April 2008 and December 2016. RESULTS During the study period, 37 OHCA patients (31 in certified nursery schools and 6 in kindergartens) were confirmed. The overall incidence rate was 0.13 per 100,000 children per year. Among 37 patients, 57% (21/37) had an OHCA while napping and 35% (13/37) experienced OHCA that was witnessed by bystanders. Although public-access automated external defibrillator pads were applied by bystanders in 24% (9/37) of cases, only 1 patient actually received defibrillation. Overall, the proportion of 1-month survival with favorable neurological outcomes after OHCA was 19% (7/37). Among those with OHCA of non-medical origins, 60% (3/5) of patients experienced arrest caused by suffocation, 60% (3/5) by drowning, and 100% (1/1) by head injury. In contrast, no patient had 1-month favorable neurological outcomes among those with OHCA of medical origins such as presumed cardiac origin (0/17), sudden infant death syndrome (0/6), acute viral myocarditis (0/1), respiratory disease (0/1), and ventricular fibrillation (0/1). CONCLUSIONS In this population, the majority of pediatric OHCAs occurring in certified nursery schools/kindergartens had non-ventricular fibrillation rhythm, and their outcomes after OHCA of medical origin were poor.
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Pruitt CM. Pediatric out-of-hospital cardiac arrest: More common than we thought? Resuscitation 2020; 153:260-261. [PMID: 32485188 DOI: 10.1016/j.resuscitation.2020.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
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Burns KM, Cottengim C, Dykstra H, Faulkner M, Lambert ABE, MacLeod H, Novak A, Parks SE, Russell MW, Shapiro-Mendoza CK, Shaw E, Tian N, Whittemore V, Kaltman JR. Epidemiology of Sudden Death in a Population-Based Study of Infants and Children. THE JOURNAL OF PEDIATRICS: X 2020; 2. [PMID: 32743542 PMCID: PMC7394394 DOI: 10.1016/j.ympdx.2020.100023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective To describe epidemiologic data from the Sudden Death in the Young (SDY) Case Registry. Understanding the scope of SDY may optimize prevention efforts. Study design We analyzed sudden, unexpected deaths of infants (<365 days) and children (1–17 years) from a population-based registry of 8 states/jurisdictions in 2015 and 9 in 2016. Natural deaths and injury deaths from drowning, motor vehicle accident drivers, and infant suffocation were included; other injury deaths, homicide, suicide, intentional overdose, and terminal illness were excluded. Cases were categorized using a standardized algorithm. Descriptive statistics were used to characterize deaths, and mortality rates were calculated. Results Of 1319 cases identified, 92% had an autopsy. We removed incomplete cases, leaving 1132 analyzable deaths (889 infants, 243 children). The SDY rate for infants was 120/100 000 live births and for children was 1.9/100 000 children. Explained Cardiac rates were greater for infants (2.7/100 000 live births) than children (0.3/100 000 children). The pediatric Sudden Unexpected Death in Epilepsy (SUDEP) mortality rate was 0.2/100 000 live births and children. Blacks comprised 42% of infant and 43% of child deaths but only 23% of the population. In all ages, myocarditis/endocarditis was the most common Explained Cardiac cause; respiratory illness was the most common Explained Other cause. SDY occurred during activity in 13% of childhood cases. Conclusions Prevention strategies include optimizing identification and treatment of respiratory and cardiac diseases.
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Affiliation(s)
- Kristin M. Burns
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Carri Cottengim
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Heather Dykstra
- National Center for Fatality Review and Prevention, Michigan Public Health Institute. Okemos, MI
| | - Meghan Faulkner
- National Center for Fatality Review and Prevention, Michigan Public Health Institute. Okemos, MI
| | | | - Heather MacLeod
- National Center for Fatality Review and Prevention, Michigan Public Health Institute. Okemos, MI
| | - Alissa Novak
- Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor, MI
| | - Sharyn E. Parks
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Mark W. Russell
- Division of Pediatric Cardiology, University of Michigan Medical School, Ann Arbor, MI
| | - Carrie K. Shapiro-Mendoza
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Esther Shaw
- National Center for Fatality Review and Prevention, Michigan Public Health Institute. Okemos, MI
| | - Niu Tian
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Vicky Whittemore
- Division of Neuroscience, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD
| | - Jonathan R. Kaltman
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
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Griffis H, Wu L, Naim MY, Bradley R, Tobin J, McNally B, Vellano K, Quan L, Markenson D, Rossano JW. Characteristics and outcomes of AED use in pediatric cardiac arrest in public settings: The influence of neighborhood characteristics. Resuscitation 2019; 146:126-131. [PMID: 31785372 DOI: 10.1016/j.resuscitation.2019.09.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/27/2019] [Accepted: 09/09/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Automated external defibrillators (AEDs) are critical in the chain of survival following out-of-hospital cardiac arrest (OHCA), yet few studies have reported on AED use and outcomes among pediatric OHCA. This study describes the association between bystander AED use, neighborhood characteristics and survival outcomes following public pediatric OHCA. METHODS Non-traumatic OHCAs among children less than18 years of age in a public setting between from January 1, 2013 through December 31, 2017 were identified in the CARES database. A neighborhood characteristic index was created from the addition of dichotomous values of 4 American Community Survey neighborhood characteristics at the Census tract level: median household income, percent high school graduates, percent unemployment, and percent African American. Multivariable logistic regression models assessed the association of OHCA characteristics, the neighborhood characteristic index and outcomes. RESULTS Of 971 pediatric OHCA, AEDs were used by bystanders in 10.3% of OHCAs. AEDs were used on 2.3% of children ≤1 year (infants), 8.3% of 2-5 year-olds, 12.4% of 6-11 year-olds, and 18.2% of 12-18 year-olds (p < 0.001). AED use was more common in neighborhoods with a median household income of >$50,000 per year (12.3%; p = 0.016), <10% unemployment (12.1%; p = 0.002), and >80% high school education (11.8%; p = 0.002). Greater survival to hospital discharge and neurologically favorable survival were among arrests with bystander AED use, varying by neighborhood characteristics. CONCLUSIONS Bystander AED use is uncommon in pediatric OHCA, particularly in high-risk neighborhoods, but improves survival. Further study is needed to understand disparities in AED use and outcomes.
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Affiliation(s)
- H Griffis
- Healthcare Analytics Unit, The Children's Hospital of Philadelphia, United States; Department of Biomedical Health Informatics, The Children's Hospital of Philadelphia, United States; Cardiac Center Research Core, The Children's Hospital of Philadelphia, United States.
| | - L Wu
- The Children's Hospital of Philadelphia, United States
| | - M Y Naim
- Cardiac Center Research Core, The Children's Hospital of Philadelphia, United States; The Children's Hospital of Philadelphia, United States; Division of Critical Care, The Children's Hospital of Philadelphia, United States
| | - R Bradley
- Division of Emergency Medical Services and Disaster Medicine, University of Texas Health Science Center, United States
| | - J Tobin
- Division of Trauma Anesthesiology, University of Southern California, United States
| | - B McNally
- Department of Emergency Medicine, Emory University, United States
| | - K Vellano
- Department of Emergency Medicine, Emory University, United States
| | - L Quan
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine, United States
| | | | - J W Rossano
- Cardiac Center Research Core, The Children's Hospital of Philadelphia, United States; The Children's Hospital of Philadelphia, United States; Division of Critical Care, The Children's Hospital of Philadelphia, United States
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Yamashita A, Kurosaki H, Takada K, Tanaka Y, Hamada Y, Ishita T, Kubo M, Inaba H. Association of school hours with outcomes of out-of-hospital cardiac arrest in schoolchildren. HEART ASIA 2019; 11:e011236. [PMID: 31565076 DOI: 10.1136/heartasia-2019-011236] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 11/03/2022]
Abstract
Objective To investigate the association of school hours with outcomes of schoolchildren with out-of-hospital cardiac arrest (OHCA). Methods From the 2005-2014 nationwide databases, we extracted the data for 1660 schoolchildren (6-17 years) with bystander-witnessed OHCA. Univariate analyses followed by propensity-matching procedures and stepwise logistic regression analyses were applied. School hours were defined as 08:00 to 18:00. Results The neurologically favourable 1-month survival rate during school hours was better than that during non-school hours only on school days: 18.4% and 10.5%, respectively. During school hours on school days, patients with OHCA more frequently received bystander cardiopulmonary resuscitation (CPR) and public access defibrillation (PAD), and had a shockable initial rhythm and presumed cardiac aetiology. The neurologically favourable 1-month survival rate did not significantly differ between school hours on school days and all other times of day after propensity score matching: 16.4% vs 16.1% (unadjusted OR 1.02; 95% CI 0.69 to 1.51). Stepwise logistic regression analysis during school hours on school days revealed that shockable initial rhythm (adjusted OR 2.44; 95% CI 1.12 to 5.42), PAD (adjusted OR 3.32; 95% CI 1.23 to 9.10), non-exogenous causes (adjusted OR 5.88; 95% CI 1.85 to 20.0) and a shorter emergency medical service (EMS) response time (adjusted OR 1.15; 95% CI 1.02 to 1.32) and witness-to-first CPR interval (adjusted OR 1.08; 95% CI 1.01 to 1.15) were major factors associated with an improved neurologically favourable 1-month survival rate. Conclusions School hours are not an independent factor associated with improved outcomes of OHCA in schoolchildren. The time delays in CPR and EMS arrival were independently associated with poor outcomes during school hours on school days.
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Affiliation(s)
- Akira Yamashita
- Department of Circulatory Emergency and Resuscitation Science, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.,Department of Cardiology, Noto General Hospital, Nanao, Japan
| | - Hisanori Kurosaki
- Department of Circulatory Emergency and Resuscitation Science, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Kohei Takada
- Department of Circulatory Emergency and Resuscitation Science, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Yoshio Tanaka
- Department of Circulatory Emergency and Resuscitation Science, Kanazawa University Graduate School of Medicine, Kanazawa, Japan.,Emergency Medical Centre, Ishikawa Prefecture Central Hospital, Kanazawa, Japan
| | | | | | - Minoru Kubo
- Ishikawa Prefectural Nursing School, Kanazawa, Japan
| | - Hideo Inaba
- Department of Circulatory Emergency and Resuscitation Science, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
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Rosengarten L, Ban S. Basic life support for the child and infant. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2019; 28:1118-1122. [PMID: 31556731 DOI: 10.12968/bjon.2019.28.17.1118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The majority of cardiorespiratory arrests in children and infants are caused by respiratory insufficiency rather than cardiac problems; therefore, the order of delivering resuscitation is different to the delivery of basic life support to adults. The Nursing and Midwifery Council has stated that all nurses must be able to provide basic life support. This article will explain the process for recognising the need for, and delivering, basic life support to infants and children.
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Affiliation(s)
- Leah Rosengarten
- Lecturer in Children's Nursing, Department of Health and Life Sciences, University of Northumbria, Newcastle
| | - Sasha Ban
- Senior Lecturer in Children's Nursing, Department of Health and Life Sciences, University of Northumbria, Newcastle
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Tsuda T, Geary EM, Temple J. Significance of automated external defibrillator in identifying lethal ventricular arrhythmias. Eur J Pediatr 2019; 178:1333-1342. [PMID: 31297625 DOI: 10.1007/s00431-019-03421-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 06/21/2019] [Accepted: 06/30/2019] [Indexed: 12/24/2022]
Abstract
Automated electrical defibrillator (AED) is critical in saving children who develop unexpected cardiac arrest (CA), but its diagnostic capacity is not fully acknowledged. Retrospective cohort study of patients with aborted sudden cardiac death (SCD) was performed. Twenty-five patients (14 males) aged 1.3 to 17.5 years who presented with CA survived with prompt cardiopulmonary resuscitation. Eighteen patients had no prior cardiac diagnosis. Cardiac arrest occurred in 10 patients with more than moderate exercise, in 7 with light exercise, and in 8 at rest (including one during sleep). Twenty-two patients were resuscitated with AED, all of which were recognized as a shockable cardiac rhythm. Thorough investigations revealed 6 ion channelopathies (4 catecholaminergic polymorphic ventricular tachycardia, one long QT syndrome, and one Brugada syndrome), 5 congenital heart disease (including 2 with coronary artery obstruction), 6 cardiomyopathies, 2 myocarditis, and 2 miscellaneous. Four patients had no identifiable heart disease. In 5 patients, the downloaded AED-recorded rhythm strip delineated the underlying arrhythmias and their responses to electrical shocks. Four patients who presented with generalized seizure at rest were initially managed for seizure disorder until AED recording identified lethal ventricular arrhythmias.Conclusions: AED reliably identifies the underlying lethal ventricular arrhythmias in addition to aborting SCD. What is Known: • Although infrequent in children, sudden cardiac death (SCD) is often an unexpected and tragic event. The etiology is diverse and sometimes remains unknown despite extensive investigations. • Automated external defibrillator (AED) is both therapeutic in aborting SCD and diagnostic in identifying the underlying lethal ventricular arrhythmias. However, the diagnostic aspect of AED is under-acknowledged by most medical providers. What is New: • Four of 25 patients (16%) were initially managed for possible seizure disorders until AED recording identified lethal ventricular arrhythmia. • The AED recording of the lethal arrhythmia during cardiopulmonary resuscitation (CPR) should always be obtained as it plays a crucial role in the decision-making process before ICD implantation. All medical providers should become familiar with downloading cardiac rhythm strips from AED when requested.
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Affiliation(s)
- Takeshi Tsuda
- Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA. .,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Elaine M Geary
- Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA
| | - Joel Temple
- Nemours Cardiac Center, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Rd, Wilmington, DE, 19803, USA.,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
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Yurtseven A, Turan C, Akarca FK, Saz EU. Pediatric cardiac arrest in the emergency department: Outcome is related to the time of admission. Pak J Med Sci 2019; 35:1434-1440. [PMID: 31489021 PMCID: PMC6717451 DOI: 10.12669/pjms.35.5.487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives: Nights and weekends represent a potentially high-risk time for pediatric cardiac arrest (CA) patients in emergency departments. Data regarding night or weekend arrest and its impact on outcomes is controversial. The purpose of this study was to determine the relationship between cardiopulmonary resuscitation during the various emergency department shifts and survival to discharge. Methods: We conducted a retrospective, observational study of patients who had visited our Emergency Department for CAs from January 2014 to December 2016. Medical records and patient characteristics of 67 children with CA were retrieved from patient admission files. Results: The mean age was 54.7±7.3 months and 59% were male. Rates of survival to discharge 35% (11/31) within working hours’ vs. out of working hours 3% (1/36). Among the CAs presenting to the emergency department, the survival rates were higher for working hours than for non-working hours (OR: 37.6 (2.62-539.7), p: 008). The rate of return of spontaneous circulation within working hours was higher than that of non-working hours (71% vs.19%) (p<0.001). Patients who received chest compression for more than 10 minutes had the lowest survival rate (2%) (p<0.001), whereas better outcome was associated with in-hospital CA, younger age (less than 12 months) and respiratory failure. Conclusion: Survival rates from pediatric CAs were significantly lower during non-working hours. Poor outcome was associated with prolonged cardiopulmonary resuscitation, out of hospital CA and older age.
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Affiliation(s)
- Ali Yurtseven
- Ali Yurtseven, MD. Department of Pediatrics, Division of Emergency Medicine, Ege University School of Medicine, Izmir, Turkey
| | - Caner Turan
- Caner Turan, MD. Department of Pediatrics, Division of Emergency Medicine, Ege University School of Medicine, Izmir, Turkey
| | - Funda Karbek Akarca
- Funda Karbek Akarca, MD. Associate Professor, Department of Emergency Medicine, Ege University School of Medicine, Izmir, Turkey
| | - Eylem Ulas Saz
- Prof. Eylem Ulas Saz, MD. Department of Pediatrics, Division of Emergency Medicine, Ege University School of Medicine, Izmir, Turkey
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Time of on-scene resuscitation in out of-hospital cardiac arrest patients transported without return of spontaneous circulation. Resuscitation 2019; 138:235-242. [DOI: 10.1016/j.resuscitation.2019.03.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/05/2019] [Accepted: 03/19/2019] [Indexed: 01/04/2023]
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Sado J, Kiyohara K, Kitamura T, Matsui S, Ayusawa M, Nitta M, Iwami T, Nakata K, Sobue T, Kitamura Y. Sports activity and paediatric out-of-hospital cardiac arrest at schools in Japan. Resuscitation 2019; 139:33-40. [PMID: 30953710 DOI: 10.1016/j.resuscitation.2019.03.041] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 03/12/2019] [Accepted: 03/26/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sudden cardiac death during exercise or sports is an important problem among young athletes and non-athletes. An understanding of the epidemiological features of sports-related out-of-hospital cardiac arrest (OHCA) among children is crucial for planning approaches for prevention and better outcomes of paediatric OHCAs. We assessed the characteristics and outcomes of sports-related OHCA among children at schools in Japan to prevent sports-related paediatric OHCA at schools. METHODS The Stop and Prevent cardIac aRrest, Injury, and Trauma in Schools (SPIRITS) is a nationwide, prospective, observational study linking databases of two nationally representative registries. Data on the characteristics and outcomes of sports-related paediatric OHCA at schools in Japan were obtained from these databases. RESULTS Between 2008 and 2015, 188 sports-related paediatric OHCAs due to presumed cardiac origin occurred. The greatest proportion of OHCA during or after sports was due to long-distance running (21.8%), followed by soccer/futsal (13.3%), basketball (12.2%), and baseball/rubber-ball baseball (11.2%). We also assessed the association between prehospital factors and one-month survival with favourable neurological outcome after sports-related OHCA. The proportions of ventricular fibrillation as the first documented rhythm, bystander cardiopulmonary resuscitation (CPR), and public-access defibrillation (PAD) were 87.8%, 87.2%, and 63.3%, respectively. Compared with the non-PAD group, the adjusted odds ratio (95% confidence interval) of the PAD group was 3.64 (1.78-7.45). CONCLUSIONS In Japan, 188 schoolchildren experienced OHCAs of cardiac origin occurring during or after sports activity at schools during the 8-year period. Increasing PAD is essential to enhance better neurological outcome after sports-related OHCA among students.
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Affiliation(s)
- Junya Sado
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita 565-0871, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Otsuma Women's University, 12 Sanbancho Chiyoda-ku, Tokyo 102-8357, Japan.
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita 565-0871, Japan
| | - Satoshi Matsui
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita 565-0871, Japan; Department of Emergency Medicine, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojima Chuo-ku, Kobe 650-0047, Japan
| | - Mamoru Ayusawa
- Department of Pediatrics, Nihon University School of Medicine, 30-1 Ooyaguchikamichou, Itabashi-ku, Tokyo 173-8610, Japan
| | - Masahiko Nitta
- Department of Emergency Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan; Department of Pediatrics, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan
| | - Taku Iwami
- Kyoto University Health Service, Yoshida Honmachi, Sakyo-ku, Kyoto 606-8501, Japan
| | - Ken Nakata
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita 565-0871, Japan
| | - Tomotaka Sobue
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita 565-0871, Japan
| | - Yuri Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-2 Yamada-Oka, Suita 565-0871, Japan
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Vehmeijer JT, Hulleman M, Kuijpers JM, Blom MT, Tan HL, Mulder BJ, de Groot JR, Koster RW. Resuscitation for out-of-hospital cardiac arrest in adults with congenital heart disease. Int J Cardiol 2019; 278:70-75. [DOI: 10.1016/j.ijcard.2018.10.096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 09/07/2018] [Accepted: 10/26/2018] [Indexed: 01/25/2023]
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Amagasa S, Kashiura M, Moriya T, Uematsu S, Shimizu N, Sakurai A, Kitamura N, Tagami T, Takeda M, Miyake Y. Relationship between institutional case volume and one-month survival among cases of paediatric out-of-hospital cardiac arrest. Resuscitation 2019; 137:161-167. [PMID: 30802557 DOI: 10.1016/j.resuscitation.2019.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
AIM To evaluate volume-outcome relationship in paediatric out-of-hospital cardiac arrest (OHCA). METHODS This post hoc analysis of the SOS-KANTO 2012 study included data of paediatric OHCA patients <18 years old who were transported to the 53 emergency hospitals in the Kanto region of Japan between January 2012 and March 2013. Based on the paediatric OHCA case volume, the higher one-third of institutions (more than 10 paediatric OHCA cases during the study period) were defined as high-volume centres, the middle one-third institutions (6-10 cases) were defined as middle-volume centres and the lower one-third of institutions (less than 6 cases) were defined as low-volume centres. The primary outcome measurement was survival at 1 month after cardiac arrest. Multivariate logistic regression analysis for 1-month survival and paediatric OHCA case volume were performed after adjusting for multiple propensity scores. To estimate the multiple propensity score, we fitted a multinomial logistic regression model, which fell into one of the three groups as patient demographics and prehospital factors. RESULTS Among the eligible 282 children, 112, 82 and 88 patients were transported to the low-volume (36 institutions), middle-volume (11 institutions) and high-volume (6 institutions) centres, respectively. Transport to a high-volume centre was significantly associated with a better 1-month survival after adjusting for multiple propensity score (adjusted odds ratio, 2.55; 95% confidence interval, 1.05-6.17). CONCLUSION There may be a relationship between institutional case volume and survival outcomes in paediatric OHCA.
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Affiliation(s)
- Shunsuke Amagasa
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan; Division of Emergency and Transport Services, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Masahiro Kashiura
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan
| | - Takashi Moriya
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan
| | - Satoko Uematsu
- Division of Emergency and Transport Services, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Naoki Shimizu
- Department of Critical Care and Emergency Medicine, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Atsushi Sakurai
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1, Oyagutikamichou, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Nobuya Kitamura
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, 1010, Sakurai, Kisarazushi, Chiba, 292-8535, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1, Nagayama, Tama-shi, Tokyo, 206-8512, Japan
| | - Munekazu Takeda
- Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yasufumi Miyake
- Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
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The Pillow Project, Infant Choking, and Basic Life Support Training for Prospective Parents: A Low-Cost Intervention for Widespread Application. J Perinat Neonatal Nurs 2019; 33:260-267. [PMID: 31335856 DOI: 10.1097/jpn.0000000000000397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Dissemination of pediatric basic life support skills, while recommended, is not done routinely for pregnant women and their partners within the maternity services. This study evaluates an e-learning program coupled with the use of a novel infant pillow mannequin to determine whether a low-cost intervention with potential for widespread application could enable training in the event of an infant choking and the provision of basic life support. A prospective cohort study with an uncontrolled pre- and posttest design was used following institutional ethical approval. A 4-week cycle of antenatal education classes in a regional Maternity Hospital in Ireland and a purposive sample of pregnant women and their partners attending the antenatal education classes were used. The following measures were assessed: (1) confidence in knowing what to do in the event of an infant choking; (2) confidence in performing infant cardiopulmonary resuscitation (CPR); (3) ability to perform the requisite skills; and (4) the perceived acceptability of the infant pillow mannequin as a means of practice. Twenty-four individuals completed a pre- and postprogram questionnaire. The e-learning program along with practice on the pillow mannequin significantly affected confidence (P < .001) in the actions to take in the event of an infant choking and in performing infant CPR. Forty-four participants used the pillow mannequin for practice and volunteered to have their skills assessed. More than 90% demonstrated correct positioning of the infant in the event of choking, correctly identified the correct ratio of chest compressions to breaths, and conducted chest compressions to the required depth. Three distinct categories of comment were identified: usefulness of the program; simplicity of the program/pillow mannequin; and accessibility for practice at home. A self-instructional e-learning program coupled with an infant pillow mannequin enables parents to learn the procedure in the event of an infant choking and to demonstrate basic life support. This low-cost intervention has the potential for widespread application within developed and developing countries.
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Auerbach M, Brown L, Whitfill T, Baird J, Abulebda K, Bhatnagar A, Lutfi R, Gawel M, Walsh B, Tay KY, Lavoie M, Nadkarni V, Dudas R, Kessler D, Katznelson J, Ganghadaran S, Hamilton MF. Adherence to Pediatric Cardiac Arrest Guidelines Across a Spectrum of Fifty Emergency Departments: A Prospective, In Situ, Simulation-based Study. Acad Emerg Med 2018; 25:1396-1408. [PMID: 30194902 DOI: 10.1111/acem.13564] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Revised: 08/09/2018] [Accepted: 08/27/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Pediatric out-of-hospital cardiac arrest survival outcomes are dismal (<10%). Care that is provided in adherence to established guidelines has been associated with improved survival. Lower mortality rates have been reported in higher-volume hospitals, teaching hospitals, and trauma centers. The primary objective of this article was to explore the relationship of hospital characteristics, such as annual pediatric patient volume, to adherence to pediatric cardiac arrest guidelines during an in situ simulation. Secondary objectives included comparing adherence to other team, provider, and system factors. METHODS This prospective, multicenter, observational study evaluated interprofessional teams in their native emergency department (ED) resuscitation bays caring for a simulated 5-year-old child presenting in cardiac arrest. The primary outcome, adherence to the American Heart Association pediatric guidelines, was assessed using a 14-item tool including three component domains: basic life support (BLS), pulseless electrical activity (PEA), and ventricular fibrillation (VF). Provider, team, and hospital-level data were collected as independent data. EDs were evaluated in four pediatric volume groups (low < 1,800/year; medium 1,800-4,999; medium-high 5,000-9,999; high > 10,000). Cardiac arrest adherence and domains were evaluated by pediatric patient volume and other team and hospital-level characteristics, and path analyses were performed to evaluate the contribution of patient volume, systems readiness, and teamwork on BLS, PEA, and VF adherence. RESULTS A total of 101 teams from a spectrum of 50 EDs participated including nine low pediatric volume (<1,800/year), 36 medium volume (1,800-4,999/year), 24 medium-high (5,000-9,999/year), and 32 high volume (≥10000/year). The median total adherence score was 57.1 (interquartile range = 50.0-78.6). This was not significantly different across the four volume groups. The highest level of adherence for BLS and PEA domains was noted in the medium-high-volume sites, while no difference was noted for the VF domain. The lowest level of BLS adherence was noted in the lowest-volume EDs. Improved adherence was not directly associated with higher pediatric readiness survey (PRS) score provider experience, simulation teamwork performance, or more providers with Pediatric Advanced Life Support (PALS) training. EDs in teaching hospitals with a trauma center designation that served only children demonstrated higher adherence compared to nonteaching hospitals (64.3 vs 57.1), nontrauma centers (64.3 vs. 57.1), and mixed pediatric and adult departments (67.9 vs. 57.1), respectively. The overall effect sizes for total cardiac adherence score are ED type γ = 0.47 and pediatric volume (low and medium vs. medium-high and high) γ = 0.41. A series of path analyses models was conducted that indicated that overall pediatric ED volume predicted significantly better guideline adherence, but the effect of volume on performance was only mediated by the PRS for the VF domain. CONCLUSIONS This study demonstrated variable adherence to pediatric cardiac arrest guidelines across a spectrum of EDs. Overall adherence was not associated with ED pediatric volume. Medium-high-volume EDs demonstrated the highest levels of adherence for BLS and PEA. Lower-volume EDs were noted to have lower adherence to BLS guidelines. Improved adherence was not directly associated with higher PRS score provider experience, simulation teamwork performance, or more providers with PALS training. This study demonstrates that current approaches optimizing the care of children in cardiac arrest in the ED (provider training, teamwork training, environmental preparation) are insufficient.
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Affiliation(s)
- Marc Auerbach
- Department of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Linda Brown
- Department of Emergency Medicine, Alpert School of Medicine at Brown University, Providence, RI
| | - Travis Whitfill
- Department of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Janette Baird
- Department of Emergency Medicine, Alpert School of Medicine at Brown University, Providence, RI
| | - Kamal Abulebda
- Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Ambika Bhatnagar
- Department of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Riad Lutfi
- Department of Pediatrics, Division of Critical Care, Indiana University School of Medicine, Riley Hospital for Children at Indiana University Health, Indianapolis, IN
| | - Marcie Gawel
- Department of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT
| | - Barbara Walsh
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Boston University, Boston, MA
| | - Khoon-Yen Tay
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Megan Lavoie
- Department of Pediatrics, Division of Pediatric Emergency Medicine, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Vinay Nadkarni
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Robert Dudas
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - David Kessler
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Jessica Katznelson
- Department of Pediatrics, Division of Pediatric Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sandeep Ganghadaran
- Department of Critical Care Medicine and Pediatrics, Children's Hospital at Montefiore, Bronx, NY
| | - Melinda Fiedor Hamilton
- Department of Critical Care Medicine and Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, PA
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Day E, Hort JR. Out-of-hospital arrests attending an Australian tertiary paediatric emergency department over 13 years: An observational study. Emerg Med Australas 2018; 30:687-693. [DOI: 10.1111/1742-6723.13127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 03/31/2018] [Accepted: 05/30/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Elisabeth Day
- Children's Hospital at Westmead; Sydney New South Wales Australia
| | - Jason R Hort
- Children's Hospital at Westmead; Sydney New South Wales Australia
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Vos A, van der Wal AC, Teeuw AH, Bras J, Vink A, Nikkels PGJ. Cardiovascular causes of sudden unexpected death in children and adolescents (0-17 years) : A nationwide autopsy study in the Netherlands. Neth Heart J 2018; 26:500-505. [PMID: 30178211 PMCID: PMC6150875 DOI: 10.1007/s12471-018-1152-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Little is known about the causes of unexpected death in minors (0–17 years). In young adults an important cause is cardiovascular disease, with primary arrhythmogenic disorders, atherosclerotic events, cardiomyopathies and myocarditis as main contributors. The aim of this autopsy study was to determine the contribution of cardiovascular disease to unexpected death in minors. Methods and results In the Netherlands, systematic investigation of all cases of unexplained death in minors was compulsory in a nationwide governmental project during a 15-month period. Autopsies were performed according to a standardised protocol (autopsy rate 85%). A cardiovascular cause of death was found in 13/56 cases (23%). In the group <1 year, the main cardiovascular causes were various congenital defects (n = 3) and myocarditis (n = 2). In the 1–9 year group, no cardiovascular causes were found. In the 10–14 year group, hypertrophic cardiomyopathy (n = 1) and ruptured ascending aortic aneurysm (n = 1) were among the observed cardiovascular causes. In 14/56 (25%) cases autopsy revealed no structural abnormalities that could explain the sudden death, mostly in the group <1 year. Conclusion This national cohort with a high autopsy rate reveals a high incidence (23%) of cardiovascular diseases as the pathological substrate of sudden unexpected death in children. Another high percentage of minors (25%) showed no structural abnormalities, with the possibility of a genetic arrhythmia. These findings underline the importance of systematic autopsy in sudden death in minors, with implications for cardiogenetic screening of relatives. Electronic supplementary material The online version of this article (10.1007/s12471-018-1152-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Vos
- Department of Pathology, University Medical Center, Utrecht, The Netherlands.
| | - A C van der Wal
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - A H Teeuw
- Department of Paediatrics, Academic Medical Center, Amsterdam, The Netherlands
| | - J Bras
- Department of Pathology, University Medical Center, Utrecht, The Netherlands.,Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - A Vink
- Department of Pathology, University Medical Center, Utrecht, The Netherlands
| | - P G J Nikkels
- Department of Pathology, University Medical Center, Utrecht, The Netherlands
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72-h therapeutic hypothermia improves neurological outcomes in paediatric asphyxial out-of-hospital cardiac arrest-An exploratory investigation. Resuscitation 2018; 133:180-186. [PMID: 30142398 DOI: 10.1016/j.resuscitation.2018.08.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 08/17/2018] [Accepted: 08/20/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Recent studies suggest that a 48-h therapeutic hypothermia protocol does not improve outcomes in paediatric out-of-hospital cardiac arrest survivors. The aim of this study was to evaluate the effect of 72-h therapeutic hypothermia at 33 °C compared to normothermia at 35.5 °C-37.5 °C on outcomes and the incidence of adverse events in paediatric asphyxial out-of-hospital cardiac arrest survivors. METHODS We conducted this retrospective cohort study at a tertiary paediatric intensive care unit between January 2010 and June 2017. All children from 1 month to 18 years of age with asphyxial out-of-hospital cardiac arrest and a history of at least 3 min of chest compressions who survived for 12 h or more after the return of circulation were eligible. RESULTS Sixty-four patients met the eligibility criteria for the study. Forty-nine (76.6%) of the 64 children were male, and the mean age was 4.86+/-5.26 years. Twenty-four (37.5%) of the children had underlying disorders. The overall 1-month survival rate was 43.2%. Twenty-five (39.1%) of the children received therapeutic hypothermia at 33 °C for 72 h. The 1-month survival rate was significantly higher (p = 0.037) in the therapeutic hypothermia group (15/25, 60%) than in the normothermia group (12/39, 30.8%). The therapeutic hypothermia group had significantly better neurological outcomes (7/15, 46.7%) than the normothermia group (1/12, 8.3%) (p = 0.043). CONCLUSION Paediatric asphyxial out-of-hospital cardiac arrest was associated with high mortality and morbidity. Seventy-two-hour therapeutic hypothermia was associated with a better 1-month survival rate and 6-month neurological outcomes than normothermia in our paediatric patients with asphyxial out-of-hospital cardiac arrest.
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50
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Patient Characteristics and Emergency Department Factors Associated with Survival After Sudden Cardiac Arrest in Children and Young Adults: A Cross-Sectional Analysis of a Nationally Representative Sample, 2006-2013. Pediatr Cardiol 2018; 39:1216-1228. [PMID: 29748701 DOI: 10.1007/s00246-018-1886-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 05/02/2018] [Indexed: 11/27/2022]
Abstract
The purpose of the study is to examine (1) nationally representative incidence rates of Emergency Department (ED) visits due to sudden cardiac arrest (SCA) in pediatric and young adult populations, (2) basic characteristics of the ED visits with SCA, and (3) patient and hospital factors associated with survival after SCA. We used the Nationwide Emergency Department Sample from 2006 to 2013. ICD-9-CM diagnostic codes identified ED visits due to SCA for patients ≤ 30 years old. Outcomes included yearly incidence of ED visits for SCA, and survival to hospital discharge. Predictors of interest were age groups, sex, and SCA case volume. A logistic regression model adjusted by patient- and hospital-level variables was used. Stratified analyses of age by (< 12 and ≥ 12 years old) were performed to explore the effect of pubertal development on SCA. With 71,881 ED visits due to SCA, the total incidence rate was 6.9 per 100,000 population, with a mortality rate of 89.6% and male/female ratio of 1.7. With the adjusted regression models, there were no differences in survival rate by sex; however, when stratified at 12 years old, males were less likely to survive than females above 12 years old (odds ratio [OR] 0.71, P < 0.01), but not under 12 years old. No statistically significant differences in survival rates between low- and high-SCA volume EDs were detected (OR 1.03, P = 0.77). Data showed no benefit of regionalized care for post-SCA in ≤ 30-year-old populations. With further examination of the differences between sexes, new management strategies for SCA cases can be developed.
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