1
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Katzenschlager S, Kelpanides IK, Ristau P, Huck M, Seewald S, Brenner S, Hoffmann F, Wnent J, Kramer-Johansen J, Tjelmeland IBM, Weigand MA, Gräsner JT, Popp E. Out-of-hospital cardiac arrest in children: an epidemiological study based on the German Resuscitation Registry identifying modifiable factors for return of spontaneous circulation. Crit Care 2023; 27:349. [PMID: 37679812 PMCID: PMC10485980 DOI: 10.1186/s13054-023-04630-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023] Open
Abstract
AIM This work provides an epidemiological overview of out-of-hospital cardiac arrest (OHCA) in children in Germany between 2007 and 2021. We wanted to identify modifiable factors associated with survival. METHODS Data from the German Resuscitation Registry (GRR) were used, and we included patients registered between 1st January 2007 and 31st December 2021. We included children aged between > 7 days and 17 years, where cardiopulmonary resuscitation (CPR) was started, and treatment was continued by emergency medical services (EMS). Incidences and descriptive analyses are presented for the overall cohort and each age group. Multivariate binary logistic regression was performed on the whole cohort to determine the influence of (1) CPR with/without ventilation started by bystander, (2) OHCA witnessed status and (3) night-time on the outcome hospital admission with return of spontaneous circulation (ROSC). RESULTS OHCA in children aged < 1 year had the highest incidence of the same age group, with 23.42 per 100 000. Overall, hypoxia was the leading presumed cause of OHCA, whereas trauma and drowning accounted for a high proportion in children aged > 1 year. Bystander-witnessed OHCA and bystander CPR rate were highest in children aged 1-4 years, with 43.9% and 62.3%, respectively. In reference to EMS-started CPR, bystander CPR with ventilation were associated with an increased odds ratio for ROSC at hospital admission after adjusting for age, sex, year of OHCA and location of OHCA. CONCLUSION This study provides an epidemiological overview of OHCA in children in Germany and identifies bystander CPR with ventilation as one primary factor for survival. Trial registrations German Clinical Trial Register: DRKS00030989, December 28th 2022.
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Affiliation(s)
- Stephan Katzenschlager
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
| | - Inga K Kelpanides
- Department of Research and Development, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Patrick Ristau
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Matthias Huck
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Stephan Seewald
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Sebastian Brenner
- Department of Pediatric and Adolescent Medicine, University Clinic Carl Gustav Carus, Dresden, Germany
| | - Florian Hoffmann
- Paediatric Intensive Care and Emergency Medicine, Dr. Von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Jan Wnent
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- School of Medicine, University of Namibia, Windhoek, Namibia
| | - Jo Kramer-Johansen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Ingvild B M Tjelmeland
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Markus A Weigand
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Jan-Thorsten Gräsner
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
| | - Erik Popp
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
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2
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Drennan IR, Thorpe KE, Scales D, Cheskes S, Mamdani M, Morrison LJ. Predicting survival post-cardiac arrest: An observational cohort study. Resusc Plus 2023; 15:100447. [PMID: 37662643 PMCID: PMC10470201 DOI: 10.1016/j.resplu.2023.100447] [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: 07/21/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction Over 400,000 out-of-hospital cardiac arrest (OHCA) occur each year in Canada and the United States with less than 10% survival to hospital discharge. Cardiac arrest is a heterogenous condition and patient outcomes are impacted by a multitude of factors. Prognostication is recommended at 72 hours after return of spontaneous circulation (ROSC), however there may be other factors that could predict patient outcome earlier in the post-arrest period. The objective of our study was to develop and internally validate a novel clinical prediction rule to risk stratify patients early in the post-cardiac arrest period. Methods We performed a retrospective cohort study of adult (≥18 years) post-cardiac arrest patients between 2010 and 2015 from the Epistry Cardiac Arrest database in Toronto. Our primary analysis used ordinal logistic regression to examine neurologic outcome at discharge using the modified Rankin Scale (mRS). Our secondary analysis used logistic regression for neurologic outcome and survival to hospital discharge. Models were internally validated using bootstrap validation. Results A total of 3432 patients met our inclusion criteria. Our clinical prediction model was able to predict neurologic outcome on an ordinal scale using our predefined variables with an AUC of 0.89 after internal validation. The predictive performance was maintained when examining neurologic outcome as a binary variable and survival to hospital discharge. Conclusion We were able to develop a model to accurately risk stratify adult cardiac arrest patients early in the post-cardiac arrest period. Future steps are needed to externally validate this model in other healthcare settings.
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Affiliation(s)
- Ian R Drennan
- Department of Emergency Services, Sunnybrook Health Science Centre, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kevin E Thorpe
- Applied Health Research Centre, St. Michael’s Hospital, Toronto, ON, Canada
| | - Damon Scales
- Department of Critical Care, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Sheldon Cheskes
- Department of Emergency Services, Sunnybrook Health Science Centre, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Sunnybrook Centre for Prehospital Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Muhammad Mamdani
- Data Science and Advanced Analytics, St. Michael’s Hospital, Toronto, ON, Canada
| | - Laurie J Morrison
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Rescu, Li Ka Shing Knowledge Institute, Department of Emergency Medicine, St. Michael’s Hospital, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, ON, Canada
| | - Rescu Epistry Investigators1
- Department of Emergency Services, Sunnybrook Health Science Centre, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre, St. Michael’s Hospital, Toronto, ON, Canada
- Department of Critical Care, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Sunnybrook Centre for Prehospital Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
- Data Science and Advanced Analytics, St. Michael’s Hospital, Toronto, ON, Canada
- Rescu, Li Ka Shing Knowledge Institute, Department of Emergency Medicine, St. Michael’s Hospital, Toronto, ON, Canada
- Division of Emergency Medicine, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, ON, Canada
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3
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Katzenschlager S, Kelpanides IK, Skogvoll E, Grindheim G, Wnent J, Popp E, Weigand MA, Kramer-Johansen J, Tjelmeland IBM, Gräsner JT. Paediatric out-of-hospital cardiac arrest: Time to update registries? Crit Care 2023; 27:304. [PMID: 37533130 PMCID: PMC10399070 DOI: 10.1186/s13054-023-04582-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 07/13/2023] [Indexed: 08/04/2023] Open
Affiliation(s)
- Stephan Katzenschlager
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
| | - Inga K Kelpanides
- Division of Emergencies and Critical Care, Department of Research and Development, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Eirik Skogvoll
- Clinic of Anaesthesia and Intensive Care, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Guro Grindheim
- Division of Emergencies and Critical Care, Department of Anaesthesiology and Intensive Care, Oslo University Hospital, Oslo, Norway
| | - Jan Wnent
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
- School of Medicine, University of Namibia, Windhoek, Namibia
| | - Erik Popp
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Markus A Weigand
- Department of Anaesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany
| | - Jo Kramer-Johansen
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Ingvild B M Tjelmeland
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Division of Prehospital Services, Oslo University Hospital, Oslo, Norway
| | - Jan-Thorsten Gräsner
- Institute for Emergency Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Kiel, Germany
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Foglia EE, Davis PG, Guinsburg R, Kapadia V, Liley HG, Rüdiger M, Schmölzer GM, Strand ML, Wyckoff MH, Wyllie J, Weiner GM. Recommended Guideline for Uniform Reporting of Neonatal Resuscitation: The Neonatal Utstein Style. Pediatrics 2023; 151:190463. [PMID: 36632729 DOI: 10.1542/peds.2022-059631] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 01/13/2023] Open
Abstract
Clinical research on neonatal resuscitation has accelerated over recent decades. However, an important methodologic limitation is that there are no standardized definitions or reporting guidelines for neonatal resuscitation clinical studies. To address this, the International Liaison Committee on Resuscitation Neonatal Life Support Task Force established a working group to develop the first Utstein-style reporting guideline for neonatal resuscitation. The working group modeled this approach on previous Utstein-style guidelines for other populations. This reporting guideline focuses on resuscitation of newborns immediately after birth for respiratory failure, bradycardia, severe bradycardia, or cardiac arrest. We identified 7 relevant domains: setting, patient, antepartum, birth/preresuscitation, resuscitation process, postresuscitation process, and outcomes. Within each domain, relevant data elements were identified as core versus supplemental. Core data elements should be collected and reported for all neonatal resuscitation studies, while supplemental data elements may be collected and reported using standard definitions when possible. The Neonatal Utstein template includes both core and supplemental elements across the 7 domains, and the associated Data Table provides detailed information and reporting standards for each data element. The Neonatal Utstein reporting guideline is anticipated to assist investigators engaged in neonatal resuscitation research by standardizing data definitions. The guideline will facilitate data pooling in meta-analyses, enhancing the strength of neonatal resuscitation treatment recommendations and subsequent guidelines.
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Affiliation(s)
- Elizabeth E Foglia
- Division of Neonatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Peter G Davis
- Newborn Research Center, the Royal Women's Hospital and the University of Melbourne, Victoria, Australia
| | - Ruth Guinsburg
- Division of Neonatal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Vishal Kapadia
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | | | - Mario Rüdiger
- Saxony Center for Fetal-Neonatal Health.,Department for Neonatology and Pediatric Intensive Care, Clinic for Pediatric and Adolescence Medicine, Medizinische Fakultät TU Dresden, Dresden, Germany
| | - Georg M Schmölzer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Marya L Strand
- Department of Pediatrics, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Myra H Wyckoff
- Division of Neonatal-Perinatal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jonathan Wyllie
- Department of Paediatrics and Neonatology, James Cook University Hospital, South Tees NHS Foundation Trust, Middlesbrough, United Kingdom
| | - Gary M Weiner
- Division of Neonatal-Perinatal Medicine, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
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Schneck E, Janßen G, Vaillant V, Voelker T, Dechert O, Trocan L, Schmitz L, Rohde M, Sander M, Hauch H. Cardiopulmonary resuscitation in pediatric patients under palliative home care - A multicenter retrospective study. Front Pediatr 2022; 10:1105609. [PMID: 36704133 PMCID: PMC9872029 DOI: 10.3389/fped.2022.1105609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/21/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction: Patients under palliative home care have special needs for their end-of-life support, which in general does not automatically include cardiopulmonary resuscitation. However, emergency medical services (EMS) respond to emergencies in children under palliative care that lead to cardiopulmonary resuscitation. To understand the underlying steps of decision-making, this retrospective, cross-sectional, multicenter study aimed to analyze pediatric patients under palliative home care who had been resuscitated. Methods: This study included patients from three spezialized pediatric palliative home care (SHPC) teams. The primary study parameters were the prevalence of cardiopulmonary resuscitation and the decision-making for carrying out pediatric advanced life support (PALS). Further analyses included the causes of cardiac arrest, the type of CPR (basic life support, advanced life support), the patient´s outcome, and involvement of the SHPC in the resuscitation. Descriptive statistical analysis was performed. Results: In total, 880 pediatric patients under palliative home care were included over 8.5 years, of which 17 patients were resuscitated once and two patients twice (overall, 19 events with CPR, 21.6 per 1,000 cases). In 10 of the 19 incidents (52.6%), cardiac arrest occurred suddenly without being predictable. The causes of cardiac arrest varied widely. PALS was performed in 78.9% of the cases by EMS teams. In 12 of 19 events (63.2%) resuscitation was performed on explicit wish of the parents. However, from a medical point of view, only four resuscitation attempts were reasonable. In total 7 of 17 (41.2%) patients survived cardiac arrest with a comparable quality of life. Discussion: Overall, resuscitation attempts were rare events in children under home palliative therapy, but if they occur, EMS are often the primary caregivers. Most resuscitation attempts occurred on explicit wish of the parents independently of the meaningfulness of the medical procedure. Despite the presence of a life-limiting disease, survival with a similar quality was achieved in one third of all resuscitated patients. This study indicates that EMS should be trained for advanced life support in children under home palliative therapy and SHPC should address the scenario of cardiac arrest also in early stages of palliative treatment. These results underline that advance care planning for these children is urgently needed.
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Affiliation(s)
- Emmanuel Schneck
- Department for Anaesthesiology, Intensive Care Medicine and Pain Therapy, Justus Liebig University, Giessen, Hesse, Germany
| | - Gisela Janßen
- Palliative Care Team for Children, Heinrich-Heine-University, Duesseldorf, North Rhine-Westphalia, Germany
| | - Vera Vaillant
- Palliative Care Team for Children, Justus Liebig University, Giessen, Hesse, Germany
| | - Thomas Voelker
- Palliative Care Team for Children, Kleine Riesen Kassel, Kassel, Hesse, Germany
| | - Oliver Dechert
- Palliative Care Team for Children, Heinrich-Heine-University, Duesseldorf, North Rhine-Westphalia, Germany
| | - Laura Trocan
- Palliative Care Team for Children, Heinrich-Heine-University, Duesseldorf, North Rhine-Westphalia, Germany
| | - Lioba Schmitz
- Palliative Care Team for Children, Heinrich-Heine-University, Duesseldorf, North Rhine-Westphalia, Germany
| | - Marius Rohde
- Department for Pediatric Oncology and Hematology, Justus Liebig University, Giessen, Hesse, Germany
| | - Michael Sander
- Department for Anaesthesiology, Intensive Care Medicine and Pain Therapy, Justus Liebig University, Giessen, Hesse, Germany
| | - Holger Hauch
- Palliative Care Team for Children, Justus Liebig University, Giessen, Hesse, Germany
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6
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Chen CY, Lee EP, Chang YJ, Yang WC, Lin MJ, Wu HP. Impact of Coronavirus Disease 2019 Pandemic on Pediatric Out-of-Hospital Cardiac Arrest in the Emergency Department. Front Pediatr 2022; 10:846410. [PMID: 35547546 PMCID: PMC9085154 DOI: 10.3389/fped.2022.846410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Out-of-hospital cardiac arrest (OHCA) in children is a critical condition with a poor prognosis. After the coronavirus disease 2019 (COVID-19) pandemic developed, the epidemiology and clinical characteristics of the pediatric emergency department (PED) visits have changed. This study aimed to analyze the impact of the COVID-19 pandemic on pediatric OHCA in the PED. METHODS From January 2018 to September 2021, we retrospectively collected data of children (18 years or younger) with a definite diagnosis of OHCA admitted to the PED. Patient data studied included demographics, pre-/in-hospital information, treatment modalities; and outcomes of interest included sustained return of spontaneous circulation (SROSC) and survival to hospital-discharge (STHD). These were analyzed and compared between the periods before and after the COVID-19 pandemic. RESULTS A total of 97 patients with OHCA (68 boys and 29 girls) sent to the PED were enrolled in our study. Sixty cases (61.9%) occurred in the pre-pandemic period and 37 during the pandemic. The most common age group was infants (40.2%) (p = 0.018). Asystole was the most predominant cardiac rhythm (72.2%, P = 0.048). Eighty patients (82.5%) were transferred by the emergency medical services, 62 (63.9%) gained SROSC, and 25 (25.8%) were STHD. During the COVID-19 pandemic, children with non-trauma OHCA had significantly shorter survival duration and prolonged EMS scene intervals (both p < 0.05). CONCLUSION During the COVID-19 pandemic, children with OHCA had a significantly lower rate of SROSC and STHD than that in the pre-pandemic period. The COVID-19 pandemic has changed the nature of PED visits and has affected factors related to ROSC and STHD in pediatric OHCA.
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Affiliation(s)
- Chun-Yu Chen
- Department of Pediatric Emergency, China Medical University Children's Hospital, China Medical University, Taichung City, Taiwan.,Department of Medicine, College of Medicine, China Medical University, Taichung City, Taiwan
| | - En-Pei Lee
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Jun Chang
- Laboratory of Epidemiology and Biostastics, Changhua Christian Hospital, Changhua City, Taiwan
| | - Wen-Chieh Yang
- Department of Pediatric Emergency, China Medical University Children's Hospital, China Medical University, Taichung City, Taiwan.,Department of Medicine, College of Medicine, China Medical University, Taichung City, Taiwan
| | - Mao-Jen Lin
- Department of Medicine, College of Medicine, Tzu Chi University, Hualien City, Taiwan.,Division of Cardiology, Department of Medicine, Taichung Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Taichung City, Taiwan
| | - Han-Ping Wu
- Department of Pediatric Emergency, China Medical University Children's Hospital, China Medical University, Taichung City, Taiwan.,Department of Medicine, College of Medicine, China Medical University, Taichung City, Taiwan.,Department of Medical Research, China Medical University Children's Hospital, China Medical University, Taichung City, Taiwan
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7
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Albargi H, Mallett S, Berhane S, Booth S, Hawkes C, Perkins GD, Norton M, Foster T, Scholefield B. Bystander cardiopulmonary resuscitation for paediatric out-of-hospital cardiac arrest in England: An observational registry cohort study. Resuscitation 2021; 170:17-25. [PMID: 34748765 DOI: 10.1016/j.resuscitation.2021.10.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/23/2021] [Accepted: 10/28/2021] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Bystander cardiopulmonary resuscitation (BCPR) is strongly advocated by resuscitation councils for paediatric out-of-hospital cardiac arrests (OHCAs). However, there are limited reports on rates of BCPR in children and its relationship with return of spontaneous circulation (ROSC) or survival outcomes. OBJECTIVE We describe the rate of BCPR and its association with any ROSC and survival- to- hospital-discharge. METHODS We conducted retrospective analysis of prospectively collected paediatric (<18 years of age) OHCA cases in England; we included specialist registry patients treated by emergency medical services (EMS) with known BCPR status and outcome between January 2014 and November 2018. Data included patient demographics, aetiology, witness status, initial rhythm, EMS, season, time of day and bystander status. Associations between BCPR, and any ROSC and survival-to-hospital-discharge outcomes were explored using multivariable logistic regression. RESULTS There were 2363 paediatric OHCAs treated across 11 EMS regions. BCPR was performed in 69.6% (1646/2363) of the cases overall (range 57.7% (206/367) to 83.7% (139/166) across EMS regions). Only 34.9% (550/1572) of BCPR cases were witnessed. Overall, any ROSC was achieved in 22.8% (523/2289) and survival to hospital discharge in 10.8% (225/2066). Adjusted odds ratio (aOR) for any ROSC was significantly improved following BCPR compared to no BCPR (aOR 1.37, 95% CI 1.03-1.81), but adjusted odds ratio for survival-to-hospital-discharge were similar (aOR 1.01, 95% CI 0.66-1.55). CONCLUSIONS BCPR was associated with improved rates of any ROSC but not survival-to-hospital-discharge. Variations in EMS BCPR rates may indicate opportunities for regional targeted increase in public BCPR education.
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Affiliation(s)
- H Albargi
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK; Emergency Medical Services Department, Faculty of Applied Medical Science, Jazan University, Jazan, Saudi Arabia
| | - S Mallett
- UCL Centre for Medical, University College London, London W1W 7TY, UK
| | - S Berhane
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, UK; Institute of Applied Health Research, University of Birmingham, UK
| | - S Booth
- Clinical Trials Unit, University of Warwick Medical School, Coventry, UK
| | - C Hawkes
- Clinical Trials Unit, University of Warwick Medical School, Coventry, UK
| | - G D Perkins
- Clinical Trials Unit, University of Warwick Medical School, Coventry, UK; Department of Critical Care Medicine, Heartlands Hospital, University Hospitals Birmingham, B9 5SS, UK
| | - M Norton
- North East Ambulance Service NHS Foundation Trust, Bernicia House, Newburn Riverside, Newcastle upon Tyne NE15 8NY, UK; School of Medicine, University of Sunderland, Chester Road, Sunderland SR1 3SD, UK
| | - T Foster
- East of England Ambulance Service NHS Trust, Whiting Way, Melbourn, Cambs SG8 6EN, UK
| | - B Scholefield
- Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK; Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham B4 6NH, UK.
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8
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Epinephrine Plus Vasopressin vs Epinephrine Plus Placebo in Pediatric Intensive Care Unit Cardiopulmonary Resuscitation: A Randomized Double Blind Controlled Clinical Trial. Indian Pediatr 2021. [DOI: 10.1007/s13312-021-2256-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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9
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Otto Q, Nolan JP, Chamberlain DA, Cummins RO, Soar J. Utstein Style for emergency care - the first 30 years. Resuscitation 2021; 163:16-25. [PMID: 33823223 DOI: 10.1016/j.resuscitation.2021.03.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/11/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Utstein Abbey near Stavanger in Norway, hosted a meeting in 1990 on guidelines for the uniform reporting of data from out-of-hospital cardiac arrest. In this paper we describe the last 30 years of the Utstein style. METHODS A systematic literature search identified publications from Utstein-style meetings or groups using the Utstein format. RESULTS 30 outputs were found, describing primarily resuscitation structure, process and outcome measures. They originated from all over the world and from multiple medical disciplines. Some were co-published in multiple journals. CONCLUSIONS The meeting at Utstein Abbey in 1990 has had a sustained and far-reaching impact, particularly in resuscitation science, implementation and outcomes. The Utstein format will continue to evolve following the key principles from the original meeting and with the ultimate aim of improving patient care and outcomes.
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Affiliation(s)
| | - Jerry P Nolan
- University of Warwick, Warwick Medical School, Coventry, Consultant in Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK
| | | | - Richard O Cummins
- Department of Emergency Medicine, University of Washington, Seattle, USA
| | - Jasmeet Soar
- Consultant in Anaesthetics and Intensive Care Medicine, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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10
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Dagan M, Butt W, d’Udekem Y, Namachivayam SP. Timing of in-hospital cardiac arrest after pediatric cardiac surgery: An important metric for quality improvement and prognostication? J Thorac Cardiovasc Surg 2019; 157:e401-e406. [DOI: 10.1016/j.jtcvs.2019.01.066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 12/12/2018] [Accepted: 01/18/2019] [Indexed: 11/24/2022]
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11
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Changing Risk of In-Hospital Cardiac Arrest in Children Following Cardiac Surgery in Victoria, Australia, 2007-2016. Heart Lung Circ 2018; 28:1904-1912. [PMID: 30591395 DOI: 10.1016/j.hlc.2018.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/18/2018] [Accepted: 11/02/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Reported incidence of in hospital cardiac arrest (IHCA) after paediatric cardiac surgery varies between 3-4% in high income countries and this risk may have changed over time. We sought to examine this trend in detail. METHODS A retrospective observational study of 3,781 children who underwent 4,938 cardiac surgeries between 1 January 2007 and 31 December 2016 in a tertiary children's hospital. IHCA was defined as cessation of cardiac mechanical activity requiring cardiac massage for ≥1minute. Surgical complexity was categorised using risk adjusted congenital heart surgery (RACHS-1) category. Poisson regression was used to analyse trends for every two-year period. RESULTS There were a total of 211 (4.3%) IHCA events after surgery. These patients were younger, more likely to have had a premature birth, have a chromosomal or genetic syndrome association and have a high surgical complexity. Overall, there was a 52% reduction in IHCA rate over 10 years: reducing from 5.4 /100 surgeries in 2007-08 to 2.6/100 surgeries in 2015-16 (p-trend=<0.001). The reduction was mainly seen in low-to-moderate risk categories (RACHS-1 categories 1-4) and not in high risk categories (RACHS-1 category 5-6). Children in high risk categories were 13.6 times more likely to experience an IHCA (compared to low risk categories). Overall hospital mortality for children suffering IHCA decreased from 42.5/100 patients in 2007-08 to 11.1/100 patients in 2015-16 (p-trend=0.037). CONCLUSIONS The IHCA rate following cardiac surgery has more than halved over the last decade; children who experience IHCA also have lower mortality than in previous years. High risk procedures still have a substantial rate of IHCA and efforts are needed to minimise the burden further in this population.
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Early On-Scene Management of Pediatric Out-of-Hospital Cardiac Arrest Can Result in Improved Likelihood for Neurologically-Intact Survival. Resuscitation 2018; 135:162-167. [PMID: 30412719 DOI: 10.1016/j.resuscitation.2018.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 10/08/2018] [Accepted: 11/02/2018] [Indexed: 11/22/2022]
Abstract
AIM To evaluate the frequency of neurologically-intact survival (SURV) following pediatric out-of-hospital cardiac arrest (POHCA) when comparing traditional early evacuation strategies to those emphasizing resuscitation efforts being performed immediately on-scene. METHODS Before 2014, emergency medical services (EMS) crews in a county-wide EMS agency provided limited treatment for POHCA on-scene and rapidly transported patients to appropriate hospitals. After 2014, training strongly concentrated upon EMS provider comfort levels with on-scene resuscitation efforts including methods to expedite protocols on-site and control positive-pressure ventilation. Frequency of SURV (hospital discharge) was compared for the two years prior to initiating the immediate on-scene care strategy to the ensuing two years following implementation. RESULTS Between 01/01/2012 and 12/31/2015, 94 children experienced POHCA. There were no significant differences before and after the on-scene focus in terms of age, sex, etiology, presenting electrocardiograph, drug infusions or bystander-performed cardiopulmonary resuscitation and total scene times actually remained similar (14.3 vs. 17.67 minutes). SURV increased significantly upon implementation of the immediate on-scene management strategy and was sustained over the next two years (0.0% to 23%; p = 0.0013). Though statistically-indeterminate in this analysis, the improvement was associated with a shorter mean time to epinephrine administration among resuscitated patients (16.6 vs. 7.65 minutes). CONCLUSION Facilitating immediate on-scene management of POHCA can result in improvements in life-saving. Although a historically-controlled evaluation, the compelling appearance of neurologically-intact survivors was immediate and sustained. Targeted training, more efficient, physiologically-driven procedures, and trusted encouragement from supervisors, likely played the most significant roles and not necessarily extended scene times.
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Cardiac Arrest in Children: Relation to Resuscitation and Outcome. Indian J Pediatr 2015; 82:612-8. [PMID: 25604246 DOI: 10.1007/s12098-014-1669-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine the outcome of cardiac arrest in pediatric intensive care unit in relation to event variables. METHODS The study included children with cardiac arrest who required resuscitation in pediatric intensive care unit over 1 y period. Two outcome variables were measured. The first was success [return of spontaneous circulation (ROSC)] and the second was survival to discharge from pediatric intensive care unit. RESULTS Out of 700 admissions, 172 (24.6 %) patients developed cardiac arrest that required resuscitation. Return of spontaneous circulation was achieved in 78 cases (45.3 %), 25 patients (14.5 %) survived to discharge and 94 patients (54.7 %) did not respond to resuscitations. Success and survival rates were significantly higher in cases resuscitated for ≤ 20 min than in cases resuscitated for > 20 min (100 % and 33.3 % vs. 32.4 % and 10.1 % respectively). Success and survival rates were better in patients undergoing mechanical ventilation than those not (48.1 % and 17.8 % vs. 37.2 % and 4.7 % respectively). Defibrillation was successful in 10 cases (25 %) and survival was in 1 case (0.5 %) and out of survivors, 80 % had good neurological outcome. CONCLUSIONS The frequency of inhospital cardiac arrest was 24.6 % where 45.3 % of them achieved successful resuscitation. The duration of cardiopulmonary resuscitation (<20 min) and mechanical ventilation were an indicator for better success and survival rates.
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Stevens A, Shamseer L, Weinstein E, Yazdi F, Turner L, Thielman J, Altman DG, Hirst A, Hoey J, Palepu A, Schulz KF, Moher D. Relation of completeness of reporting of health research to journals' endorsement of reporting guidelines: systematic review. BMJ 2014; 348:g3804. [PMID: 24965222 PMCID: PMC4070413 DOI: 10.1136/bmj.g3804] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess whether the completeness of reporting of health research is related to journals' endorsement of reporting guidelines. DESIGN Systematic review. DATA SOURCES Reporting guidelines from a published systematic review and the EQUATOR Network (October 2011). Studies assessing the completeness of reporting by using an included reporting guideline (termed "evaluations") (1990 to October 2011; addendum searches in January 2012) from searches of either Medline, Embase, and the Cochrane Methodology Register or Scopus, depending on reporting guideline name. STUDY SELECTION English language reporting guidelines that provided explicit guidance for reporting, described the guidance development process, and indicated use of a consensus development process were included. The CONSORT statement was excluded, as evaluations of adherence to CONSORT had previously been reviewed. English or French language evaluations of included reporting guidelines were eligible if they assessed the completeness of reporting of studies as a primary intent and those included studies enabled the comparisons of interest (that is, after versus before journal endorsement and/or endorsing versus non-endorsing journals). DATA EXTRACTION Potentially eligible evaluations of included guidelines were screened initially by title and abstract and then as full text reports. If eligibility was unclear, authors of evaluations were contacted; journals' websites were consulted for endorsement information where needed. The completeness of reporting of reporting guidelines was analyzed in relation to endorsement by item and, where consistent with the authors' analysis, a mean summed score. RESULTS 101 reporting guidelines were included. Of 15,249 records retrieved from the search for evaluations, 26 evaluations that assessed completeness of reporting in relation to endorsement for nine reporting guidelines were identified. Of those, 13 evaluations assessing seven reporting guidelines (BMJ economic checklist, CONSORT for harms, PRISMA, QUOROM, STARD, STRICTA, and STROBE) could be analyzed. Reporting guideline items were assessed by few evaluations. CONCLUSIONS The completeness of reporting of only nine of 101 health research reporting guidelines (excluding CONSORT) has been evaluated in relation to journals' endorsement. Items from seven reporting guidelines were quantitatively analyzed, by few evaluations each. Insufficient evidence exists to determine the relation between journals' endorsement of reporting guidelines and the completeness of reporting of published health research reports. Journal editors and researchers should consider collaborative prospectively designed, controlled studies to provide more robust evidence. SYSTEMATIC REVIEW REGISTRATION Not registered; no known register currently accepts protocols for methodology systematic reviews.
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Affiliation(s)
- Adrienne Stevens
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6
| | - Larissa Shamseer
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6 Department of Epidemiology and Community Medicine, University of Ottawa, K1H 8M5 Ottawa, Canada
| | - Erica Weinstein
- Albert Einstein College of Medicine, Yeshiva University, Bronx, NY 10461, USA
| | - Fatemeh Yazdi
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6
| | - Lucy Turner
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6
| | - Justin Thielman
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6
| | - Douglas G Altman
- Centre for Statistics in Medicine, University of Oxford, Oxford OX3 7LD, UK
| | - Allison Hirst
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX3 9DU, UK
| | - John Hoey
- Population and Public Health Initiative, Queen's University, Kingston, ON, Canada, K7L 3N6
| | - Anita Palepu
- Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada, V6Z 1Y9 Department of Medicine, University of British Columbia, Vancouver, BC, Canada, V5Z 1M9
| | - Kenneth F Schulz
- International Clinical Sciences Support Center, FHI 360, Durham, NC 27713, USA
| | - David Moher
- Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, ON, Canada, K1H 8L6 Department of Epidemiology and Community Medicine, University of Ottawa, K1H 8M5 Ottawa, Canada
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Demographics, bystander CPR, and AED use in out-of-hospital pediatric arrests. Resuscitation 2014; 85:920-6. [PMID: 24681302 DOI: 10.1016/j.resuscitation.2014.03.044] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 02/03/2014] [Accepted: 03/19/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND In 2005 the American Heart Association released guidelines calling for routine use of automated external defibrillators during pediatric out-of-hospital arrest. The goal of this study was to determine if these guidelines are used during resuscitations. METHODS We conducted a secondary analysis of prospectively collected data from 29 U.S. cities that participate in the Cardiac Arrest Registry to Enhance Survival (CARES). Patients were included if they were older than 1 year of age and had a documented resuscitation attempt from October 1, 2005 through December 31, 2009 from an arrest presumed to be cardiac in nature. Hierarchical multivariable logistic regression analysis was used to estimate the associations between age, demographic factors, and AED use. RESULTS 129 patients were 1-8 years of age (younger children), 88 patients were 9-17 years of age (older children), and 19,338 patients were ≥18 years of age (adults). When compared to adults, younger children were less likely to be found in a shockable rhythm (young children 11.6%, adults 23.7%) and were less likely to have an AED used (young children 16.3%, adults 28.3%). Older children had a similar prevalence of shockable rhythms as adults (31.8%) and AED use (20.5%). A multivariable analysis demonstrated that, when compared to adults, younger children had decreased odds of having an AED used (OR 0.42, 95% CI 0.26-0.69), but there was no difference in AED use among older children and adults. CONCLUSIONS Young children suffering from presumed out-of-hospital cardiac arrests are less likely to have a shockable rhythm when compared to adults, and are less likely to have an AED used during resuscitation.
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Schlunt ML, Wang L. Hypothermia and pediatric cardiac arrest. J Emerg Trauma Shock 2011; 3:277-81. [PMID: 20930973 PMCID: PMC2938494 DOI: 10.4103/0974-2700.66533] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2009] [Accepted: 04/24/2010] [Indexed: 12/27/2022] Open
Abstract
The survival outcome following pediatric cardiac arrest still remains poor. Survival to hospital discharge ranges anywhere from 0 to 38% when considering both out-of-hospital and in-hospital arrests, with up to 50% of the survivors having neurologic injury. The use of mild induced hypothermia has not been definitively proven to improve outcomes following pediatric cardiac arrest. This may be due to the lack of consensus regarding target temperature, best method of cooling, optimal duration of cooling and identifying the patient population who will receive the greatest benefit. We review the current applications of induced hypothermia in pediatric patients following cardiac arrest after searching the current literature through Pubmed and Ovid journal databases. We put forth compiled recommendations/guidelines for initiating hypothermia therapy, its maintenance, associated monitoring and suggested adjunctive therapies to produce favorable neurologic and survival outcomes.
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Affiliation(s)
- Michelle L Schlunt
- Department of Anesthesiology, Loma Linda University School of Medicine, California, USA
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17
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Describing reporting guidelines for health research: a systematic review. J Clin Epidemiol 2011; 64:718-42. [DOI: 10.1016/j.jclinepi.2010.09.013] [Citation(s) in RCA: 112] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Revised: 09/28/2010] [Accepted: 09/29/2010] [Indexed: 11/24/2022]
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Brady WJ, Gurka KK, Mehring B, Peberdy MA, O’Connor RE. In-hospital cardiac arrest: Impact of monitoring and witnessed event on patient survival and neurologic status at hospital discharge. Resuscitation 2011; 82:845-52. [DOI: 10.1016/j.resuscitation.2011.02.028] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 01/30/2011] [Accepted: 02/14/2011] [Indexed: 11/25/2022]
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Moler FW, Donaldson AE, Meert K, Brilli RJ, Nadkarni V, Shaffner DH, Schleien CL, Clark RSB, Dalton HJ, Statler K, Tieves KS, Hackbarth R, Pretzlaff R, van der Jagt EW, Pineda J, Hernan L, Dean JM. Multicenter cohort study of out-of-hospital pediatric cardiac arrest. Crit Care Med 2011; 39:141-9. [PMID: 20935561 PMCID: PMC3297020 DOI: 10.1097/ccm.0b013e3181fa3c17] [Citation(s) in RCA: 143] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe a large cohort of children with out-of-hospital cardiac arrest with return of circulation and to identify factors in the early postarrest period associated with survival. These objectives were for planning an interventional trial of therapeutic hypothermia after pediatric cardiac arrest. METHODS A retrospective cohort study was conducted at 15 Pediatric Emergency Care Applied Research Network clinical sites over an 18-month study period. All children from 1 day (24 hrs) to 18 yrs of age with out-of-hospital cardiac arrest and a history of at least 1 min of chest compressions with return of circulation for at least 20 mins were eligible. MEASUREMENTS AND MAIN RESULTS One hundred thirty-eight cases met study entry criteria; the overall mortality was 62% (85 of 138 cases). The event characteristics associated with increased survival were as follows: weekend arrests, cardiopulmonary resuscitation not ongoing at hospital arrival, arrest rhythm not asystole, no atropine or NaHCO3, fewer epinephrine doses, shorter duration of cardiopulmonary resuscitation, and drowning or asphyxial arrest event. For the 0- to 12-hr postarrest return-of-circulation period, absence of any vasopressor or inotropic agent (dopamine, epinephrine) use, higher lowest temperature recorded, greater lowest pH, lower lactate, lower maximum glucose, and normal pupillary responses were all associated with survival. A multivariate logistic model of variables available at the time of arrest, which controlled for gender, age, race, and asystole or ventricular fibrillation/ventricular tachycardia anytime during the arrest, found the administration of atropine and epinephrine to be associated with mortality. A second model using additional information available up to 12 hrs after return of circulation found 1) preexisting lung or airway disease; 2) an etiology of arrest drowning or asphyxia; 3) higher pH, and 4) bilateral reactive pupils to be associated with lower mortality. Receiving more than three doses of epinephrine was associated with poor outcome in 96% (44 of 46) of cases. CONCLUSIONS Multiple factors were identified as associated with survival after out-of-hospital pediatric cardiac arrest with the return of circulation. Additional information available within a few hours after the return of circulation may diminish outcome associations of factors available at earlier times in regression models. These factors should be considered in the design of future interventional trials aimed to improve outcome after pediatric cardiac arrest.
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Affiliation(s)
- Frank W Moler
- Pediatric Emergency Care Applied Research Network, Salt Lake City, UT, USA.
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Meert KL, Donaldson A, Nadkarni V, Tieves KS, Schleien CL, Brilli RJ, Clark RSB, Shaffner DH, Levy F, Statler K, Dalton H, van der Jagt EW, Hackbarth R, Pretzlaff R, Hernan L, Dean JM, Moler FW. Multicenter cohort study of in-hospital pediatric cardiac arrest. Pediatr Crit Care Med 2009; 10:544-53. [PMID: 19451846 PMCID: PMC2741542 DOI: 10.1097/pcc.0b013e3181a7045c] [Citation(s) in RCA: 169] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES 1) To describe clinical characteristics, hospital courses, and outcomes of a cohort of children cared for within the Pediatric Emergency Care Applied Research Network who experienced in-hospital cardiac arrest with sustained return of circulation between July 1, 2003 and December 31, 2004, and 2) to identify factors associated with hospital mortality in this population. These data are required to prepare a randomized trial of therapeutic hypothermia on neurobehavioral outcomes in children after in-hospital cardiac arrest. DESIGN Retrospective cohort study. SETTING Fifteen children's hospitals associated with Pediatric Emergency Care Applied Research Network. PATIENTS Patients between 1 day and 18 years of age who had cardiopulmonary resuscitation and received chest compressions for >1 min, and had a return of circulation for >20 mins. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 353 patients met entry criteria; 172 (48.7%) survived to hospital discharge. Among survivors, 132 (76.7%) had good neurologic outcome documented by Pediatric Cerebral Performance Category scores. After adjustment for age, gender, and first documented cardiac arrest rhythm, variables available before and during the arrest that were independently associated with increased mortality included pre-existing hematologic, oncologic, or immunologic disorders, genetic or metabolic disorders, presence of an endotracheal tube before the arrest, and use of sodium bicarbonate during the arrest. Variables associated with decreased mortality included postoperative cardiopulmonary resuscitation. Extending the time frame to include variables available before, during, and within 12 hours following arrest, variables independently associated with increased mortality included the use of calcium during the arrest. Variables associated with decreased mortality included higher minimum blood pH and pupillary responsiveness. CONCLUSIONS Many factors are associated with hospital mortality among children after in-hospital cardiac arrest and return of circulation. Such factors must be considered when designing a trial of therapeutic hypothermia after cardiac arrest in pediatric patients.
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Moler FW, Meert K, Donaldson AE, Nadkarni V, Brilli RJ, Dalton HJ, Clark RSB, Shaffner DH, Schleien CL, Statler K, Tieves KS, Hackbarth R, Pretzlaff R, van der Jagt EW, Levy F, Hernan L, Silverstein FS, Dean JM. In-hospital versus out-of-hospital pediatric cardiac arrest: a multicenter cohort study. Crit Care Med 2009; 37:2259-67. [PMID: 19455024 PMCID: PMC2711020 DOI: 10.1097/ccm.0b013e3181a00a6a] [Citation(s) in RCA: 154] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES : To describe a large multicenter cohort of pediatric cardiac arrest (CA) with return of circulation (ROC) from either the in-hospital (IH) or the out-of-hospital (OH) setting and to determine whether significant differences related to pre-event, arrest event, early postarrest event characteristics, and outcomes exist that would be critical in planning a clinical trial of therapeutic hypothermia (TH). DESIGN : Retrospective cohort study. SETTING : Fifteen Pediatric Emergency Care Applied Research Network sites. PATIENTS : Patients aged 24 hours to 18 years with either IH or OH CA who had a history of at least 1 minute of chest compressions and ROC for at least 20 minutes were eligible. INTERVENTIONS : None. MEASUREMENTS AND MAIN RESULTS : A total of 491 patients met study entry criteria with 353 IH cases and 138 OH cases. Major differences between the IH and OH cohorts were observed for patient prearrest characteristics, arrest event initial rhythm described, and arrest medication use. Several postarrest interventions were used differently, however, the use of TH was similar (<5%) in both cohorts. During the 0-12-hour interval following ROC, OH cases had lower minimum temperature and pH, and higher maximum serum glucose recorded. Mortality was greater in the OH cohort (62% vs. 51%, p = 0.04) with the cause attributed to a neurologic indication much more frequent in the OH than in the IH cohort (69% vs. 20%; p < 0.01). CONCLUSIONS : For pediatric CA with ROC, several major differences exist between IH and OH cohorts. The finding that the etiology of death was attributed to neurologic indications much more frequently in OH arrests has important implications for future research. Investigators planning to evaluate the efficacy of new interventions, such as TH, should be aware that the IH and OH populations differ greatly and require independent clinical trials.
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Affiliation(s)
- Frank W Moler
- Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH, USA.
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Mandt MJ, Rappaport LD. Update in pediatric resuscitation. Adv Pediatr 2009; 56:359-85. [PMID: 19968956 DOI: 10.1016/j.yapd.2009.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Maria J Mandt
- University of Colorado School of Medicine, The Children's Hospital, Aurora, CO, USA
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Abstract
The use of automated external defibrillators (AEDs) has been advocated in recent years as one part of the chain of survival to improve outcomes for adult cardiac arrest victims. When AEDs first entered the market, they had not been tested for pediatric usage and rhythm interpretation. In addition, the presumption was that children do not experience ventricular fibrillation, so they would not benefit from the use of AEDs. Recent literature has shown that children do experience ventricular fibrillation, which has a better outcome than do other cardiac arrest rhythms. At the same time, the arrhythmia software on AEDs has become more extensive and validated for children, and attenuation devices have become available to downregulate the energy delivered by AEDs to allow their use on children. Pediatricians are now being asked whether AED programs should be implemented, and where they are being implemented, pediatricians are being asked to provide guidance on the use of them on children. As AED programs expand, pediatricians must advocate on behalf of children so that their needs are accounted for. For pediatricians to be able to provide guidance and ensure that children are included in AED programs, it is important for pediatricians to know how AEDs work, be up-to-date on the literature regarding pediatric fibrillation and energy delivery, and understand the role of AEDs as life-saving interventions for children.
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Markenson D, Pyles L, Neish S. Ventricular fibrillation and the use of automated external defibrillators on children. Pediatrics 2007; 120:e1368-79. [PMID: 17967922 DOI: 10.1542/peds.2007-2679] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The use of automated external defibrillators (AEDs) has been advocated in recent years as a part of the chain of survival to improve outcomes for adult cardiac arrest victims. When AEDs first entered the market, they were not tested for pediatric usage and rhythm interpretation. In addition, the presumption was that children do not experience ventricular fibrillation, so they would not benefit from use of AEDs. Recent literature has shown that children do experience ventricular fibrillation, and this rhythm has a better outcome than do other cardiac arrest rhythms. At the same time, the arrhythmia software on AEDs has become more extensive and validated for children, and attenuation devices have become available to downregulate the energy delivered by AEDs to allow their use in children. Pediatricians are now being asked whether AED programs should be implemented, and where they are being implemented, pediatricians are being asked to provide guidance on the use of AEDs in children. As AED programs expand, pediatricians must advocate on behalf of children so that their needs are accounted for in these programs. For pediatricians to be able to provide guidance and ensure that children are included in AED programs, it is important for pediatricians to know how AEDs work, be up-to-date on the literature regarding pediatric fibrillation and energy delivery, and understand the role of AEDs as life-saving interventions for children.
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Carrillo Alvarez A, López-Herce Cid J. [Definitions and prevention of cardiorespiratory arrest in children]. An Pediatr (Barc) 2006; 65:140-6. [PMID: 17014066 DOI: 10.1016/s1695-4033(06)70166-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In cardiopulmonary resuscitation ages are divided in neonates (in the inmediate period after the birth), infant (from birth to 12 months) and child (from 12 months to puberty). Respiratory arrest is defined by the absence of spontaneous respiration (apnea) or a severe respiratory insufficiency (agonal gasping) that require respiratory assistance. Cardiac arrest is defined as the absence of central arterial pulse or signs of circulation (movement, cough or normal breathing) or the presence of a central pulse less than 60 lpm in a child who does not respond, not breath and with poor perfusion. After resuscitation the return of spontaneous circulation is defined as the recuperation of central arterial pulse or signs of circulation in a child with previous cardiorespiratory arrest. It is maintained when the duration is longer than 20 minutes. Injuries, sudden infant death syndrome, and respiratory diseases are the most frequent etiologies of cardiorrespiratory arrest in children. The prevention and the formation of citizens in basic cardiopulmonary resuscitation are the most effective measures to reduce the mortality of cardiorespiratory arrest in children.
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Affiliation(s)
- A Carrillo Alvarez
- Sección de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España
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Gerein RB, Osmond MH, Stiell IG, Nesbitt LP, Burns S. What are the etiology and epidemiology of out-of-hospital pediatric cardiopulmonary arrest in Ontario, Canada? Acad Emerg Med 2006; 13:653-8. [PMID: 16670256 DOI: 10.1197/j.aem.2005.12.025] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pediatric cardiopulmonary arrest (CPA) outside of the hospital has a very high mortality rate. OBJECTIVES To evaluate the etiology and initial compromise of pediatric CPA cases in hopes of developing strategies to improve out-of-hospital resuscitation. METHODS The Ontario Prehospital Advanced Life Support (OPALS) study was a large multicenter initiative to evaluate the impact of emergency medical services (EMS) programs on 17 communities with 40,000 critically ill and injured patients who were older than 11 years. As part of this study, the authors conducted a retrospective observational cohort study that included all children younger than 18 years of age with out-of-hospital CPA, during an 11-year period from 1991-2002. CPA was defined as patient being pulseless, apneic, and requiring chest compressions. Data were collected from ambulance call reports and centralized dispatch data and were reviewed by two independent investigators. RESULTS There were 503 children with CPA in the sample. Mean age was 5.6 years (range, 0-17 yr); 58.4% of patients were male, and 37.8% were younger than 1 year of age. Cardiopulmonary resuscitation (CPR) first was started by a bystander in 32.4% of cases, whereas 66.0% were unwitnessed arrests. Initial rhythms were asystole 77.2% of the time, pulseless electrical activity 16.4% of the time, and ventricular fibrillation or ventricular tachycardia 4% of the time. Annual incidence was 9.1/100,000 children. CPA was witnessed in 34.0% of cases; 80.7% of these were bystander-witnessed, and 18.1% were EMS-witnessed. Primary pathogenic cause of arrest was medical in 61.2% of cases, trauma in 37.2% of cases, and indeterminate in 1.6% of cases. Initial underlying physiologic compromise of witnessed arrests was judged to be respiratory in 39.8% of cases, sudden collapse (presumed electrical) in 16.4% of cases, progressive shock in 1.2% of cases, and indeterminate in 42.6% of cases. Presumed etiology was trauma, 37.6%; sudden infant death syndrome (SIDS), 20.3%; and respiratory disease, 11.6%, most commonly. Survival to hospital discharge was 2.0%. CONCLUSIONS This is one of the largest population-based, prospective cohorts of pediatric CPA reported to date, and it reveals that most pediatric arrests are unwitnessed and receive no bystander CPR. Those that are witnessed most often are caused by respiratory arrests or trauma. Trauma, SIDS, and respiratory disease are the most common etiologies overall. These data are vital to planning large resuscitation trials looking at specific interventions (i.e., increasing bystander CPR) and highlight the need for better strategies for prevention and early recognition.
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Cavalcante TDMC, Lopes RS. O atendimento à parada cardiorrespiratória em unidade coronariana segundo o Protocolo Utstein. ACTA PAUL ENFERM 2006. [DOI: 10.1590/s0103-21002006000100002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVOS: registrar os esforços de ressuscitação cardiopulmonar (RCP) conforme o preconizado pelo protocolo de registro de Utstein e apresentar os resultados de acordo com o recomendado pelo mesmo. MÉTODOS: estudo de natureza exploratório-descritiva de 30 esforços ressuscitatórios realizados na Unidade Coronariana do HSP entre Agosto à Dezembro de 2003. RESULTADOS: Dos 30 pacientes estudados 56.66% eram do sexo masculino, com média de idade de 64.5 anos. A modalidade mais freqüente foi a Atividade Elétrica Sem Pulso. Do total de pacientes, treze (43.33%) retornaram a circulação espontânea, porém somente quatro destes mantiveram-se vivos até o término da pesquisa. CONCLUSÃO: Em 90% dos prontuários, os registros apresentavam-se incompletos demonstrando a necessidade de um registro único e sistematizado para RCP, no intuito de melhorar os registros para uma melhor organização do serviço e realização de pesquisas, além de prevenir dispustas éticas e legais.
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Abstract
Resuscitation documentation assists health care professionals in trending patient status, determining what treatments may be most effective, and determining where opportunities for improvement may exist. An overview of what is known about resuscitation documentation is provided in this article, as are implications for future research related to documentation of resuscitation events. Use of the Utstein guidelines in determining essential elements of resuscitation documentation is also presented.
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Affiliation(s)
- Patricia Kunz Howard
- Cardiovascular Nursing, College of Nursing, University of Kentucky, Lexington, KY 40536-0232, USA.
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Young KD, Gausche-Hill M, McClung CD, Lewis RJ. A prospective, population-based study of the epidemiology and outcome of out-of-hospital pediatric cardiopulmonary arrest. Pediatrics 2004; 114:157-64. [PMID: 15231922 DOI: 10.1542/peds.114.1.157] [Citation(s) in RCA: 259] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND This study reports the epidemiologic features, survival rates, and neurologic outcomes of the largest population-based series of pediatric out-of-hospital cardiopulmonary arrest patients with prospectively collected data. METHODS Secondary analysis of data from a prospective, interventional trial of out-of-hospital pediatric airway management conducted from 1994 to 1997 (Gausche M, Lewis RJ, Stratton SJ, et al. JAMA. 2000;283:783-790). Consecutive out-of-hospital patients from 2 large urban counties in California <12 years old or 40 kg in bodyweight who were determined by paramedics to be pulseless and apneic were included. Main outcome measures included survival to hospital discharge, patient demographics, arrest etiology, arrest rhythm, event intervals, and neurologic outcomes. RESULTS In 599 patients, 601 events were studied (54% were <1 year old, 58% were male). Return of spontaneous circulation was achieved in 29%; 25% were admitted to the hospital, and 8.6% (51) survived to hospital discharge. The most prevalent etiologies were sudden infant death syndrome and trauma; these resulted in relatively higher mortality. Respiratory etiologies and submersions followed; these resulted in relatively lower mortality. Twenty-six percent of the arrests were witnessed by citizens, and an additional 8% were witnessed by rescue personnel. Witnessed arrests had a higher survival rate (16%). Thirty-one percent of patients received bystander cardiopulmonary resuscitation, which was not demonstrated to result in improved survival rates. Arrest rhythms were asystole (67%), pulseless electrical activity (24%), and ventricular fibrillation (9%); children with the latter 2 rhythms had better survival rates. One third of the survivors (16 of 51) had good neurologic outcome, none of whom received >3 doses of epinephrine or were resuscitated for >31 minutes in the emergency department. CONCLUSIONS The 8.6% survival rate after out-of-hospital pediatric cardiopulmonary arrest is poor. Administration of >3 doses of epinephrine or prolonged resuscitation is futile.
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Affiliation(s)
- Kelly D Young
- Department of Pediatrics, David Geffen University of California Los Angeles School of Medicine, Los Angeles, California, USA.
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Affiliation(s)
- David S Markenson
- Program for Pediatric Preparedness, Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York 10467, USA.
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Ebmeyer U, Keilhoff G, Wolf G, Röse W. Strain specific differences in a cardio-pulmonary resuscitation rat model. Resuscitation 2002; 53:189-200. [PMID: 12009223 DOI: 10.1016/s0300-9572(02)00003-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
An asphyxial cardiac arrest rat model, originally developed for Sprague-Dawley rats, was transferred to a Wistar rat model. Several strain specific life support adjustments, i.e. ventilator settings, anaesthesia, and drug requirements, were necessary to stabilize the model for Wistar rats. Despite these arrangements numerous resuscitation related variables appeared different. Three groups were evaluated and compared: a temperature monitored Wistar group 1 (n=34), a temperature controlled Wistar group 2 (n=26) and a temperature controlled Sprague-Dawley group 3 (n=7). Overall, Wistar rats seem to have more sensitive cardio-circulatory system evidenced by a more rapid development of cardiac arrest (164 vs. 201 s), requiring higher adrenaline/epinephrine doses (10 vs. 5 microg/kg) and requiring more time for recovery after resuscitation (i.e. for return of blood pressure and blood gases). Without strict temperature control (as in groups 2+3 rats) group 1 rats went into spontaneous mild to moderate hypothermia during the first 24 h after restoration of spontaneous circulation (ROSC). Spontaneous hypothermia delayed the development of overall visible CA1 neuronal damage 24-48 h, but did not prevent it; therefore the model seemed to be suitable for future studies. Neuronal damages in the CA1 region in Wistar rats appeared to be more as shrunken cell bodies and pyknotic nuclei before resorption took place, whereas in Sprague-Dawley rats appeared in the same region.
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Affiliation(s)
- U Ebmeyer
- Institute of Medical Neurobiology, Otto-von-Guericke University Magdeburg, Leipziger Strasse 44, 39120 Magdeburg, Germany.
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Abstract
This article updates research concerning the resuscitation of a pediatric patient. The topics discussed include the state of pediatric life support, the current guidelines, the management of those guidelines, and coping with death.
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Affiliation(s)
- Kathleen Brown
- Department of Emergency Medicine, State University of New York, Upstate Medical University, Syracuse, New York, USA.
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Gausche-Hill M, Lewis RJ, Gunter CS, Henderson DP, Haynes BE, Stratton SJ. Design and implementation of a controlled trial of pediatric endotracheal intubation in the out-of-hospital setting. Ann Emerg Med 2000; 36:356-65. [PMID: 11020685 DOI: 10.1067/mem.2000.109447] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This article describes the design and implementation of the Pediatric Airway Management Project. The project was completed January 1, 1997, and evaluated the effectiveness of endotracheal intubation relative to bag-valve-mask ventilation in improving survival to hospital discharge and neurologic outcome in children, the effect of training on paramedic airway management skills and self-efficacy, the length of time the skills can be retained, and the costs of training and retraining. The main focus of project design was the implementation of a controlled trial comparing methods of airway management for acutely ill and injured pediatric patients in the out-of-hospital setting. To date, this project is the largest prospective, controlled, out-of-hospital study of the care of children ever reported. Barriers to implementation of a study of this size are described.
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Affiliation(s)
- M Gausche-Hill
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Harbor-UCLA Research and Education Institute, Los Angeles, USA.
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Parra DA, Totapally BR, Zahn E, Jacobs J, Aldousany A, Burke RP, Chang AC. Outcome of cardiopulmonary resuscitation in a pediatric cardiac intensive care unit. Crit Care Med 2000; 28:3296-300. [PMID: 11008995 DOI: 10.1097/00003246-200009000-00030] [Citation(s) in RCA: 160] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the eventual outcome of children with heart disease who had cardiopulmonary resuscitation (CPR) in a specialized pediatric cardiac intensive care unit (CICU), and to define the influence of any prearrest variables on the outcome. DESIGN A retrospective review of patients' medical records. SETTING A pediatric CICU of a tertiary pediatric teaching hospital. PATIENTS AND METHODS Patients were all children who presented with cardiopulmonary arrest and who were administered CPR in the pediatric CICU between June 1995 and June 1997. Prearrest variables such as age, diagnosis, prior cardiac surgery, and inotropic support with epinephrine, as well as cause of arrest, were evaluated. MEASUREMENTS AND MAIN RESULTS Thirty-two patients, ranging in age from 1 day to 21 yrs (median, 1 month), satisfied criteria for inclusion in the study group. These 32 patients had a total of 38 episodes of cardiopulmonary arrest. Twenty-five of these patients (78%) had cardiac surgery before arrest. Inotropic support with continuous infusion of epinephrine was being administered at the time of arrest in 18 of 38 (47%) arrests. These prearrest variables did not influence outcome of CPR. Of the 38 episodes of CPR, 24 episodes (63%) were successful, with 20 episodes resulting in return of spontaneous circulation and four patients being successfully placed on mechanical cardiopulmonary support. Fourteen children, including all four patients who were rescued with mechanical cardiopulmonary support, survived to discharge. At 6-month follow-up, 11 patients were still alive, with three having neurologic impairment. CONCLUSIONS After cardiopulmonary resuscitation in this pediatric CICU, the rate of success was 63% and the rate of survival was 42%. Prior cardiac surgery and use of epinephrine before arrest did not influence the outcome of CPR. The availability of effective mechanical cardiopulmonary support can improve the outcome of CPR.
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Affiliation(s)
- D A Parra
- Division of Cardiology, Miami Children's Hospital, FL 33155-4069, USA
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Abstract
OBJECTIVES To examine the extent to which the Utstein style has been used for out-of-hospital cardiac arrest (OOHCA) research since its publication in 1991. The style was developed in an effort to standardize OOHCA research and reporting. METHODS To locate all OOHCA research papers published between 1992 and 1997, all issues of six emergency medicine/emergency medical services (EM/ EMS) journals were examined manually, and papers from other journals were located using computerized searches. All located articles were examined by the first author to determine whether use of the Utstein style was indicated and if so, whether it had actually been used. When either of these was uncertain, all three authors reviewed the paper, and a consensus was reached. The Pearson chi-square test was used to compare rates of use from U.S. and non-U.S. institutions, and from the EM/EMS and non-EM/EMS literature, with significance set at p < 0.05. RESULTS All 143 OOHCA research articles identified by the search were examined. The Utstein style was found to be not applicable to 41 (29%), and these were eliminated. The Utstein style was indicated for the remaining 102 studies. Of these, 41 (40%) used the Utstein style, and 61 (60%) did not. There was no difference in rates between papers from sites in the United States (18/48, 38%) and elsewhere (23/54, 43%), or between papers from the EM/EMS literature (17/44, 39%) and non-EM/EMS literature (25/59, 42%). Despite an upward trend in the use of the Utstein style seen from 1992 to 1994, use leveled off from 1994 to 1997, and has not exceeded 60% in any given calendar year studied. CONCLUSIONS Six years after the release of the Utstein style for OOHCA research, fewer than 60% of OOHCA research articles actually use the style.
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Affiliation(s)
- D C Cone
- Department of Emergency Medicine, MCP Hahnemann School of Medicine, Philadelphia, PA, USA.
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Sirbaugh PE, Pepe PE, Shook JE, Kimball KT, Goldman MJ, Ward MA, Mann DM. A prospective, population-based study of the demographics, epidemiology, management, and outcome of out-of-hospital pediatric cardiopulmonary arrest. Ann Emerg Med 1999; 33:174-84. [PMID: 9922413 DOI: 10.1016/s0196-0644(99)70391-4] [Citation(s) in RCA: 220] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVES To perform a population-based study addressing the demography, epidemiology, management, and outcome of out-of-hospital pediatric cardiopulmonary arrest (PCPA). METHODS Prospective, population-based study of all children (17 years of age or younger) in a large urban municipality who were treated by EMS personnel for apneic, pulseless conditions. Data were collected prospectively for 3(1/2) years using a comprehensive data collection tool and on-line computerized database. Each child received standard pediatric advanced cardiac life support. RESULTS During the 3(1/2)-year period, 300 children presented with PCPA (annual incidence of 19. 7/100,000 at risk). Of these, 60% (n=181) were male (P =.0003), and 54% (n=161) were patients 12 months of age or younger (152,500 at risk). Compared with the population at risk (32% black patients, 36% Hispanic patients, 26% white patients), a disproportionate number of arrests occurred in black children (51.6% versus 26.6% in Hispanics, and 17% in white children; P <.0001). Over 60% of all cases (n=181) occurred in the home with family members present, and yet those family members initiated basic CPR in only 31 (17%) of such cases. Only 33 (11%) of the total 300 PCPA cases had a return of spontaneous circulation, and 5 of the 6 discharged survivors had significant neurologic sequelae. Only 1 factor, endotracheal intubation, was correlated positively with return of spontaneous circulation (P =.032). CONCLUSION This population-based study underscores the need to investigate new therapeutic interventions for PCPA, as well as innovative strategies for improving the frequency of basic CPR for children.
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Affiliation(s)
- P E Sirbaugh
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
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Abstract
Little information is available about the effects of CPR in children, although it is known that the outcomes are dismal. Examples of unanswered questions include which advanced life support (ALS) procedures should be performed out-of-hospital, whether high-dose epinephrine improves survival, and the true prevalence of ventricular fibrillation as a presenting rhythm. Children differ from adults as to the cause and pathophysiology of cardiopulmonary arrest, but prehospital EMS and hospital resuscitation teams were initially designed for the care of adults. Because pediatric cardiopulmonary arrest is rare, prospective data are difficult to gather, and there are few large published studies. The purpose of this collective review was to review the current body of knowledge regarding survival rates and outcomes in pediatric CPR and, based on this review, to outline a course for future research.
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Affiliation(s)
- K D Young
- Departments of Emergency Medicine and Pediatrics, Harbor-UCLA Medical Center, University of California Los Angeles School of Medicine, Torrance, Torrance, CA.
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Cummins RO, Hazinski MF. Resuscitations from pulseless electrical activity and asystole: how big a piece of the survivors' pie? Ann Emerg Med 1998; 32:490-2. [PMID: 9774934 DOI: 10.1016/s0196-0644(98)70179-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Hassan TB. Use and effect of paediatric advanced life support skills for paediatric arrest in the A&E department. J Accid Emerg Med 1997; 14:357-62. [PMID: 9413773 PMCID: PMC1342973 DOI: 10.1136/emj.14.6.357] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To define the use of paediatric advanced life support by the Leicestershire Ambulance and Paramedic Service (LAPS) and the A&E department of a large university teaching hospital; and to identify the outcome and determine the factors that are consistent with a successful outcome. SUBJECTS AND METHODS The prehospital, accident and emergency (A&E), and inpatient notes of all patients aged 0-16 years who had been admitted to the resuscitation room at the Leicester Royal Infirmary in cardiac arrest between 1 January 1992 and 31 December 1995 were reviewed. Cardiac arrest was defined according to the Utstein template for reporting of prehospital data. RESULTS During the four year period, 51 cases of paediatric cardiac arrest were identified, with a median age of 3.2 years (range two days to 15 years). In eight patients, resuscitation was not attempted. Of the remaining 43, 15 (37%) were discharged from A&E to the intensive care unit. Five (11.5%) ultimately survived to discharge from hospital. Subsequent neurological development was recorded as normal in four of the five. Of the patients who had a prehospital cardiac arrest and were initially resuscitated by the LAPS there was only one survivor. He was discharged from hospital with severe neurological injury and died three months later. CONCLUSIONS The outcome for established prehospital paediatric cardiac arrest, in a well defined emergency medical services system, is very poor at present. It does not seem to be affected by the institution of paediatric life support teaching programmes for hospital staff alone. The timing in instituting advanced life support measures remains the most critical factor affecting outcome in these patients.
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Affiliation(s)
- T B Hassan
- Department of Accident and Emergency Medicine, Leicester Royal Infirmary NHS Trust, UK
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Cummins RO, Chamberlain D, Hazinski MF, Nadkarni V, Kloeck W, Kramer E, Becker L, Robertson C, Koster R, Zaritsky A, Ornato JP, Callanan V, Allen M, Steen P, Connolly B, Sanders A, Idris A, Cobbe S. Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital "Utstein style". American Heart Association. Ann Emerg Med 1997; 29:650-79. [PMID: 9140252 DOI: 10.1016/s0196-0644(97)70256-7] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- R O Cummins
- Emergency Cardiac Care Committee, American Heart Association, Dallas, Tx 75231-4596, USA.
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Cummins RO, Chamberlain D, Hazinski MF, Nadkarni V, Kloeck W, Kramer E, Becker L, Robertson C, Koster R, Zaritsky A, Bossaert L, Ornato JP, Callanan V, Allen M, Steen P, Connolly B, Sanders A, Idris A, Cobbe S. Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital 'Utstein style'. American Heart Association. Circulation 1997; 95:2213-39. [PMID: 9133537 DOI: 10.1161/01.cir.95.8.2213] [Citation(s) in RCA: 242] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Cummins RO, Chamberlain D, Hazinski MF, Nadkarni V, Kloeck W, Kramer E, Becker L, Robertson C, Koster R, Zaritsky A, Bossaert L, Ornato JP, Callanan V, Allen M, Steen P, Connolly B, Sanders A, Idris A, Cobbe S. Recommended guidelines for reviewing, reporting, and conducting research on in-hospital resuscitation: the in-hospital 'Utstein style'. A statement for healthcare professionals from the American Heart Association, the European Resuscitation Council, the Heart and Stroke Foundation of Canada, the Australian Resuscitation Council, and the Resuscitation Councils of Southern Africa. Resuscitation 1997; 34:151-83. [PMID: 9141159 DOI: 10.1016/s0300-9572(97)01112-x] [Citation(s) in RCA: 182] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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