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Validation of a Pediatric Early Warning Score in Hospitalized Pediatric Oncology and Hematopoietic Stem Cell Transplant Patients. Pediatr Crit Care Med 2016; 17:e146-53. [PMID: 26914628 DOI: 10.1097/pcc.0000000000000662] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the correlation of a Pediatric Early Warning Score with unplanned transfer to the PICU in hospitalized oncology and hematopoietic stem cell transplant patients. DESIGN We performed a retrospective matched case-control study, comparing the highest documented Pediatric Early Warning Score within 24 hours prior to unplanned PICU transfers in hospitalized pediatric oncology and hematopoietic stem cell transplant patients between September 2011 and December 2013. Controls were patients who remained on the inpatient unit and were matched 2:1 using age, condition (oncology vs hematopoietic stem cell transplant), and length of hospital stay. Pediatric Early Warning Scores were documented by nursing staff at least every 4 hours as part of routine care. Need for transfer was determined by a PICU physician called to evaluate the patient. SETTING A large tertiary/quaternary free-standing academic children's hospital. PATIENTS One hundred ten hospitalized pediatric oncology patients (42 oncology, 68 hematopoietic stem cell transplant) requiring unplanned PICU transfer and 220 matched controls. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Using the highest score in the 24 hours prior to transfer for cases and a matched time period for controls, the Pediatric Early Warning Score was highly correlated with the need for PICU transfer overall (area under the receiver operating characteristic = 0.96), and in the oncology and hematopoietic stem cell transplant groups individually (area under the receiver operating characteristic = 0.95 and 0.96, respectively). The difference in Pediatric Early Warning Score results between the cases and controls was noted as early as 24 hours prior to PICU admission. Seventeen patients died (15.4%). Patients with higher Pediatric Early Warning Scores prior to transfer had increased PICU mortality (p = 0.028) and length of stay (p = 0.004). CONCLUSIONS We demonstrate that our institution's Pediatric Early Warning Score is highly correlated with the need for unplanned PICU transfer in hospitalized oncology and hematopoietic stem cell transplant patients. Furthermore, we found an association between higher scores and PICU mortality. This is the first validation of a Pediatric Early Warning Score specific to the pediatric oncology and hematopoietic stem cell transplant populations, and supports the use of Pediatric Early Warning Scores as a method of early identification of clinical deterioration in this high-risk population.
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Impact of System Factors and Modifiable ICU Interventions on the Outcome of Cardio-pulmonary Resuscitation in PICU. Indian Pediatr 2016; 52:485-8. [PMID: 26121723 DOI: 10.1007/s13312-015-0661-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To assess the impact of system factors and modifiable interventions on outcome of cardiac arrest in a pediatric intensive care unit. DESIGN Retrospective medical record review. SETTING Pediatric intensive care unit of a hospital in China. PARTICIPANTS Children (age<14 yrs) who had cardiac arrest within our PICU over a period of two years. RESULTS Sixty-one of the 94 cardiac arrest events were successfully resuscitated. There was no significant association between personal and unit factors with immediate outcomes in our unit. The rate of unsuccessful resuscitation in sedated patients and those without sedation was 26% and 50%, respectively. Unsuccessful resuscitation occurred in 19% of patients who were on positive pressure ventilation as compared with 74% for those without positive pressure ventilation. Arrests which had resuscitation attempts that lasted more than 30 min had 135-fold higher odds of unsuccessful outcome. 78% of patients who received base supplement at the time of arrest had unsuccessful resuscitation compared with 21% for those without base supplement. CONCLUSION Our data shows no impact of system factors on the outcome of cardio-pulmonary resuscitation in our PICU. Pre-arrest sedation in pediatric critical ill patients might be beneficial to the outcome of cardiac arrests.
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Mancini ME, Diekema DS, Hoadley TA, Kadlec KD, Leveille MH, McGowan JE, Munkwitz MM, Panchal AR, Sayre MR, Sinz EH. Part 3: Ethical Issues: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2016; 132:S383-96. [PMID: 26472991 DOI: 10.1161/cir.0000000000000254] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Drummond D, Arnaud C, Thouvenin G, Guedj R, Duguet A, de Suremain N, Petit A. [Newly formed French residents in pediatrics are not well prepared for conducting pediatric resuscitation after medical school]. Arch Pediatr 2016; 23:150-8. [PMID: 26774839 DOI: 10.1016/j.arcped.2015.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 09/24/2015] [Accepted: 11/13/2015] [Indexed: 01/12/2023]
Abstract
BACKGROUND Medical schools aim to prepare medical students for their residency responsibilities. However, in France, there is no assessment of medical students' skills when they start their residency. GOAL The objective of this study was to assess the quality of basic life support delivered by first-year residents in pediatrics during a simulated pediatric cardiopulmonary arrest. MATERIALS AND METHODS First-year residents in pediatrics were assessed during a simulated pediatric cardiopulmonary arrest. Their performance score (based on adherence to international guidelines) and no-flow and no-blow fractions were recorded. RESULTS Forty-two first-year residents were evaluated. Their median performance score was 4 out of 13. No-blow and no-flow fractions were 55 and 81 %, respectively. There was no correlation between their skills and their knowledge assessed during the national ranking exam at the end of the 6th year of medical school. CONCLUSION At the beginning of their residency, pediatric residents are not able to properly provide basic life support. The introduction of simulation in French medical schools may be an effective way to improve their skills.
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Affiliation(s)
- D Drummond
- Université Paris Descartes, 75006 Paris, France
| | - C Arnaud
- Service des urgences pédiatriques, hôpital Trousseau, AP-HP, HUEP26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - G Thouvenin
- Service de pneumologie pédiatrique, hôpital Trousseau, AP-HP, HUEP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - R Guedj
- Service des urgences pédiatriques, hôpital Trousseau, AP-HP, HUEP26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - A Duguet
- Sorbonne universités, UPMC - université Paris 06, Paris, groupe PEPITE, 75005 Paris, France
| | - N de Suremain
- Service des urgences pédiatriques, hôpital Trousseau, AP-HP, HUEP26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - A Petit
- Service d'hémato-oncologie pédiatrique, hôpital Trousseau, AP-HP, HUEP, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Sorbonne universités, UPMC - université Paris 06, Paris, groupe PEPITE, 75005 Paris, France.
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de Caen AR, Berg MD, Chameides L, Gooden CK, Hickey RW, Scott HF, Sutton RM, Tijssen JA, Topjian A, van der Jagt ÉW, Schexnayder SM, Samson RA. Part 12: Pediatric Advanced Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2015; 132:S526-42. [PMID: 26473000 PMCID: PMC6191296 DOI: 10.1161/cir.0000000000000266] [Citation(s) in RCA: 346] [Impact Index Per Article: 38.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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de Caen AR, Berg MD, Chameides L, Gooden CK, Hickey RW, Scott HF, Sutton RM, Tijssen JA, Topjian A, van der Jagt ÉW, Schexnayder SM, Samson RA. Part 12: Pediatric Advanced Life Support: 2015 American Heart Association Guidelines Update for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care (Reprint). Pediatrics 2015; 136 Suppl 2:S176-95. [PMID: 26471384 DOI: 10.1542/peds.2015-3373f] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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de Caen AR, Maconochie IK, Aickin R, Atkins DL, Biarent D, Guerguerian AM, Kleinman ME, Kloeck DA, Meaney PA, Nadkarni VM, Ng KC, Nuthall G, Reis AG, Shimizu N, Tibballs J, Pintos RV. Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations (Reprint). Pediatrics 2015; 136 Suppl 2:S88-119. [PMID: 26471382 DOI: 10.1542/peds.2015-3373c] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Long-term evolution after in-hospital cardiac arrest in children: Prospective multicenter multinational study. Resuscitation 2015; 96:126-34. [DOI: 10.1016/j.resuscitation.2015.07.037] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/11/2015] [Accepted: 07/27/2015] [Indexed: 11/23/2022]
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Maconochie IK, de Caen AR, Aickin R, Atkins DL, Biarent D, Guerguerian AM, Kleinman ME, Kloeck DA, Meaney PA, Nadkarni VM, Ng KC, Nuthall G, Reis AG, Shimizu N, Tibballs J, Pintos RV. Part 6: Pediatric basic life support and pediatric advanced life support: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2015; 95:e147-68. [PMID: 26477423 DOI: 10.1016/j.resuscitation.2015.07.044] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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de Caen AR, Maconochie IK, Aickin R, Atkins DL, Biarent D, Guerguerian AM, Kleinman ME, Kloeck DA, Meaney PA, Nadkarni VM, Ng KC, Nuthall G, Reis AG, Shimizu N, Tibballs J, Veliz Pintos R. Part 6: Pediatric Basic Life Support and Pediatric Advanced Life Support. Circulation 2015; 132:S177-203. [DOI: 10.1161/cir.0000000000000275] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Maconochie IK, Bingham R, Eich C, López-Herce J, Rodríguez-Núñez A, Rajka T, Van de Voorde P, Zideman DA, Biarent D, Monsieurs KG, Nolan JP. European Resuscitation Council Guidelines for Resuscitation 2015. Resuscitation 2015; 95:223-48. [DOI: 10.1016/j.resuscitation.2015.07.028] [Citation(s) in RCA: 217] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Long-term neuropsychological outcomes in children and adolescents after cardiac arrest. Intensive Care Med 2015; 41:1057-66. [PMID: 25894622 PMCID: PMC4477720 DOI: 10.1007/s00134-015-3789-y] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 03/30/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE Research into neuropsychological functioning of survivors of cardiac arrest (CA) in childhood is scarce. We sought to assess long-term neuropsychological functioning in children and adolescents surviving CA. METHODS Neuropsychological follow-up study involving all consecutive children surviving CA between January 2002 and December 2011. Intelligence (IQ), language, attention, memory, visual-spatial, and executive functioning were assessed with internationally validated, neuropsychological tests and questionnaires. Scores were compared with Dutch normative data. RESULTS Of 107 eligible children, 47 who visited the outpatient clinic (median follow-up interval: 5.6 years) were analyzed. Fifty-five percent had an in-hospital CA, 86% a non-shockable rhythm, and 49% a respiratory-related etiology. CA survivors scored significantly worse on full-scale IQ (mean = 87.3), verbal IQ (mean = 92.7), performance IQ (mean = 85.6), verbal comprehension index (mean = 93.4), perceptual organization index (mean = 83.8), and processing speed index (mean = 91.1), than the norm population (mean IQ = 100). On neuropsychological tests, compared with norms, respectively adjusted for IQ, significantly worse scores were found on visual memory, significantly better on verbal memory (recognition), and comparable outcomes on visual-motor integration, attention, other measures of verbal memory, and executive functioning. On questionnaires, parents reported better executive functioning than the norm, but teachers reported more problems in planning/organizing skills. CONCLUSIONS Long-term neuropsychological assessment of CA survivors showed significant weaknesses, but also relatively intact functioning. As deficits in IQ, memory and executive functioning have significant impact on the child, long-term follow-up and neuropsychological support of CA survivors is warranted.
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Raymond TT, Stromberg D, Stigall W, Burton G, Zaritsky A. Sodium bicarbonate use during in-hospital pediatric pulseless cardiac arrest - a report from the American Heart Association Get With The Guidelines(®)-Resuscitation. Resuscitation 2015; 89:106-13. [PMID: 25613362 PMCID: PMC6155484 DOI: 10.1016/j.resuscitation.2015.01.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 01/07/2015] [Accepted: 01/12/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite limited recommendations for using sodium bicarbonate (SB) during cardiopulmonary resuscitation (CPR), we hypothesized that SB continues to be used frequently during pediatric in-hospital cardiac arrest (IHCA) and that its use varies by hospital-specific, patient-specific, and event-specific characteristics. METHODS We analyzed 3719 pediatric (<18 years) index pulseless CPR events from the American Heart Association Get With The Guidelines-Resuscitation database from 1/2000 to 9/2010. RESULTS SB was used in 2536 (68%) of 3719 CPR events. Incidence of SB use between 2000 and 2005 vs. 2006 and 2010 was 71.1% vs. 66.2% (P=0.002). The primary outcome was survival to discharge. Secondary outcomes included 24-h survival and neurologic outcome. Multivariable logistic regression analyzed the association between SB use and outcomes. SB had increased use an ICU location, metabolic/electrolyte disturbance, prolonged CPR, pVT/VF, and concurrently with other pharmacologic interventions. Adjusting for confounding factors, SB use was associated with decreased 24-h survival (aOR 0.83, 95% CI: 0.69, 0.99) and decreased survival to discharge (aOR 0.80; 95% CI: 0.65, 0.97). Inclusion of metabolic/electrolyte abnormalities, hyperkalemia, and toxicologic abnormalities only (n=674), SB use was not associated with worse outcomes or unfavorable neurologic outcome. CONCLUSIONS SB is used frequently during pediatric pulseless IHCA, yet there is a significant trend toward less routine use over the last decade. Because SB is more likely to be used in an ICU, with prolonged CPR, and concurrently with other pharmacologic interventions; its use during CPR may be associated with poor prognosis due to an association with "last ditch" efforts of resuscitation rather than causation.
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Affiliation(s)
- Tia T. Raymond
- Department of Pediatrics and Critical Care Medicine, Section of Pediatric Cardiac Intensive Care, Medical City Children’s Hospital, Dallas, TX, United States
| | - Daniel Stromberg
- Department of Pediatrics and Critical Care Medicine, Section of Pediatric Cardiac Intensive Care, Medical City Children’s Hospital, Dallas, TX, United States
| | - William Stigall
- Department of Pediatrics and Critical Care Medicine, Section of Pediatric Cardiac Intensive Care, Medical City Children’s Hospital, Dallas, TX, United States
| | - Grant Burton
- Department of Pediatrics and Critical Care Medicine, Section of Pediatric Cardiac Intensive Care, Medical City Children’s Hospital, Dallas, TX, United States
| | - Arno Zaritsky
- Department of Pediatrics, Children’s Hospital of The King’s Daughters, Norfolk, VA, United States
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Abstract
OBJECTIVES The objective of this study was to analyze the characteristic and the prognostic factors of in-hospital pediatric cardiac arrest (CA) in a public hospital Honduras. METHODS A prospective observational study was performed on pediatric in-hospital CA as a part of a multicenter international study. One hundred forty-six children were studied. The primary end point was survival at hospital discharge. Univariate and multivariate logistic regression analyses were performed to assess the influence of each factor on mortality. RESULTS Cardiac arrest occurred in the emergency department in 66.9%. Respiratory diseases and sepsis were predominant causes of CA. Return of spontaneous circulation was achieved in 60% of patients, and 22.6% survived to hospital discharge. The factors related with mortality were nonrespiratory cause of CA (odds ratio [OR], 2.55; P = 0.045), adrenaline administration (OR, 4.96; P = 0.008), and a duration of cardiopulmonary resuscitation more than 10 minutes (OR, 3.40; P = 0.012). CONCLUSIONS In-hospital CA in children in a developing country has low survival. Patients with nonrespiratory causes and those who need adrenaline administration and prolonged resuscitation had worse prognosis.
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López-Herce J, del Castillo J, Matamoros M, Canadas S, Rodriguez-Calvo A, Cecchetti C, Rodríguez-Núnez A, Carrillo Á. Post return of spontaneous circulation factors associated with mortality in pediatric in-hospital cardiac arrest: a prospective multicenter multinational observational study. Crit Care 2014; 18:607. [PMID: 25672247 PMCID: PMC4245792 DOI: 10.1186/s13054-014-0607-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 10/20/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Most studies have analyzed pre-arrest and resuscitation factors associated with mortality after cardiac arrest (CA) in children, but many patients that reach return of spontaneous circulation die within the next days or weeks. The objective of our study was to analyze post-return of spontaneous circulation factors associated with in-hospital mortality after cardiac arrest in children. METHODS A prospective multicenter, multinational, observational study in 48 hospitals from 12 countries was performed. A total of 502 children aged between 1 month and 18 years with in-hospital cardiac arrest were analyzed. The primary endpoint was survival to hospital discharge. Univariate and multivariate logistic regression analyses were performed to assess the influence of each post-return of spontaneous circulation factor on mortality. RESULTS Return of spontaneous circulation was achieved in 69.5% of patients; 39.2% survived to hospital discharge and 88.9% of survivors had good neurological outcome. In the univariate analysis, post- return of spontaneous circulation factors related with mortality were pH, base deficit, lactic acid, bicarbonate, FiO2, need for inotropic support, inotropic index, dose of dopamine and dobutamine at 1 hour and at 24 hours after return of spontaneous circulation as well as Pediatric Intensive Care Unit and total hospital length of stay. In the multivariate analysis factors associated with mortality at 1 hour after return of spontaneous circulation were PaCO2 < 30 mmHg and >50 mmHg, inotropic index >14 and lactic acid >5 mmol/L. Factors associated with mortality at 24 hours after return of spontaneous circulation were PaCO2 > 50 mmHg, inotropic index >14 and FiO2 ≥ 0.80. CONCLUSIONS Secondary in-hospital mortality among the initial survivors of CA is high. Hypoventilation, hyperventilation, FiO2 ≥ 0.80, the need for high doses of inotropic support, and high levels of lactic acid were the most important post-return of spontaneous circulation factors associated with in-hospital mortality in children in our population.
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Affiliation(s)
- Jesús López-Herce
- />Pediatric Intensive Care Department, Hospital General Universitario Gregorio Maranón, Dr Castelo 47, 28009 Madrid, Spain
- />Instituto de Investigación Sanitaria del Hospital Gregorio Marañón de Madrid, Red de Salud Materno Infantil y del Desarrollo (Red SAMID), Dr Castelo 47, 28009 Madrid, Spain
| | - Jimena del Castillo
- />Pediatric Intensive Care Department, Hospital General Universitario Gregorio Maranón, Dr Castelo 47, 28009 Madrid, Spain
- />Instituto de Investigación Sanitaria del Hospital Gregorio Marañón de Madrid, Red de Salud Materno Infantil y del Desarrollo (Red SAMID), Dr Castelo 47, 28009 Madrid, Spain
| | | | - Sonia Canadas
- />Hospital Valle de Hebrón, Passeig Vall d’Hebron, 119-129 08035 Barcelona, Spain
| | | | - Corrado Cecchetti
- />Ospedale Bambinu Gesu, Via della Torre di Palidoro, 00050 Fiumicino Roma, Italy
| | - Antonio Rodríguez-Núnez
- />Hospital Clínico Universitario de Santiago de Compostela, Travesía de Choupana, s/n, 15706 A Coruña, Spain
| | - Ángel Carrillo
- />Pediatric Intensive Care Department, Hospital General Universitario Gregorio Maranón, Dr Castelo 47, 28009 Madrid, Spain
- />Instituto de Investigación Sanitaria del Hospital Gregorio Marañón de Madrid, Red de Salud Materno Infantil y del Desarrollo (Red SAMID), Dr Castelo 47, 28009 Madrid, Spain
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del Castillo J, López-Herce J, Cañadas S, Matamoros M, Rodríguez-Núnez A, Rodríguez-Calvo A, Carrillo A. Cardiac arrest and resuscitation in the pediatric intensive care unit: A prospective multicenter multinational study. Resuscitation 2014; 85:1380-6. [DOI: 10.1016/j.resuscitation.2014.06.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 05/13/2014] [Accepted: 06/20/2014] [Indexed: 11/25/2022]
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Serrano M, Rodríguez J, Espejo A, del Olmo R, Llanos S, del Castillo J, López-Herce J. Relationship between previous severity of illness and outcome of in-hospital cardiac arrest. An Pediatr (Barc) 2014. [DOI: 10.1016/j.anpede.2013.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Serrano M, Rodríguez J, Espejo A, del Olmo R, Llanos S, Del Castillo J, López-Herce J. [Relationship between previous severity of illness and outcome of in-hospital cardiac arrest]. An Pediatr (Barc) 2014; 81:9-15. [PMID: 24286880 DOI: 10.1016/j.anpedi.2013.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 09/09/2013] [Accepted: 09/26/2013] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To analyze the relationship between previous severity of illness, lactic acid, creatinine and inotropic index with mortality of in-hospital cardiac arrest (CA) in children, and the value of a prognostic index designed for adults. METHODS The study included total of 44 children aged from 1 month to 18 years old who suffered a cardiac arrest while in hospital. The relationship between previous severity of illness scores (PRIMS and PELOD), lactic acid, creatinine, treatment with vasoactive drugs, inotropic index with return of spontaneous circulation and survival at hospital discharge was analyzed. RESULTS The large majority (90.3%) of patients had a return of spontaneous circulation, and 59% survived at hospital discharge. More than two-thirds (68.2%) were treated with inotropic drugs at the time of the CA. The patients who died had a higher lactic acid before the CA (3.4 mmol/L) than survivors (1.4 mmol/L), P=.04. There were no significant differences in PRIMS, PELOD, creatinine, inotropic drugs, and inotropic index before CA between patients who died and survivors. CONCLUSION A high lactic acid previous to cardiac arrest could be a prognostic factor of in-hospital cardiac arrest in children.
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Affiliation(s)
- M Serrano
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España
| | - J Rodríguez
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España
| | - A Espejo
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España
| | - R del Olmo
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España
| | - S Llanos
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España
| | - J Del Castillo
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España
| | - J López-Herce
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Instituto de Investigación, Hospital General Universitario Gregorio Marañón, Madrid, Red de Salud Maternoinfantil y del Desarrollo (Red SAMID), Madrid, España.
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The impact of oxygen and carbon dioxide management on outcome after cardiac arrest. Curr Opin Crit Care 2014; 20:266-72. [DOI: 10.1097/mcc.0000000000000084] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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López-Herce J, del Castillo J, Cañadas S, Rodríguez-Núñez A, Carrillo A. Parada cardiaca pediátrica intrahospitalaria en España. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.07.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zeng J, Qian S. Reply to Letter: Cardiac arrest prognostic factors in children. Resuscitation 2014; 85:e37. [DOI: 10.1016/j.resuscitation.2013.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 12/01/2013] [Indexed: 11/29/2022]
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Timsit JF, Citerio G, Bakker J, Bassetti M, Benoit D, Cecconi M, Curtis JR, Hernandez G, Herridge M, Jaber S, Joannidis M, Papazian L, Peters M, Singer P, Smith M, Soares M, Torres A, Vieillard-Baron A, Azoulay E. Year in review in Intensive Care Medicine 2013: III. Sepsis, infections, respiratory diseases, pediatrics. Intensive Care Med 2014; 40:471-83. [PMID: 24519574 PMCID: PMC7095429 DOI: 10.1007/s00134-014-3235-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Accepted: 01/29/2014] [Indexed: 01/03/2023]
Affiliation(s)
- Jean-Francois Timsit
- Medical and Infectious Diseases ICU, Bichat Hospital, Paris Diderot University, Paris, France,
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López-Herce J, del Castillo J, Cañadas S, Rodríguez-Núñez A, Carrillo A. In-hospital pediatric cardiac arrest in Spain. ACTA ACUST UNITED AC 2013; 67:189-95. [PMID: 24774393 DOI: 10.1016/j.rec.2013.07.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 07/17/2013] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND OBJECTIVES The objective was to analyze the characteristics and prognostic factors of in-hospital pediatric cardiac arrest in Spain. METHODS A prospective observational study was performed to examine in-hospital pediatric cardiac arrest. Two hundred children were studied, aged between 1 month and 18 years, with in-hospital cardiac arrest. Univariate and multivariate logistic regression analyses were performed to assess the influence of each factor on survival to hospital discharge. RESULTS Return of spontaneous circulation was achieved in 74% of the patients and 41% survived to hospital discharge. The survival rate was significantly higher than that reported in a previous Spanish study 10 years earlier (25.9%). In the univariate analysis, the factors related to mortality were body weight higher than 10 kg; continuous infusion of vasoactive drugs prior to cardiac arrest; sepsis and neurological disorders as causes of cardiac arrest, the need for treatment with adrenaline, bicarbonate, and volume expansion, and prolonged cardiopulmonary resuscitation. In the multivariate analysis, the factors related to mortality were hematologic/oncologic diseases, continuous infusion of vasoactive drugs prior to cardiac arrest, cardiopulmonary resuscitation for more than 20 min, and treatment with bicarbonate and volume expansion. CONCLUSIONS Survival after in-hospital cardiac arrest in children has significantly improved in recent years. The factors related to in-hospital mortality were hematologic/oncologic diseases, continuous infusion of vasoactive drugs prior to cardiac arrest, the duration of cardiopulmonary resuscitation, and treatment with bicarbonate and volume expansion.
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Affiliation(s)
- Jesús López-Herce
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación del Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Jimena del Castillo
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación del Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Sonia Cañadas
- Sección de Cuidados Intensivos Pediátricos, Hospital Vall d'Hebron, Barcelona, Spain
| | - Antonio Rodríguez-Núñez
- Servicio de Cuidados Intensivos Pediátricos y Urgencias, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
| | - Angel Carrillo
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación del Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Lopez-Herce J, Del Castillo J, Carrillo A. Cardiac arrest prognostic factors in children. Resuscitation 2013; 85:e35. [PMID: 24333645 DOI: 10.1016/j.resuscitation.2013.10.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 10/14/2013] [Indexed: 11/25/2022]
Affiliation(s)
- Jesus Lopez-Herce
- Hospital General Universitario Gregorio Marañón, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Spain.
| | - Jimena Del Castillo
- Hospital General Universitario Gregorio Marañón, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Spain
| | - Angel Carrillo
- Hospital General Universitario Gregorio Marañón, Universidad Complutense, Instituto de Investigación Sanitaria del Hospital Gregorio Marañón, Spain
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Rodríguez-Núñez A, López-Herce J, del Castillo J, Bellón JM. Shockable rhythms and defibrillation during in-hospital pediatric cardiac arrest. Resuscitation 2013; 85:387-91. [PMID: 24291590 DOI: 10.1016/j.resuscitation.2013.11.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Revised: 10/22/2013] [Accepted: 11/09/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To analyze the results of cardiopulmonary resuscitation (CPR) that included defibrillation during in-hospital cardiac arrest (IH-CA) in children. METHODS A prospective multicenter, international, observational study on pediatric IH-CA in 12 European and Latin American countries, during 24 months. Data from 502 children between 1 month and 18 years were collected using the Utstein template. Patients with a shockable rhythm that was treated by electric shock(s) were included. The primary endpoint was survival at hospital discharge. Univariate logistic regression analysis was performed to find outcome factors. RESULTS Forty events in 37 children (mean age 48 months, IQR: 7-15 months) were analyzed. An underlying disease was present in 81.1% of cases and 24.3% had a previous CA. The main cause of arrest was a cardiac disease (56.8%). In 17 episodes (42.5%) ventricular fibrillation (VF) or pulseless ventricular tachycardia (pVT) was the first documented rhythm, and in 23 (57.5%) it developed during CPR efforts. In 11 patients (27.5%) three or more shocks were needed to achieve defibrillation. Return of spontaneous circulation (ROSC) was obtained in 25 cases (62.5%), that was sustained in 20 (50.0%); however only 12 children (32.4%) survived to hospital discharge. Children with VF/pVT as first documented rhythm had better sustained ROSC (64.7% vs. 39.1%, p=0.046) and survival to hospital discharge rates (58.8% vs. 21.7%, p=0.02) than those with subsequent VF/pVT. Survival rate was inversely related to duration of CPR. Clinical outcome was not related to the cause or location of arrest, type of defibrillator and waveform, energy dose per shock, number of shocks, or cumulative energy dose, although there was a trend to better survival with higher doses per shock (25.0% with <2Jkg(-1), 43.4% with 2-4Jkg(-1) and 50.0% with >4Jkg(-1)) and worse with higher number of shocks and cumulative energy dose. CONCLUSION The termination of pediatric VF/pVT in the IH-CA setting is achieved in a low percentage of instances with one electrical shock at 4Jkg(-1). When VF/pVT is the first documented rhythm, the results of defibrillation are better than in the case of subsequent VF/pVT. No clear relationship between defibrillation protocol and ROSC or survival has been observed. The optimal pediatric defibrillation dose remains to be determined; therefore current resuscitation guidelines cannot be considered evidence-based, and additional research is needed.
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Affiliation(s)
- Antonio Rodríguez-Núñez
- Paediatric Emergency and Critical Care Division, Hospital Clínico Universitario de Santiago de Compostela, Spain.
| | - Jesús López-Herce
- Paediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jimena del Castillo
- Paediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José María Bellón
- Paediatric Intensive Care Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Pediatric cardiopulmonary arrest after failed tracheostomy tube exchange. Resuscitation 2013. [DOI: 10.1016/j.resuscitation.2013.08.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Topjian AA, Berg RA, Nadkarni VM. Advances in recognition, resuscitation, and stabilization of the critically ill child. Pediatr Clin North Am 2013; 60:605-20. [PMID: 23639658 DOI: 10.1016/j.pcl.2013.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Advances in early recognition, effective response, and high-quality resuscitation before, during, and after cardiac arrest have resulted in improved survival for infants and children over the past 10 years. This review addresses several key factors that can make a difference in survival outcomes, including the etiology of pediatric cardiac arrests in and out of hospital, mechanisms and techniques of circulation of blood flow during cardiopulmonary resuscitation (CPR), quality of CPR, meticulous postresuscitative care, and effective training. Monitoring and quality improvement of each element in the system of resuscitation care are increasingly recognized as key factors in saving lives.
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Affiliation(s)
- Alexis A Topjian
- Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, The University of Pennsylvania, Philadelphia, PA 19063, USA
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