1
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Esangbedo ID. Pediatric out-of-hospital cardiac arrest still needs more attention. Resuscitation 2024; 198:110195. [PMID: 38522729 DOI: 10.1016/j.resuscitation.2024.110195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 03/19/2024] [Indexed: 03/26/2024]
Affiliation(s)
- Ivie D Esangbedo
- Division of Cardiac Critical Care Medicine, Department of Pediatrics, University of Washington (Seattle Children's Hospital), USA.
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2
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Balaji S, Atkins DL, Berger S, Etheridge SP, Shah MJ. The Case for Home AED in Children, Adolescents, and Young Adults Not Meeting Criteria for ICD. JACC Clin Electrophysiol 2022; 8:1165-1172. [PMID: 36137726 DOI: 10.1016/j.jacep.2022.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/20/2022] [Accepted: 07/22/2022] [Indexed: 12/01/2022]
Abstract
Children, adolescents, and young adults with conditions such as cardiomyopathies and channelopathies are at higher risk of sudden cardiac death caused by lethal arrhythmias, especially ventricular fibrillation. Timely defibrillation saves lives. Patients thought to be at significantly high risk of sudden death typically undergo placement of an implantable cardioverter-defibrillator. Patients thought to be at lower risk are typically followed medically but do not undergo implantable cardioverter-defibrillator placement. However, low risk does not equal no risk. Compared with the general population, many of these patients are at significantly higher risk for lethal arrhythmias. We make the case that such individuals and families will benefit from having an at-home automatic external defibrillator. Used in conjunction with conventional measures such as training on cardiopulmonary resuscitation, an at-home automatic external defibrillator could lead to significantly shortened time to defibrillation with better overall and neurological survival. We recommend that the cost of such home automatic external defibrillators should be covered by medical insurance.
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Affiliation(s)
- Seshadri Balaji
- Department of Pediatrics, Oregon Health and Science University, Portland Oregon, USA.
| | - Dianne L Atkins
- Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | | | | | - Maully J Shah
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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3
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Shekhar AC, Campbell T, Mann NC, Blumen IJ, Madhok M. Age and Racial/Ethnic Disparities in Pediatric Out-of-Hospital Cardiac Arrest. Circulation 2022; 145:1288-1289. [PMID: 35285238 DOI: 10.1161/circulationaha.121.057508] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Out-of-hospital cardiac arrest (OHCA) in the pediatric population is a significant public health concern. Estimates of mortality suggest ≈7000 pediatric cardiac arrests occur annually in the United States.1 The existence of racial disparities in adult OHCA has been well established2; however, there is limited research examining whether similar disparities might also be present in the pediatric population. Age-related disparities in pediatric OHCA have also been previously identified.3 For cardiac arrests in both adult and pediatric patients, early cardiopulmonary resuscitation (CPR) is crucial to prevent permanent injury and promote a desirable outcome; in the out-of-hospital setting, this often involves CPR being initiated by nonmedical bystanders.1,3 Emergency medical services (EMS) are often the first professional responders to OHCA, and data from the EMS perspective might be the only means of determining whether disparities-defined as significant differences in care and/or outcomes-are present in pediatric OHCA.
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Affiliation(s)
- Aditya C Shekhar
- Center for Bioethics, Harvard Medical School, Boston, MA; University of Minnesota-Twin Cities, Minneapolis, MN
| | - Teri Campbell
- University of Chicago Aeromedical Network (UCAN), University of Chicago, Chicago, IL
| | - N Clay Mann
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Ira J Blumen
- University of Chicago Aeromedical Network (UCAN), University of Chicago, Chicago, IL; Department of Emergency Medicine, University of Chicago, Chicago, IL
| | - Manu Madhok
- University of Minnesota-Twin Cities, Minneapolis, MN; Department of Emergency Medicine, Children's Minnesota, Minneapolis, MN
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4
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Yoshinaga M, Ishikawa S, Otsubo Y, Shida M, Hoshiko K, Yatsunami K, Kanaya Y, Takagi J, Takamura K, Ganaha H, Sunagawa M, Soeda O, Ogawa Y, Ogata H, Kashima N. Sudden out-of-hospital cardiac arrest in pediatric patients in Kyushu area in Japan. Pediatr Int 2021; 63:1441-1450. [PMID: 34237185 DOI: 10.1111/ped.14683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 02/16/2021] [Accepted: 03/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND It is well-known that a neurologically favorable outcome of out-of-hospital cardiac arrest (OHCA) is associated with the presence of bystander-initiated cardiopulmonary resuscitation (bystander CPR) and use of an automated external defibrillator. However, little is known about the effect of the presence of pre-existing conditions, prior activity, and locations on the outcome of pediatric OHCA. METHODS We analyzed the data from questionnaires about pediatric patients with OHCA aged from 3 days to 19 years in the Kyushu area in Japan between 2012 and 2016. RESULTS A total of 594 OHCA cases were collected. The numbers of OHCA cases and the rate of 1 month survival with a favorable neurological outcome during sleeping, swimming / bathing, and exercise were 192 (1.0%), 83 (32.5%), and 44 (65.9%), respectively. When an OHCA occurred at school (n = 56), 88% of children / adolescents received bystander CPR, but when it occurred at home (n = 390), 15% received bystander CPR. Cardiovascular (n = 61), suicide (n = 61), and neurological / neuromuscular (n = 44) diseases were three major pre-existing conditions. The OHCA of cardiovascular disease was associated with exercise (24/61) and mainly occurred at school (22/61). The OHCA of neurological / neuromuscular disease was associated with swimming/bathing (15/44) and mainly occurred during bathing at home (12/44). Multivariate regression analysis showed that the presence of bystander CPR (P < 0.001) and occurrence of OHCA at school (P < 0.001) were independently predictive of a favorable outcome in pediatric OHCA. CONCLUSION The outcome was different among pre-existing conditions, prior activity, and location of OHCA. These findings might be useful for preventing OHCA and improving the outcome of pediatric OHCA.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Yumi Ogawa
- Kagoshima Medical Association, Kagoshima, Japan
| | - Hiromitsu Ogata
- Epidemiology and Biostatistics, Kagawa Nutrition University, Sakado, Japan
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5
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Naim MY, Griffis HM, Berg RA, Bradley RN, Burke RV, Markenson D, McNally BF, Nadkarni VM, Song L, Vellano K, Vetter V, Rossano JW. Compression-Only Versus Rescue-Breathing Cardiopulmonary Resuscitation After Pediatric Out-of-Hospital Cardiac Arrest. J Am Coll Cardiol 2021; 78:1042-1052. [PMID: 34474737 DOI: 10.1016/j.jacc.2021.06.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/07/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND There are conflicting data regarding the benefit of compression-only bystander cardiopulmonary resuscitation (CO-CPR) compared with CPR with rescue breathing (RB-CPR) after pediatric out-of-hospital cardiac arrest (OHCA). OBJECTIVES This study sought to test the hypothesis that RB-CPR is associated with improved neurologically favorable survival compared with CO-CPR following pediatric OHCA, and to characterize age-stratified outcomes with CPR type compared with no bystander CPR (NO-CPR). METHODS Analysis of the CARES registry (Cardiac Arrest Registry to Enhance Survival) for nontraumatic pediatric OHCAs (patients aged ≤18 years) from 2013-2019 was performed. Age groups included infants (<1 year), children (1 to 11 years), and adolescents (≥12 years). The primary outcome was neurologically favorable survival at hospital discharge. RESULTS Of 13,060 pediatric OHCAs, 46.5% received bystander CPR. CO-CPR was the most common bystander CPR type. In the overall cohort, neurologically favorable survival was associated with RB-CPR (adjusted OR: 2.16; 95% CI: 1.78-2.62) and CO-CPR (adjusted OR: 1.61; 95% CI: 1.34-1.94) compared with NO-CPR. RB-CPR was associated with a higher odds of neurologically favorable survival compared with CO-CPR (adjusted OR: 1.36; 95% CI: 1.10-1.68). In age-stratified analysis, RB-CPR was associated with better neurologically favorable survival versus NO-CPR in all age groups. CO-CPR was associated with better neurologically favorable survival compared with NO-CPR in children and adolescents, but not in infants. CONCLUSIONS CO-CPR was the most common type of bystander CPR in pediatric OHCA. RB-CPR was associated with better outcomes compared with CO-CPR. These results support present guidelines for RB-CPR as the preferred CPR modality for pediatric OHCA.
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Affiliation(s)
- Maryam Y Naim
- The Cardiac Center, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
| | - Heather M Griffis
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Richard N Bradley
- Division of Emergency Medicine, University of Texas Health Science Center, Houston, Texas, USA
| | - Rita V Burke
- Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Bryan F McNally
- Department of Emergency Medicine, Emory University, Atlanta, Georgia, USA
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Lihai Song
- Department of Biomedical and Health Informatics, Data Science and Biostatistics Unit, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kimberly Vellano
- Department of Emergency Medicine, Emory University, Atlanta, Georgia, USA
| | - Victoria Vetter
- The Cardiac Center, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Joseph W Rossano
- The Cardiac Center, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA; Leonard Davis Institute, The University of Pennsylvania, Philadelphia, Pennsylvania, USA
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6
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Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. [Paediatric Life Support]. Notf Rett Med 2021; 24:650-719. [PMID: 34093080 PMCID: PMC8170638 DOI: 10.1007/s10049-021-00887-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 12/11/2022]
Abstract
The European Resuscitation Council (ERC) Paediatric Life Support (PLS) guidelines are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations of the International Liaison Committee on Resuscitation (ILCOR). This section provides guidelines on the management of critically ill or injured infants, children and adolescents before, during and after respiratory/cardiac arrest.
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Affiliation(s)
- Patrick Van de Voorde
- Department of Emergency Medicine, Faculty of Medicine UG, Ghent University Hospital, Gent, Belgien
- Federal Department of Health, EMS Dispatch Center, East & West Flanders, Brüssel, Belgien
| | - Nigel M. Turner
- Paediatric Cardiac Anesthesiology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Niederlande
| | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Tschechien
- Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Tschechien
| | | | - Abel Martinez-Mejias
- Department of Paediatrics and Emergency Medicine, Hospital de Terassa, Consorci Sanitari de Terrassa, Barcelona, Spanien
| | - Dominique Biarent
- Paediatric Intensive Care & Emergency Department, Hôpital Universitaire des Enfants, Université Libre de Bruxelles, Brüssel, Belgien
| | - Robert Bingham
- Hon. Consultant Paediatric Anaesthetist, Great Ormond Street Hospital for Children, London, Großbritannien
| | - Olivier Brissaud
- Réanimation et Surveillance Continue Pédiatriques et Néonatales, CHU Pellegrin – Hôpital des Enfants de Bordeaux, Université de Bordeaux, Bordeaux, Frankreich
| | - Florian Hoffmann
- Pädiatrische Intensiv- und Notfallmedizin, Kinderklinik und Kinderpoliklinik im Dr. von Haunerschen Kinderspital, Ludwig-Maximilians-Universität, München, Deutschland
| | | | - Torsten Lauritsen
- Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen, Kopenhagen, Dänemark
| | - Ian Maconochie
- Paediatric Emergency Medicine, Faculty of Medicine Imperial College, Imperial College Healthcare Trust NHS, London, Großbritannien
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7
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Van de Voorde P, Turner NM, Djakow J, de Lucas N, Martinez-Mejias A, Biarent D, Bingham R, Brissaud O, Hoffmann F, Johannesdottir GB, Lauritsen T, Maconochie I. European Resuscitation Council Guidelines 2021: Paediatric Life Support. Resuscitation 2021; 161:327-387. [PMID: 33773830 DOI: 10.1016/j.resuscitation.2021.02.015] [Citation(s) in RCA: 151] [Impact Index Per Article: 50.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
These European Resuscitation Council Paediatric Life Support (PLS) guidelines, are based on the 2020 International Consensus on Cardiopulmonary Resuscitation Science with Treatment Recommendations. This section provides guidelines on the management of critically ill infants and children, before, during and after cardiac arrest.
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Affiliation(s)
- Patrick Van de Voorde
- Department of Emergency Medicine Ghent University Hospital, Faculty of Medicine UG, Ghent, Belgium; EMS Dispatch Center, East & West Flanders, Federal Department of Health, Belgium.
| | - Nigel M Turner
- Paediatric Cardiac Anesthesiology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, Netherlands
| | - Jana Djakow
- Paediatric Intensive Care Unit, NH Hospital, Hořovice, Czech Republic; Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Medical Faculty of Masaryk University, Brno, Czech Republic
| | | | - Abel Martinez-Mejias
- Department of Paediatrics and Emergency Medicine, Hospital de Terassa, Consorci Sanitari de Terrassa, Barcelona, Spain
| | - Dominique Biarent
- Paediatric Intensive Care & Emergency Department, Hôpital Universitaire des Enfants, Université Libre de Bruxelles, Brussels, Belgium
| | - Robert Bingham
- Hon. Consultant Paediatric Anaesthetist, Great Ormond Street Hospital for Children, London, UK
| | - Olivier Brissaud
- Réanimation et Surveillance Continue Pédiatriques et Néonatales, CHU Pellegrin - Hôpital des Enfants de Bordeaux, Université de Bordeaux, Bordeaux, France
| | - Florian Hoffmann
- Paediatric Intensive Care and Emergency Medicine, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | | | - Torsten Lauritsen
- Paediatric Anaesthesia, The Juliane Marie Centre, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Ian Maconochie
- Paediatric Emergency Medicine, Imperial College Healthcare Trust NHS, Faculty of Medicine Imperial College, London, UK
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8
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Shimoda-Sakano TM, Schvartsman C, Reis AG. Epidemiology of pediatric cardiopulmonary resuscitation. J Pediatr (Rio J) 2020; 96:409-421. [PMID: 31580845 PMCID: PMC9432320 DOI: 10.1016/j.jped.2019.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/31/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To analyze the main epidemiological aspects of prehospital and hospital pediatric cardiopulmonary resuscitation and the impact of scientific evidence on survival. SOURCE OF DATA This was a narrative review of the literature published at PubMed/MEDLINE until January 2019 including original and review articles, systematic reviews, meta-analyses, annals of congresses, and manual search of selected articles. SYNTHESIS OF DATA The prehospital and hospital settings have different characteristics and prognoses. Pediatric prehospital cardiopulmonary arrest has a three-fold lower survival rate than cardiopulmonary arrest in the hospital setting, occurring mostly at home and in children under 1year. Higher survival appears to be associated with age progression, shockable rhythm, emergency medical care, use of automatic external defibrillator, high-quality early life support, telephone dispatcher-assisted cardiopulmonary resuscitation, and is strongly associated with witnessed cardiopulmonary arrest. In the hospital setting, a higher incidence was observed in children under 1year of age, and mortality increased with age. Higher survival was observed with shorter cardiopulmonary resuscitation duration, occurrence on weekdays and during daytime, initial shockable rhythm, and previous monitoring. Despite the poor prognosis of pediatric cardiopulmonary resuscitation, an increase in survival has been observed in recent years, with good neurological prognosis in the hospital setting. CONCLUSIONS A great progress in the science of pediatric cardiopulmonary resuscitation has been observed, especially in developed countries. The recognition of the epidemiological aspects that influence cardiopulmonary resuscitation survival may direct efforts towards more effective actions; thus, studies in emerging and less favored countries remains a priority regarding the knowledge of local factors.
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Affiliation(s)
- Tania Miyuki Shimoda-Sakano
- Universidade de São Paulo (USP), Pediatria, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Pronto Socorro do Instituto da Criança, São Paulo, SP, Brazil; Sociedade de Pediatria de São Paulo (SPSP), Departamento de Emergência, Coordenação Ressuscitação Pediátrica, São Paulo, SP, Brazil; Sociedade de Cardiologia de São Paulo, Curso de PALS (Pediatric Advanced Life Support), São Paulo, SP, Brazil.
| | - Cláudio Schvartsman
- Universidade de São Paulo (USP), Pediatria, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Pronto Socorro do Instituto da Criança, São Paulo, SP, Brazil
| | - Amélia Gorete Reis
- Universidade de São Paulo (USP), Pediatria, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Pronto Socorro do Instituto da Criança, São Paulo, SP, Brazil; International Liaison Committee on Resuscitation (ILCOR), Brazil
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9
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Shimoda‐Sakano TM, Schvartsman C, Reis AG. Epidemiology of pediatric cardiopulmonary resuscitation. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2020. [DOI: 10.1016/j.jpedp.2019.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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10
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Griffis H, Wu L, Naim MY, Bradley R, Tobin J, McNally B, Vellano K, Quan L, Markenson D, Rossano JW. Characteristics and outcomes of AED use in pediatric cardiac arrest in public settings: The influence of neighborhood characteristics. Resuscitation 2019; 146:126-131. [PMID: 31785372 DOI: 10.1016/j.resuscitation.2019.09.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/27/2019] [Accepted: 09/09/2019] [Indexed: 01/17/2023]
Abstract
BACKGROUND Automated external defibrillators (AEDs) are critical in the chain of survival following out-of-hospital cardiac arrest (OHCA), yet few studies have reported on AED use and outcomes among pediatric OHCA. This study describes the association between bystander AED use, neighborhood characteristics and survival outcomes following public pediatric OHCA. METHODS Non-traumatic OHCAs among children less than18 years of age in a public setting between from January 1, 2013 through December 31, 2017 were identified in the CARES database. A neighborhood characteristic index was created from the addition of dichotomous values of 4 American Community Survey neighborhood characteristics at the Census tract level: median household income, percent high school graduates, percent unemployment, and percent African American. Multivariable logistic regression models assessed the association of OHCA characteristics, the neighborhood characteristic index and outcomes. RESULTS Of 971 pediatric OHCA, AEDs were used by bystanders in 10.3% of OHCAs. AEDs were used on 2.3% of children ≤1 year (infants), 8.3% of 2-5 year-olds, 12.4% of 6-11 year-olds, and 18.2% of 12-18 year-olds (p < 0.001). AED use was more common in neighborhoods with a median household income of >$50,000 per year (12.3%; p = 0.016), <10% unemployment (12.1%; p = 0.002), and >80% high school education (11.8%; p = 0.002). Greater survival to hospital discharge and neurologically favorable survival were among arrests with bystander AED use, varying by neighborhood characteristics. CONCLUSIONS Bystander AED use is uncommon in pediatric OHCA, particularly in high-risk neighborhoods, but improves survival. Further study is needed to understand disparities in AED use and outcomes.
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Affiliation(s)
- H Griffis
- Healthcare Analytics Unit, The Children's Hospital of Philadelphia, United States; Department of Biomedical Health Informatics, The Children's Hospital of Philadelphia, United States; Cardiac Center Research Core, The Children's Hospital of Philadelphia, United States.
| | - L Wu
- The Children's Hospital of Philadelphia, United States
| | - M Y Naim
- Cardiac Center Research Core, The Children's Hospital of Philadelphia, United States; The Children's Hospital of Philadelphia, United States; Division of Critical Care, The Children's Hospital of Philadelphia, United States
| | - R Bradley
- Division of Emergency Medical Services and Disaster Medicine, University of Texas Health Science Center, United States
| | - J Tobin
- Division of Trauma Anesthesiology, University of Southern California, United States
| | - B McNally
- Department of Emergency Medicine, Emory University, United States
| | - K Vellano
- Department of Emergency Medicine, Emory University, United States
| | - L Quan
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine, United States
| | | | - J W Rossano
- Cardiac Center Research Core, The Children's Hospital of Philadelphia, United States; The Children's Hospital of Philadelphia, United States; Division of Critical Care, The Children's Hospital of Philadelphia, United States
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11
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Topjian AA, de Caen A, Wainwright MS, Abella BS, Abend NS, Atkins DL, Bembea MM, Fink EL, Guerguerian AM, Haskell SE, Kilgannon JH, Lasa JJ, Hazinski MF. Pediatric Post–Cardiac Arrest Care: A Scientific Statement From the American Heart Association. Circulation 2019; 140:e194-e233. [DOI: 10.1161/cir.0000000000000697] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Successful resuscitation from cardiac arrest results in a post–cardiac arrest syndrome, which can evolve in the days to weeks after return of sustained circulation. The components of post–cardiac arrest syndrome are brain injury, myocardial dysfunction, systemic ischemia/reperfusion response, and persistent precipitating pathophysiology. Pediatric post–cardiac arrest care focuses on anticipating, identifying, and treating this complex physiology to improve survival and neurological outcomes. This scientific statement on post–cardiac arrest care is the result of a consensus process that included pediatric and adult emergency medicine, critical care, cardiac critical care, cardiology, neurology, and nursing specialists who analyzed the past 20 years of pediatric cardiac arrest, adult cardiac arrest, and pediatric critical illness peer-reviewed published literature. The statement summarizes the epidemiology, pathophysiology, management, and prognostication after return of sustained circulation after cardiac arrest, and it provides consensus on the current evidence supporting elements of pediatric post–cardiac arrest care.
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12
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Naim MY, Griffis HM, Burke RV, McNally BF, Song L, Berg RA, Nadkarni VM, Vellano K, Markenson D, Bradley RN, Rossano JW. Race/Ethnicity and Neighborhood Characteristics Are Associated With Bystander Cardiopulmonary Resuscitation in Pediatric Out-of-Hospital Cardiac Arrest in the United States: A Study From CARES. J Am Heart Assoc 2019; 8:e012637. [PMID: 31288613 PMCID: PMC6662125 DOI: 10.1161/jaha.119.012637] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Whether racial and neighborhood characteristics are associated with bystander cardiopulmonary resuscitation (BCPR) in pediatric out‐of‐hospital cardiac arrest (OHCA) is unknown. Methods and Results An analysis was conducted of CARES (Cardiac Arrest Registry to Enhance Survival) for pediatric nontraumatic OHCAs from 2013 to 2017. An index (range, 0–4) was created for each arrest based on neighborhood characteristics associated with low BCPR (>80% black; >10% unemployment; <80% high school; median income, <$50 000). The primary outcome was BCPR. BCPR occurred in 3399 of 7086 OHCAs (48%). Compared with white children, BCPR was less likely in other races/ethnicities (black: adjusted odds ratio [aOR], 0.59; 95% CI, 0.52–0.68; Hispanic: aOR, 0.78; 95% CI, 0.66–0.94; and other: aOR, 0.54; 95% CI, 0.40–0.72). Compared with arrests in neighborhoods with an index score of 0, BCPR occurred less commonly for arrests with an index score of 1 (aOR, 0.80; 95% CI, 0.70–0.91), 2 (aOR, 0.75; 95% CI, 0.65–0.86), 3 (aOR, 0.52; 95% CI, 0.45–0.61), and 4 (aOR, 0.46; 95% CI, 0.36–0.59). Black children had an incrementally lower likelihood of BCPR with increasing index score while white children had an overall similar likelihood at most scores. Black children with an index of 4 were approximately half as likely to receive BCPR compared with white children with a score of 0. Conclusions Racial and neighborhood characteristics are associated with BCPR in pediatric OHCA. Targeted CPR training for nonwhite, low‐education, and low‐income neighborhoods may increase BCPR and improve pediatric OHCA outcomes.
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Affiliation(s)
- Maryam Y Naim
- 1 The Cardiac Center Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine Philadelphia PA.,5 Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | - Heather M Griffis
- 2 Healthcare Analytics Unit of Center for Pediatric Clinical Effectiveness and PolicyLab Children's Hospital of Philadelphia PA
| | - Rita V Burke
- 3 Children's Hospital of Los Angeles Keck School of Medicine University of Southern California Los Angeles CA
| | - Bryan F McNally
- 4 Department of Emergency Medicine Emory University Atlanta GA
| | - Lihai Song
- 2 Healthcare Analytics Unit of Center for Pediatric Clinical Effectiveness and PolicyLab Children's Hospital of Philadelphia PA
| | - Robert A Berg
- 5 Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | - Vinay M Nadkarni
- 5 Department of Anesthesiology and Critical Care Medicine Children's Hospital of Philadelphia Perelman School of Medicine at the University of Pennsylvania Philadelphia PA
| | | | | | - Richard N Bradley
- 7 Division of Emergency Medicine University of Texas Health Science Center Houston TX
| | - Joseph W Rossano
- 1 The Cardiac Center Children's Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine Philadelphia PA.,8 Leonard Davis Institute The University of Pennsylvania Philadelphia PA
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13
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El-Assaad I, Al-Kindi SG, McNally B, Vellano K, Worley S, Tang AS, Aziz PF. Automated External Defibrillator Application Before EMS Arrival in Pediatric Cardiac Arrests. Pediatrics 2018; 142:peds.2017-1903. [PMID: 30262669 DOI: 10.1542/peds.2017-1903] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Little is known about the predictors of pre-emergency medical service (EMS) automated external defibrillator (AED) application in pediatric out-of-hospital cardiac arrests. We sought to determine patient- and neighborhood-level characteristics associated with pre-EMS AED application in the pediatric population. METHODS We reviewed prospectively collected data from the Cardiac Arrest Registry to Enhance Survival on pediatric patients (age >1 to ≤18 years old) who had out-of-hospital nontraumatic arrest (2013-2015). RESULTS A total of 1398 patients were included in this analysis (64% boys, 45% white, and median age of 11 years old). An AED was applied in 28% of the cases. Factors associated with pre-EMS AED application in univariable analyses were older age (odds ratio [OR]: 1.9; 12-18 years old vs 2-11 years old; P < .001), white versus African American race (OR: 1.4; P = .04), public location (OR: 1.9; P < .001), witnessed status (OR: 1.6; P < .001), arrests presumed to be cardiac versus respiratory etiology (OR: 1.5; P = .02) or drowning etiology (OR: 2.0; P < .001), white-populated neighborhoods (OR: 1.2 per 20% increase in white race; P = .01), neighborhood median household income (OR: 1.1 per $20 000 increase; P = .02), and neighborhood level of education (OR: 1.3 per 20% increase in high school graduates; P = .006). However, only age, witnessed status, arrest location, and arrests of presumed cardiac etiology versus drowning remained significant in the multivariable model. The overall cohort survival to hospital discharge was 19%. CONCLUSIONS The overall pre-EMS AED application rate in pediatric patients remains low.
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Affiliation(s)
- Iqbal El-Assaad
- Department of Pediatrics, Cleveland Clinic Children's, Cleveland, Ohio
| | - Sadeer G Al-Kindi
- University Hospitals Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, Ohio
| | - Bryan McNally
- Division of Emergency Medicine, School of Medicine and Rollins School of Public Health, Emory University, Atlanta, Georgia; and
| | - Kimberly Vellano
- Division of Emergency Medicine, School of Medicine and Rollins School of Public Health, Emory University, Atlanta, Georgia; and
| | - Sarah Worley
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, Ohio
| | - Anne S Tang
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland, Ohio
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14
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Owen DD, McGovern SK, Murray A, Leary M, del Rios M, Merchant RM, Abella BS, Dutwin D, Blewer AL. Association of race and socioeconomic status with automatic external defibrillator training prevalence in the United States. Resuscitation 2018; 127:100-104. [DOI: 10.1016/j.resuscitation.2018.03.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/08/2018] [Accepted: 03/30/2018] [Indexed: 11/30/2022]
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15
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Tham LP, Wah W, Phillips R, Shahidah N, Ng YY, Shin SD, Nishiuchi T, Wong KD, Ko PCI, Khunklai N, Naroo GY, Ong MEH. Epidemiology and outcome of paediatric out-of-hospital cardiac arrests: A paediatric sub-study of the Pan-Asian resuscitation outcomes study (PAROS). Resuscitation 2018; 125:111-117. [PMID: 29421664 DOI: 10.1016/j.resuscitation.2018.01.040] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 12/27/2017] [Accepted: 01/26/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Pan Asian Resuscitation Outcomes Study (PAROS) is a retrospective study of out- of-hospital cardiac arrest(OHCA), collaborating with EMS agencies and academic centers in Japan, South Korea, Malaysia, Singapore, Taiwan, Thailand and UAE-Dubai. The objectives of this study is to describe the characteristics and outcomes, and to find factors associated with survival after paediatric OHCA. METHODS We studied all children less than 17 years of age with OHCA conveyed by EMS and non-EMS transports from January 2009 to December 2012. We did univariate and multivariate logistic regression analyses to assess the factors associated with survival-to-discharge outcomes. RESULTS A total of 974 children with OHCA were included. Bystander cardiopulmonary resuscitation rates ranged from 53.5% (Korea), 35.6% (Singapore) to 11.8% (UAE). Overall, 8.6% (range 0%-9.7%) of the children survived to discharge from hospital. Adolescents (13-17 years) had the highest survival rate of 13.8%. 3.7% of the children survived with good neurological outcomes of CPC 1 or 2. The independent pre-hospital factors associated with survival to discharge were witnessed arrest and initial shockable rhythm. In the sub-group analysis, pre-hospital advanced airway [odds ratio (OR) = 3.35, 95% confidence interval (CI) = 1.23-9.13] was positively associated with survival-to-discharge outcomes in children less than 13 years-old. Among adolescents, bystander CPR (OR = 2.74, 95%CI = 1.03-7.3) and initial shockable rhythm (OR = 20.51, 95%CI = 2.15-195.7) were positive factors. CONCLUSION The wide variation in the survival outcomes amongst the seven countries in our study may be due to the differences in the delivery of pre-hospital interventions and bystander CPR rates.
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Affiliation(s)
- Lai Peng Tham
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore.
| | - Win Wah
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Rachel Phillips
- Department of Primary Care and Public Health Sciences, King's College London, London, United Kingdom
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Yih Yng Ng
- Medical Department, Singapore Civil Defence Force, Singapore, Singapore
| | - Sang Do Shin
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Tatsuya Nishiuchi
- Department of Acute Medicine, Kindai University Faculty of Medicine, Osaka, Japan
| | | | - Patrick Chow-In Ko
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Nalinas Khunklai
- Department of Emergency Medicine, Rajavithi Hospital, Bangkok, Thailand
| | - Ghulam Yasin Naroo
- Department of Health and Medical Services, ED-Trauma Center, Rashid Hospital, Dubai, United Arab Emirates
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
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16
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Ho YK, Mok YT. Epidemiology of Paediatric Out-of-Hospital Cardiac Arrest Presented to a Local Emergency Department: A Retrospective Case Series. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791602300604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To outline the epidemiology of paediatric out-of-hospital cardiac arrest (OHCA) cases presented to a regional hospital. Design Retrospective case series. Methods Attendance records of critical cases aged from 0 to 17 years old from year 2001 to 2014 attending Emergency Department (ED) of Yan Chai Hospital were searched. Demographic data and predictive parameters were analysed for association with outcome. Results There were 40 cases of paediatric OHCA throughout the study period. A total of 21 (52.5%) had witnessed arrest; 27 (67.5%) had cardiac arrest at home. Twenty-eight (70%) of the cardiac arrest were first noted by family members; 8 (20%) received bystander cardiopulmonary resuscitation (CPR). Only 13 (32.5%) cases had return of spontaneous circulation (ROSC) in the ED and were admitted. Seven patients (17.5%) survived to hospital discharge. Conclusion Paediatric OHCA, although a rare occurrence, has a high mortality of 82.5% in our series. Majority of the cases occur at home, and are witnessed. Family members are often the first persons to detect the arrest. Yet the rate of providing bystander CPR is low in Hong Kong.
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17
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El-Assaad I, Al-Kindi SG, Aziz PF. Trends of Out-of-Hospital Sudden Cardiac Death Among Children and Young Adults. Pediatrics 2017; 140:peds.2017-1438. [PMID: 29180463 DOI: 10.1542/peds.2017-1438] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Previous estimates of sudden cardiac death in children and young adults vary significantly, and population-based studies in the United States are lacking. We sought to estimate the incidence, causes, and mortality trends of sudden cardiac death in children and young adults (1-34 years). METHODS Demographic and mortality data based on death certificates for US residents (1-34 years) were obtained (1999-2015). Cases of sudden death and sudden cardiac death were retrieved by using the International Classification of Diseases, 10th Revision codes. RESULTS A total of 1 452 808 subjects aged 1 to 34 years died in the United States, of which 31 492 (2%) were due to sudden cardiac death. The estimated incidence of sudden cardiac death is 1.32 per 100 000 individuals and increased with age from 0.49 (1-10 years) to 2.76 (26-34 years). During the study period, incidence of sudden cardiac death declined from 1.48 to 1.13 per 100 000 (P < .001). Mortality reduction was observed across all racial and ethnic groups with a varying magnitude and was highest in children aged 11 to 18 years. Significant disparities were found, with non-Hispanic African American individuals and individuals aged 26 to 34 years having the highest mortality rates. The majority of young children (1-10 years) died of congenital heart disease (n = 1525, 46%), whereas young adults died most commonly from ischemic heart disease (n = 5075, 29%). CONCLUSIONS Out-of-hospital sudden cardiac death rates declined 24% from 1999 to 2015. Disparities in mortality exist across age groups and racial and ethnic groups, with non-Hispanic African American individuals having the highest mortality rates.
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Affiliation(s)
- Iqbal El-Assaad
- Department of Pediatrics, Cleveland Clinic Children's, Cleveland, Ohio; and
| | - Sadeer G Al-Kindi
- Department of Cardiology, Harrington Heart and Vascular Institute, University Hospitals and Case Western Reserve University, Cleveland, Ohio
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18
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Perkins G, Handley A, Koster R, Castrén M, Smyth M, Olasveengen T, Monsieurs K, Raffay V, Gräsner JT, Wenzel V, Ristagno G, Soar J. [Adult basic life support and automated external defibrillation.]. Notf Rett Med 2017; 20:3-24. [PMID: 32214897 PMCID: PMC7087749 DOI: 10.1007/s10049-017-0328-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- G.D. Perkins
- Warwick Medical School, University of Warwick, Coventry, UK
- Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | | | - R.W. Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, Niederlande
| | - M. Castrén
- Department of Emergency Medicine and Services, Helsinki University Hospital and Helsinki University, Helsinki, Finnland
| | - M.A. Smyth
- Warwick Medical School, University of Warwick, Coventry, UK
- West Midlands Ambulance Service NHS Foundation Trust, Dudley, UK
| | - T. Olasveengen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine and Department of Anesthesiology, Oslo University Hospital, Oslo, Norwegen
| | - K.G. Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgien
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgien
| | - V. Raffay
- Municipal Institute for Emergency Medicine Novi Sad, Novi Sad, Serbien
| | - J.-T. Gräsner
- Department of Anaesthesia and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Kiel, Deutschland
| | - V. Wenzel
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Österreich
| | - G. Ristagno
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche „Mario Negri“, Milan, Italien
| | - J. Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
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19
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Park YM, Shin SD, Lee YJ, Song KJ, Ro YS, Ahn KO. Cardiopulmonary resuscitation by trained responders versus lay persons and outcomes of out-of-hospital cardiac arrest: A community observational study. Resuscitation 2017; 118:55-62. [PMID: 28668701 DOI: 10.1016/j.resuscitation.2017.06.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 05/18/2017] [Accepted: 06/26/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The study aims to compare bystander processes of care (cardiopulmonary resuscitation (CPR) and defibrillation) and outcomes for witnessed presumed cardiac etiology in OHCA patients in whom initial resuscitation was provided by dedicated trained responder (TR) versus lay person (LP) bystanders. METHODS Data on witnessed and presumed cardiac OHCA in adults (15 years or older) from 2011 to 2015 in a metropolitan city with 10 million persons were collected, excluding cases in which the information on TRs, bystander CPR, defibrillation, and clinical outcomes was unknown. Exposure variables were TRs who were legally designated with CPR education and response and LPs who were bystanders who witnessed the OHCA by chance. The primary/secondary/tertiary outcomes were a good cerebral performance category (CPC) of 1 or 2, survival to discharge, and bystander defibrillation. A multivariable logistic regression analysis was used to calculate the adjusted odds ratio (AOR) with 95% confidence intervals (CIs), adjusting for potential confounders. RESULTS Of 20,984 OHCA events, 6475 cases were ultimately analyzed. The TR group constituted 6.4% of the cases, and the patients showed significantly better survival and a good CPC. From the multivariable logistic regression analysis of the outcomes, by comparing the TR group with the LP group, the AOR (95% CIs) was 1.49 (1.04-2.15) for a good CPC, 1.59 (1.20-2.11) for survival to discharge, and 10.02 (7.04-14.26) for bystander defibrillation. CONCLUSION The TR group witnessed a relatively low proportion of OHCA but was associated with better survival outcomes and good neurological recovery through higher CPR rates and defibrillation of adults older than 15 years with witnessed OHCA in a metropolitan city.
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Affiliation(s)
- Yoo Mi Park
- Hallym University Graduate School of Public Health, Republic of Korea.
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Republic of Korea.
| | - Yu Jin Lee
- Department of Emergency Medicine, Inha University Hospital, Republic of Korea.
| | - Kyoung Jun Song
- Department of Emergency Medicine, Seoul National University Hospital, Republic of Korea.
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Republic of Korea.
| | - Ki Ok Ahn
- Department of Emergency Medicine, Myongji Hospital, Republic of Korea.
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20
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Pediatric out-of-hospital cardiac arrest caused by left coronary-artery agenesis with primary shockable rhythm. Am J Emerg Med 2017; 35:1718-1723. [PMID: 28549578 DOI: 10.1016/j.ajem.2017.05.011] [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: 03/08/2017] [Revised: 05/09/2017] [Accepted: 05/10/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To illustrate a rare cause of out-of-hospital cardiac arrest in children, its differential diagnoses, emergency and subsequent treatment at various steps in the rescue chain, and potential outcomes. CASE PRESENTATION A 4-year-old boy with unknown agenesis of the left coronary ostium sustained out-of-hospital cardiac arrest. Bystander cardio-pulmonary resuscitation was initiated and defibrillation was performed via an automated external defibrillator (AED) shortly after paramedics arrived at the scene, restoring sinus rhythm and spontaneous circulation. After admission to the intensive care unit the child was intubated for airway and seizure control. Further diagnostic work-up by angiography revealed agenesis of the left coronary artery. After initial seizures, the boy's neurological recovery was complete. He subsequently underwent successful internal mammary artery in-situ bypass surgery to the trunk of the left coronary artery. One year after cardiac arrest, the patient had completely recovered with no physical or intellectual sequelae. A catheter examination proved excellent growth of the bypass and good cardiac function. CONCLUSIONS This case illustrates the long term outcome after agenesis of the LCA while reiterating that prompt access to pediatric defibrillation may be lifesaving-albeit in a minority of pediatric OHCA.
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21
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Abstract
Children and young adults tend to have reduced mortality and disability after acquired brain injuries such as trauma or stroke and across other disease processes seen in critical care medicine. However, after out-of-hospital cardiac arrest (OHCA), outcomes are remarkably similar across age groups. The consistent lack of witnessed arrests and a high incidence of asphyxial or respiratory etiology arrests among pediatric and young adult patients with OHCA account for a substantial portion of the difference in outcomes. Additionally, in younger children, differences in pre-hospital response and the activation of developmental apoptosis may explain more severe outcomes after OHCA. These require us to consider whether present practices are in line with the science. The present recommendations for compression-only cardiopulmonary resuscitation in young adults, normothermia as opposed to hypothermia (33°C) after asphyxial arrests, and paramedic training are considered within this review in light of existing evidence. Modifications in present standards of care may help restore the benefits of youth after brain injury to the young survivor of OHCA.
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Affiliation(s)
- Brian Griffith
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Patrick Kochanek
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Cameron Dezfulian
- Safar Center for Resuscitation Research, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Clinical and Translational Sciences, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Vascular Medicine Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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22
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Pediatric Out-of-Hospital Cardiac Arrest Characteristics and Their Association With Survival and Neurobehavioral Outcome. Pediatr Crit Care Med 2016; 17:e543-e550. [PMID: 27679965 PMCID: PMC5138073 DOI: 10.1097/pcc.0000000000000969] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate relationships between cardiac arrest characteristics and survival and neurobehavioral outcome among children recruited to the Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital trial. DESIGN Secondary analysis of Therapeutic Hypothermia after Pediatric Cardiac Arrest Out-of-Hospital trial data. SETTING Thirty-six PICUs in the United States and Canada. PATIENTS All children (n = 295) had chest compressions for greater than or equal to 2 minutes, were comatose, and required mechanical ventilation after return of circulation. INTERVENTIONS Neurobehavioral function was assessed using the Vineland Adaptive Behavior Scales, Second Edition at baseline (reflecting prearrest status) and 12 months postarrest. U.S. norms for Vineland Adaptive Behavior Scales, Second Edition scores are 100 (mean) ± 15 (SD). Higher scores indicate better functioning. Outcomes included 12-month survival and 12-month survival with Vineland Adaptive Behavior Scales, Second Edition greater than or equal to 70. MEASUREMENT AND MAIN RESULTS Cardiac etiology of arrest, initial arrest rhythm of ventricular fibrillation/tachycardia, shorter duration of chest compressions, compressions not required at hospital arrival, fewer epinephrine doses, and witnessed arrest were associated with greater 12-month survival and 12-month survival with Vineland Adaptive Behavior Scales, Second Edition greater than or equal to 70. Weekend arrest was associated with lower 12-month survival. Body habitus was associated with 12-month survival with Vineland Adaptive Behavior Scales, Second Edition greater than or equal to 70; underweight children had better outcomes, and obese children had worse outcomes. On multivariate analysis, acute life threatening event/sudden unexpected infant death, chest compressions more than 30 minutes, and weekend arrest were associated with lower 12-month survival; witnessed arrest was associated with greater 12-month survival. Acute life threatening event/sudden unexpected infant death, other respiratory causes of arrest except drowning, other/unknown causes of arrest, and compressions more than 30 minutes were associated with lower 12-month survival with Vineland Adaptive Behavior Scales, Second Edition greater than or equal to 70. CONCLUSIONS Many factors are associated with survival and neurobehavioral outcome among children who are comatose and require mechanical ventilation after out-of-hospital cardiac arrest. These factors may be useful for identifying children at risk for poor outcomes, and for improving prevention and resuscitation strategies.
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23
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Goto Y, Funada A, Goto Y. Subsequent Shockable Rhythm During Out-of-Hospital Cardiac Arrest in Children With Initial Non-Shockable Rhythms: A Nationwide Population-Based Observational Study. J Am Heart Assoc 2016; 5:e003589. [PMID: 27792647 PMCID: PMC5121473 DOI: 10.1161/jaha.116.003589] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Accepted: 09/22/2016] [Indexed: 11/24/2022]
Abstract
BACKGROUND The effect of a subsequent treated shockable rhythm during cardiopulmonary resuscitation on the outcome of children who suffer out-of-hospital cardiac arrest with initial nonshockable rhythm is unclear. We hypothesized that subsequent treated shockable rhythm in children with out-of-hospital cardiac arrest would improve survival with favorable neurological outcomes (Cerebral Performance Category scale 1-2). METHODS AND RESULTS From the All-Japan Utstein Registry, we analyzed the records of 12 402 children (aged <18 years) with out-of-hospital cardiac arrest and initial nonshockable rhythms. Patients were divided into 2 cohorts: subsequent treated shockable rhythm (YES; n=239) and subsequent treated shockable rhythm (NO; n=12 163). The rate of 1-month cerebral performance category 1 to 2 in the subsequent treated shockable rhythm (YES) cohort was significantly higher when compared to the subsequent treated shockable rhythm (NO) cohort (4.6% [11 of 239] vs 1.3% [155 of 12 163]; adjusted odds ratio, 2.90; 95% CI, 1.42-5.36; all P<0.001). In the subsequent treated shockable rhythm (YES) cohort, the rate of 1-month cerebral performance category 1 to 2 decreased significantly as time to shock delivery increased (17.7% [3 of 17] for patients with shock-delivery time 0-9 minutes, 7.3% [8 of 109] for 10-19 minutes, and 0% [0 of 109] for 20-59 minutes; P<0.001 [for trend]). Age-stratified outcomes showed no significant differences between the 2 cohorts in the group aged <7 years old: 1.3% versus 1.4%, P=0.62. CONCLUSIONS In children with out-of-hospital cardiac arrest and initial nonshockable rhythms, subsequent treated shockable rhythm was associated with improved 1-month survival with favorable neurological outcomes. In the cohort of older children (7-17 years), these outcomes worsened as time to shock delivery increased.
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Affiliation(s)
- Yoshikazu Goto
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Akira Funada
- Department of Emergency and Critical Care Medicine, Kanazawa University Hospital, Kanazawa, Japan
| | - Yumiko Goto
- Department of Cardiology, Yawata Medical Center, Komatsu, Japan
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24
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Fink EL, Prince DK, Kaltman JR, Atkins DL, Austin M, Warden C, Hutchison J, Daya M, Goldberg S, Herren H, Tijssen JA, Christenson J, Vaillancourt C, Miller R, Schmicker RH, Callaway CW. Unchanged pediatric out-of-hospital cardiac arrest incidence and survival rates with regional variation in North America. Resuscitation 2016; 107:121-8. [PMID: 27565862 PMCID: PMC5037038 DOI: 10.1016/j.resuscitation.2016.07.244] [Citation(s) in RCA: 145] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/23/2016] [Accepted: 07/29/2016] [Indexed: 11/18/2022]
Abstract
AIM Outcomes for pediatric out-of-hospital cardiac arrest (OHCA) are poor. Our objective was to determine temporal trends in incidence and mortality for pediatric OHCA. METHODS Adjusted incidence and hospital mortality rates of pediatric non-traumatic OHCA patients from 2007-2012 were analyzed using the 9 region Resuscitation Outcomes Consortium-Epidemiological Registry (ROC-Epistry) database. Children were divided into 4 age groups: perinatal (<3 days), infants (3days-1year), children (1-11 years), and adolescents (12-19 years). ROC regions were analyzed post-hoc. RESULTS We studied 1738 children with OHCA. The age- and sex-adjusted incidence rate of OHCA was 8.3 per 100,000 person-years (75.3 for infants vs. 3.7 for children and 6.3 for adolescents, per 100,000 person-years, p<0.001). Incidence rates differed by year (p<0.001) without overall linear trend. Annual survival rates ranged from 6.7-10.2%. Survival was highest in the perinatal (25%) and adolescent (17.3%) groups. Stratified by age group, survival rates over time were unchanged (all p>0.05) but there was a non-significant linear trend (1.3% increase) in infants. In the multivariable logistic regression analysis, infants, unwitnessed event, initial rhythm of asystole, and region were associated with worse survival, all p<0.001. Survival by region ranged from 2.6-14.7%. Regions with the highest survival had more cases of EMS-witnessed OHCA, bystander CPR, and increased EMS-defibrillation (all p<0.05). CONCLUSIONS Overall incidence and survival of children with OHCA in ROC regions did not significantly change over a recent 5year period. Regional variation represents an opportunity for further study to improve outcomes.
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Affiliation(s)
- Ericka L Fink
- Division of Pediatric Critical Care Medicine, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Faculty Pavilion, 2nd Floor, Pittsburgh, PA 15224, USA.
| | - David K Prince
- Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Jonathan R Kaltman
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Dianne L Atkins
- Stead Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Michael Austin
- Department of Emergency Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - Craig Warden
- Oregon Health & Science University Doernbecher Children's Hospital, Portland, OR, USA
| | - Jamie Hutchison
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mohamud Daya
- Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Scott Goldberg
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Heather Herren
- Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Janice A Tijssen
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - James Christenson
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Christian Vaillancourt
- Department of Emergency Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
| | - Ronna Miller
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Robert H Schmicker
- Clinical Trial Center, Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - Clifton W Callaway
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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25
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Abstract
Although the occurrence of sudden cardiac death (SCD) in a young person is a rare event, it is traumatic and often widely publicized. In recent years, SCD in this population has been increasingly seen as a public health and safety issue. This review presents current knowledge relevant to the epidemiology of SCD and to strategies for prevention, resuscitation, and identification of those at greatest risk. Areas of active research and controversy include the development of best practices in screening, risk stratification approaches and postmortem evaluation, and identification of modifiable barriers to providing better outcomes after resuscitation of young SCD patients. Institution of a national registry of SCD in the young will provide data that will help to answer these questions.
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Affiliation(s)
- Michael Ackerman
- From Departments of Internal Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Cardiovascular Diseases and Pediatric Cardiology; Windland Smith Rice Sudden Death Genomics Laboratory; Mayo Clinic, Rochester, MN (M.A.);Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa, City (D.L.A.); andDepartment of Cardiology, Boston Children's Hospital, MA (J.K.T.)
| | - Dianne L Atkins
- From Departments of Internal Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Cardiovascular Diseases and Pediatric Cardiology; Windland Smith Rice Sudden Death Genomics Laboratory; Mayo Clinic, Rochester, MN (M.A.);Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa, City (D.L.A.); andDepartment of Cardiology, Boston Children's Hospital, MA (J.K.T.)
| | - John K Triedman
- From Departments of Internal Medicine, Pediatrics, and Molecular Pharmacology & Experimental Therapeutics; Divisions of Cardiovascular Diseases and Pediatric Cardiology; Windland Smith Rice Sudden Death Genomics Laboratory; Mayo Clinic, Rochester, MN (M.A.);Stead Family Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa, City (D.L.A.); andDepartment of Cardiology, Boston Children's Hospital, MA (J.K.T.).
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Krmpotic K, Writer H. Cardiorespiratory arrest in children (out of hospital). BMJ CLINICAL EVIDENCE 2015; 2015:0307. [PMID: 26689353 PMCID: PMC4684149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Cardiorespiratory arrest outside hospital occurs in approximately 1/10,000 children per year in resource-rich countries, with two-thirds of arrests occurring in children under 18 months of age. Approximately 45% of cases have undetermined causes, including sudden infant death syndrome. Of the rest, 20% are caused by trauma, 10% by chronic disease, and 6% by pneumonia. METHODS AND OUTCOMES We conducted a systematic overview, aiming to answer the following clinical question: What are the effects of treatments for non-submersion out-of-hospital cardiorespiratory arrest in children? We searched: Medline, Embase, The Cochrane Library, and other important databases up to November 2014 (Clinical Evidence overviews are updated periodically; please check our website for the most up-to-date version of this overview). RESULTS At this update, searching of electronic databases retrieved 192 studies. After deduplication and removal of conference abstracts, 81 records were screened for inclusion in the overview. Appraisal of titles and abstracts led to the exclusion of 68 studies and the further review of 13 full publications. Of the 13 full articles evaluated, three systematic reviews were added at this update. We have also added eight studies to the Comment section. We performed a GRADE evaluation for three PICO combinations. CONCLUSIONS In this systematic overview, we categorised the efficacy for nine interventions based on information about the effectiveness and safety of airway management and ventilation (bag-mask ventilation and intubation), bystander cardiopulmonary resuscitation, direct-current cardiac shock, high dose and standard dose intravenous adrenaline (epinephrine), intravenous sodium bicarbonate, intubation versus bag-mask ventilation, targeted temperature management, and training parents to perform resuscitation.
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Affiliation(s)
- Kristina Krmpotic
- Memorial University of Newfoundland Faculty of Medicine, Janeway Children's Health and Rehabilitation Centre, St. John's, Newfoundland and Labrador, Canada
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Monsieurs K, Nolan J, Bossaert L, Greif R, Maconochie I, Nikolaou N, Perkins G, Soar J, Truhlář A, Wyllie J, Zideman D. Kurzdarstellung. Notf Rett Med 2015. [DOI: 10.1007/s10049-015-0097-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Perkins G, Handley A, Koster R, Castrén M, Smyth M, Olasveengen T, Monsieurs K, Raffay V, Gräsner JT, Wenzel V, Ristagno G, Soar J. [Adult basic life support and automated external defibrillation.]. Notf Rett Med 2015; 18:748-769. [PMID: 32214896 PMCID: PMC7088113 DOI: 10.1007/s10049-015-0081-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- G.D. Perkins
- Warwick Medical School, University of Warwick, Coventry, UK
- Critical Care Unit, Heart of England NHS Foundation Trust, Birmingham, UK
| | | | - R.W. Koster
- Department of Cardiology, Academic Medical Center, Amsterdam, Niederlande
| | - M. Castrén
- Department of Emergency Medicine and Services, Helsinki University Hospital and Helsinki University, Helsinki, Finnland
| | - M.A. Smyth
- Warwick Medical School, University of Warwick, Coventry, UK
- West Midlands Ambulance Service NHS Foundation Trust, Dudley, UK
| | - T. Olasveengen
- Norwegian National Advisory Unit on Prehospital Emergency Medicine and Department of Anesthesiology, Oslo University Hospital, Oslo, Norwegen
| | - K.G. Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgien
- Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgien
| | - V. Raffay
- Municipal Institute for Emergency Medicine Novi Sad, Novi Sad, Serbien
| | - J.-T. Gräsner
- Department of Anaesthesia and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Kiel, Deutschland
| | - V. Wenzel
- Department of Anesthesiology and Critical Care Medicine, Medical University of Innsbruck, Innsbruck, Österreich
| | - G. Ristagno
- Department of Cardiovascular Research, IRCCS-Istituto di Ricerche Farmacologiche „Mario Negri“, Milan, Italien
| | - J. Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
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European Resuscitation Council Guidelines for Resuscitation 2015: Section 2. Adult basic life support and automated external defibrillation. Resuscitation 2015; 95:81-99. [PMID: 26477420 DOI: 10.1016/j.resuscitation.2015.07.015] [Citation(s) in RCA: 709] [Impact Index Per Article: 78.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Monsieurs KG, Nolan JP, Bossaert LL, Greif R, Maconochie IK, Nikolaou NI, Perkins GD, Soar J, Truhlář A, Wyllie J, Zideman DA, Alfonzo A, Arntz HR, Askitopoulou H, Bellou A, Beygui F, Biarent D, Bingham R, Bierens JJ, Böttiger BW, Bossaert LL, Brattebø G, Brugger H, Bruinenberg J, Cariou A, Carli P, Cassan P, Castrén M, Chalkias AF, Conaghan P, Deakin CD, De Buck ED, Dunning J, De Vries W, Evans TR, Eich C, Gräsner JT, Greif R, Hafner CM, Handley AJ, Haywood KL, Hunyadi-Antičević S, Koster RW, Lippert A, Lockey DJ, Lockey AS, López-Herce J, Lott C, Maconochie IK, Mentzelopoulos SD, Meyran D, Monsieurs KG, Nikolaou NI, Nolan JP, Olasveengen T, Paal P, Pellis T, Perkins GD, Rajka T, Raffay VI, Ristagno G, Rodríguez-Núñez A, Roehr CC, Rüdiger M, Sandroni C, Schunder-Tatzber S, Singletary EM, Skrifvars MB, Smith GB, Smyth MA, Soar J, Thies KC, Trevisanuto D, Truhlář A, Vandekerckhove PG, de Voorde PV, Sunde K, Urlesberger B, Wenzel V, Wyllie J, Xanthos TT, Zideman DA. European Resuscitation Council Guidelines for Resuscitation 2015: Section 1. Executive summary. Resuscitation 2015; 95:1-80. [PMID: 26477410 DOI: 10.1016/j.resuscitation.2015.07.038] [Citation(s) in RCA: 568] [Impact Index Per Article: 63.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Koenraad G Monsieurs
- Emergency Medicine, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Faculty of Medicine and Health Sciences, University of Ghent, Ghent, Belgium.
| | - Jerry P Nolan
- Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath, UK; School of Clinical Sciences, University of Bristol, Bristol, UK
| | | | - Robert Greif
- Department of Anaesthesiology and Pain Medicine, University Hospital Bern, Bern, Switzerland; University of Bern, Bern, Switzerland
| | - Ian K Maconochie
- Paediatric Emergency Medicine Department, Imperial College Healthcare NHS Trust and BRC Imperial NIHR, Imperial College, London, UK
| | | | - Gavin D Perkins
- Warwick Medical School, University of Warwick, Coventry, UK; Heart of England NHS Foundation Trust, Birmingham, UK
| | - Jasmeet Soar
- Anaesthesia and Intensive Care Medicine, Southmead Hospital, Bristol, UK
| | - Anatolij Truhlář
- Emergency Medical Services of the Hradec Králové Region, Hradec Králové, Czech Republic; Department of Anaesthesiology and Intensive Care Medicine, University Hospital Hradec Králové, Hradec Králové, Czech Republic
| | - Jonathan Wyllie
- Department of Neonatology, The James Cook University Hospital, Middlesbrough, UK
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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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Varvarousi G, Chalkias A, Stefaniotou A, Pliatsika P, Varvarousis D, Koutsovasilis A, Xanthos T. Intraarrest rhythms and rhythm conversion in asphyxial cardiac arrest. Acad Emerg Med 2015; 22:518-24. [PMID: 25903291 DOI: 10.1111/acem.12643] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 07/22/2014] [Accepted: 01/05/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective was to analyze the cardiac arrest rhythms presenting during asphyxial cardiac arrest (ACA). METHODS Asphyxial cardiac arrest was induced in 30 Landrace large white piglets, aged 12 to 15 weeks and with a mean (±SD) weight of 20 (±2) kg. After the onset of cardiac arrest, the animals were left untreated for 4 minutes, after which cardiopulmonary resuscitation was commenced. Heart rhythms were monitored from the onset of asphyxia until return of spontaneous circulation or death. RESULTS After endotracheal tube clamping and prior to cardiac arrest, normal sinus rhythm was noted in 14 animals, atrial fibrillation in two animals, Mobitz II atrioventricular block in 10 animals, and third-degree atrioventricular block in four animals. At the onset of cardiac arrest, seven animals had ventricular fibrillation (VF), two had asystole, and 21 had pulseless electrical activity (PEA). During the 4-minute period of untreated arrest, however, significant changes in the monitored rhythm were noted; at the end of the fourth minute, 19 animals had VF, two animals had asystole, and nine animals had PEA. CONCLUSIONS The most common rhythm after 4 minutes of untreated ACA was VF, while in 57% of animals, PEA was spontaneously converted to VF during the cardiac arrest interval.
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Affiliation(s)
- Giolanda Varvarousi
- The National and Kapodistrian University of Athens; Medical School, MSc Cardiopulmonary Resuscitation; Athens Greece
| | - Athanasios Chalkias
- The National and Kapodistrian University of Athens; Medical School, MSc Cardiopulmonary Resuscitation; Athens Greece
- The Hellenic Society of Cardiopulmonary Resuscitation; Athens Greece
| | - Antonia Stefaniotou
- The National and Kapodistrian University of Athens; Medical School, MSc Cardiopulmonary Resuscitation; Athens Greece
| | - Paraskevi Pliatsika
- The National and Kapodistrian University of Athens; Medical School, MSc Cardiopulmonary Resuscitation; Athens Greece
| | - Dimitrios Varvarousis
- The National and Kapodistrian University of Athens; Medical School, MSc Cardiopulmonary Resuscitation; Athens Greece
| | - Anastasios Koutsovasilis
- The National and Kapodistrian University of Athens; Medical School, MSc Cardiopulmonary Resuscitation; Athens Greece
| | - Theodoros Xanthos
- The National and Kapodistrian University of Athens; Medical School, MSc Cardiopulmonary Resuscitation; Athens Greece
- The Hellenic Society of Cardiopulmonary Resuscitation; Athens Greece
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