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Zhao WT, He WL, Yang LJ, Lin R. Outcomes in pediatric extracorporeal cardiopulmonary resuscitation: A single-center retrospective study from 2007 to 2022 in China. Am J Emerg Med 2024; 83:25-31. [PMID: 38943709 DOI: 10.1016/j.ajem.2024.06.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 05/08/2024] [Accepted: 06/24/2024] [Indexed: 07/01/2024] Open
Abstract
OBJECTIVE We aimed to investigate the prognostic factors of pediatric extracorporeal cardiopulmonary resuscitation (ECPR). METHODS The retrospective study included a total of 77 pediatric cases (7 neonates and 70 children) who underwent ECPR after in-hospital and out-of-hospital cardiac arrest between July 2007 and December 2022. Primary endpoints were complications, while secondary endpoints included all-cause in-hospital mortality. RESULTS Among the 45 cases experiencing complications, 4 neonates and 41 children had multiple simultaneous complications, primarily neurological issues in 25 cases. Additionally, organ failure occurred in 11 cases, and immunodeficiency was present in two cases. Furthermore, 9 cases experienced bleeding events, and 13 cases showed thrombosis. Patients with complications had lower weight, shorter ECMO durations, and longer CPR durations. Non-survivors had longer CPR durations and shorter durations of ECMO, ICU stay, and mechanical ventilation compared to survivors. Complications were more prevalent in non-survivors, particularly organ failure and bleeding events. CONCLUSION Weight, CPR duration, and ECMO duration were associated with complications, suggesting areas for treatment optimization. The higher occurrence of complications in non-survivors underscores the importance of early detection and management to improve survival rates. Our findings suggest clinicians consider these factors in prognostic assessments to enhance the effectiveness of ECPR programs.
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Affiliation(s)
- Wen-Ting Zhao
- Department of HF&MCS, Children's Hospital, Zhejiang University School of Medicine, Zhejiang, 310052, Hangzhou, China
| | - Wen-Long He
- Department of HF&MCS, Children's Hospital, Zhejiang University School of Medicine, Zhejiang, 310052, Hangzhou, China; Department of CPB, Children's Hospital, Zhejiang University School of Medicine, Zhejiang, 310052, Hangzhou, China
| | - Li-Jun Yang
- Department of HF&MCS, Children's Hospital, Zhejiang University School of Medicine, Zhejiang, 310052, Hangzhou, China
| | - Ru Lin
- Department of HF&MCS, Children's Hospital, Zhejiang University School of Medicine, Zhejiang, 310052, Hangzhou, China.
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2
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Morioka D, Sagisaka R, Nakagawa K, Takahashi H, Tanaka H. Effect of timing of advanced life support on out-of-hospital cardiac arrests at home. Am J Emerg Med 2024; 82:94-100. [PMID: 38848664 DOI: 10.1016/j.ajem.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/14/2024] [Accepted: 05/24/2024] [Indexed: 06/09/2024] Open
Abstract
AIM In cases of out-of-hospital cardiac arrests (OHCA) occurring at home, Japanese emergency medical services personnel decide whether to provide treatment on the scene or during transport based on their judgment. This study aimed to evaluate the association between the timing of advanced life support (ALS) (i.e., endotracheal intubation [ETI] or adrenaline administration) for OHCA at home and prognosis. METHOD This retrospective cohort study used data from the Japan Utstein Registry and emergency transport data collected from patients who underwent pre-hospital ETI (n = 6806) and received adrenaline (n = 22,636) between 2016 and 2019. The timing of ETI or adrenaline administration was determined as "on the scene" or "in the ambulance." Multiple logistic regression analysis was used to estimate the association among the timing of ALS implementation, pre-hospital return of spontaneous circulation (ROSC), and survival at 1 month. RESULT ETI on the scene was significantly positively associated with pre-hospital ROSC (adjusted odds ratio [AOR], 1.81; 95% confidence interval [CI], 1.57-2.09) and survival at 1 month (AOR, 1.81; 95% CI, 1.47-2.23). Adrenaline administration on the scene was significantly positively associated with pre-hospital ROSC (AOR, 2.51; 95% CI, 2.33-2.70) and survival at 1 month (AOR, 2.13; 95% CI, 1.89-2.40). CONCLUSION Our analysis suggests performing ALS on the scene was associated with pre-hospital ROSC and survival at 1 month. Further efforts are needed to increase the rate of ALS implementation on the scene by emergency life-saving technicians.
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Affiliation(s)
- Daigo Morioka
- Faculty of Emergency Medical Science, School of Health Science and Medical Care, Meiji University of Integrative Medicine, Kyoto, Japan; Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan.
| | - Ryo Sagisaka
- Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan; Research Institute of Disaster Management and Emergency Medical System, Kokushikan University, Tokyo, Japan
| | - Koshi Nakagawa
- Department of Integrated Science and Engineering for Sustainable Societies, Faculty of Science and Engineering, Chuo University, Tokyo, Japan
| | - Hiroyuki Takahashi
- Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan
| | - Hideharu Tanaka
- Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan
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Nielsen VML, Søvsø MB, Skals RG, Bender L, Corfield AR, Lossius HM, Mikkelsen S, Christensen EF. Mortality after paediatric emergency calls for patients with or without pre-existing comorbidity: a nationwide population based cohort study. Scand J Trauma Resusc Emerg Med 2024; 32:48. [PMID: 38807153 PMCID: PMC11134704 DOI: 10.1186/s13049-024-01212-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 04/24/2024] [Indexed: 05/30/2024] Open
Abstract
BACKGROUND Life-threatening conditions are infrequent in children. Current literature in paediatric prehospital research is centred around trauma and paediatric out-of-hospital cardiac arrests (POHCA). The aims of this study were to (1) outline the distribution of trauma, POHCA or other medical symptoms among survivors and non-survivors after paediatric emergency calls, and (2) to investigate these clinical presentations' association with mortality in children with and without pre-existing comorbidity, respectively. METHODS Nationwide population-based cohort study including ground and helicopter emergency medical services in Denmark for six consecutive years (2016-2021). The study included all calls to the emergency number 1-1-2 regarding children ≤ 15 years (N = 121,230). Interhospital transfers were excluded, and 1,143 patients were lost to follow-up. Cox regressions were performed with trauma or medical symptoms as exposure and 7-day mortality as the outcome, stratified by 'Comorbidity', 'Severe chronic comorbidity' and 'None' based on previous healthcare visits. RESULTS Mortality analysis included 76,956 unique patients (median age 5 (1-12) years). Annual all-cause mortality rate was 7 per 100,000 children ≤ 15 years. For non-survivors without any pre-existing comorbidity (n = 121), reasons for emergency calls were trauma 18.2%, POHCA 46.3% or other medical symptoms 28.9%, whereas the distribution among the 134 non-survivors with any comorbidity was 7.5%, 27.6% and 55.2%, respectively. Compared to trauma patients, age- and sex-adjusted hazard ratio for patients with calls regarding medical symptoms besides POHCA was 0.8 [0.4;1.3] for patients without comorbidity, 1.1 [0.5;2.2] for patients with comorbidity and 6.1 [0.8;44.7] for patients with severe chronic comorbidity. CONCLUSION In both non-survivors with and without comorbidity, a considerable proportion of emergency calls had been made because of various medical symptoms, not because of trauma or POHCA. This outline of diagnoses and mortality following paediatric emergency calls can be used for directing paediatric in-service training in emergency medical services.
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Affiliation(s)
- Vibe Maria Laden Nielsen
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Selma Lagerløfs Vej 249, Gistrup, 9260, Denmark.
- Emergency Medical Services, North Denmark Region, Hjulmagervej 20, Aalborg, 9000, Denmark.
| | - Morten Breinholt Søvsø
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Selma Lagerløfs Vej 249, Gistrup, 9260, Denmark
| | - Regitze Gyldenholm Skals
- Unit of Clinical Biostatistics, Aalborg University Hospital, Søndre Skovvej 15, Aalborg, 9000, Denmark
| | - Lars Bender
- Paediatric Department, Aalborg University Hospital, Reberbansgade 15, Aalborg, 9000, Denmark
| | | | - Hans Morten Lossius
- Norwegian Air Ambulance Foundation, Postboks 414 Sentrum Oslo 0103, Norway, United Kingdom
| | - Søren Mikkelsen
- The Prehospital Research Unit, Region of Southern Denmark, Odense University Hospital, , J. B. Winsløws Vej 4, Odense C 5000, Denmark
| | - Erika Frischknecht Christensen
- Centre for Prehospital and Emergency Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Selma Lagerløfs Vej 249, Gistrup, 9260, Denmark
- Emergency Medical Services, North Denmark Region, Hjulmagervej 20, Aalborg, 9000, Denmark
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4
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Nadkarni VM, Tijssen J, Denny V. Intra-Arrest Transport vs On-Scene Cardiopulmonary Resuscitation for Children-Scoop and Run vs Stay and Play. JAMA Netw Open 2024; 7:e2411616. [PMID: 38767922 DOI: 10.1001/jamanetworkopen.2024.11616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024] Open
Affiliation(s)
- Vinay M Nadkarni
- Anesthesiology, Critical Care and Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Janice Tijssen
- Paediatric Critical Care Medicine, London Health Sciences Centre, London, Ontario, Canada
| | - Vanessa Denny
- Pediatric Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Okubo M, Komukai S, Izawa J, Chung S, Drennan IR, Grunau BE, Lupton JR, Ramgopal S, Rea TD, Callaway CW. Survival After Intra-Arrest Transport vs On-Scene Cardiopulmonary Resuscitation in Children. JAMA Netw Open 2024; 7:e2411641. [PMID: 38767920 PMCID: PMC11107299 DOI: 10.1001/jamanetworkopen.2024.11641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/28/2024] [Indexed: 05/22/2024] Open
Abstract
Importance For pediatric out-of-hospital cardiac arrest (OHCA), emergency medical services (EMS) may elect to transport to the hospital during active cardiopulmonary resuscitation (CPR) (ie, intra-arrest transport) or to continue on-scene CPR for the entirety of the resuscitative effort. The comparative effectiveness of these strategies is unclear. Objective To evaluate the association between intra-arrest transport compared with continued on-scene CPR and survival after pediatric OHCA, and to determine whether this association differs based on the timing of intra-arrest transport. Design, Setting, and Participants This cohort study included pediatric patients aged younger than 18 years with EMS-treated OHCA between December 1, 2005 and June 30, 2015. Data were collected from the Resuscitation Outcomes Consortium Epidemiologic Registry, a prospective 10-site OHCA registry in the US and Canada. Data analysis was performed from May 2022 to February 2024. Exposures Intra-arrest transport, defined as an initiation of transport prior to the return of spontaneous circulation, and the interval between EMS arrival and intra-arrest transport. Main Outcomes and Measures The primary outcome was survival to hospital discharge. Patients who underwent intra-arrest transport at any given minute after EMS arrival were compared with patients who were at risk of undergoing intra-arrest transport within the same minute using time-dependent propensity scores calculated from patient demographics, arrest characteristics, and EMS interventions. We examined subgroups based on age (<1 year vs ≥1 year). Results Of 2854 eligible pediatric patients (median [IQR] age, 1 [0-9] years); 1691 males [59.3%]) who experienced OHCA between December 2005 and June 2015, 1892 children (66.3%) were treated with intra-arrest transport and 962 children (33.7%) received continued on-scene CPR. The median (IQR) time between EMS arrival and intra-arrest transport was 15 (9-22) minutes. In the propensity score-matched cohort (3680 matched cases), there was no significant difference in survival to hospital discharge between the intra-arrest transport group and the continued on-scene CPR group (87 of 1840 patients [4.7%] vs 95 of 1840 patients [5.2%]; risk ratio [RR], 0.81 [95% CI, 0.59-1.10]). Survival to hospital discharge was not modified by the timing of intra-arrest transport (P value for the interaction between intra-arrest transport and time to matching = .10). Among patients aged younger than 1 year, intra-arrest transport was associated with lower survival to hospital discharge (RR, 0.52; 95% CI, 0.33-0.83) but there was no association for children aged 1 year or older (RR, 1.22; 95% CI, 0.77-1.93). Conclusions and Relevance In this cohort study of a North American OHCA registry, intra-arrest transport compared with continued on-scene CPR was not associated with survival to hospital discharge among children with OHCA. However, intra-arrest transport was associated with a lower likelihood of survival to hospital discharge among children aged younger than 1 year.
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Affiliation(s)
- Masashi Okubo
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sho Komukai
- Division of Biomedical Statistics, Department of Integrated Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Junichi Izawa
- Department of Internal Medicine, Okinawa Prefectural Chubu Hospital, Okinawa, Japan
- Department of Preventive Services, Graduate School of Public Health, Kyoto University, Kyoto, Japan
- Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - SunHee Chung
- Department of Emergency Medicine, Oregon Health and Science University, Portland
| | - Ian R. Drennan
- Division of Emergency Medicine, Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brian E. Grunau
- Department of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joshua R. Lupton
- Department of Emergency Medicine, Oregon Health and Science University, Portland
| | - Sriram Ramgopal
- Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Thomas D. Rea
- Department of Medicine, University of Washington, Seattle
| | - Clifton W. Callaway
- Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Idrees S, Anderson KK, Choi Y, Tijssen JA. Sociodemographic Factors and the Risk of Pediatric Out-of-Hospital Cardiac Arrest in Ontario, Canada: A Province-Wide Case-Control Study. J Am Heart Assoc 2024; 13:e032718. [PMID: 37930073 PMCID: PMC10863821 DOI: 10.1161/jaha.123.032718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 10/25/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Pediatric out-of-hospital cardiac arrest (POHCA) is associated with significant mortality and poor neurological outcomes. We aimed to describe the association between sociodemographic factors and POHCA risk in Ontario, Canada. METHODS AND RESULTS We conducted a province-wide case-control study at ICES, where patient records are linked across administrative databases. The case group included children (aged 1 day to 17 years) who experienced an out-of-hospital cardiac arrest between 2004 and 2020. Controls were matched up to 1:4 on age, sex, index date, and key comorbidities. We used conditional logistic regression to measure the association between sociodemographic indicators and POHCA risk. The case and control groups included 1826 and 7254 children, respectively. Children living in areas with the highest levels of material deprivation (adjusted odds ratio [aOR], 2.35 [95% CI, 1.94-2.85]) and dependency (aOR, 1.22 [95% CI, 1.01-1.48]) had a higher odds of POHCA, relative to children living in regions with the lowest levels of material deprivation and dependency, respectively. Children living in neighborhoods with the lowest levels of ethnic diversity had a higher odds of POHCA (aOR, 1.62 [95% CI, 1.30-2.01]), relative to children living in neighborhoods with the highest levels of ethnic diversity. The odds of POHCA were lower in immigrants (aOR, 0.67 [95% CI, 0.47-0.95]), relative to the general population. Northern urban residence was associated with a higher odds of POHCA (aOR, 1.45 [95% CI, 1.13-1.87]), relative to southern urban residence. CONCLUSIONS Children living in neighborhoods with high levels of marginalization may have an elevated risk of experiencing POHCA. These findings highlight the importance of addressing disparities through targeted prevention and intervention efforts.
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Affiliation(s)
- Samina Idrees
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & DentistryWestern UniversityLondonOntarioCanada
- ICES WesternLondonOntarioCanada
- Lawson Health Research InstituteLondon Health Sciences CentreLondonOntarioCanada
| | - Kelly K. Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & DentistryWestern UniversityLondonOntarioCanada
- ICES WesternLondonOntarioCanada
- Lawson Health Research InstituteLondon Health Sciences CentreLondonOntarioCanada
- Department of Psychiatry, Schulich School of Medicine & DentistryWestern UniversityLondonOntarioCanada
| | - Yun‐Hee Choi
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & DentistryWestern UniversityLondonOntarioCanada
| | - Janice A. Tijssen
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & DentistryWestern UniversityLondonOntarioCanada
- ICES WesternLondonOntarioCanada
- Lawson Health Research InstituteLondon Health Sciences CentreLondonOntarioCanada
- Department of Paediatrics, Schulich School of Medicine & DentistryWestern UniversityLondonOntarioCanada
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Breeding T, Rosander A, Abella M, Martinez B, Maka P, Elkbuli A. Retrospective Study of EMS Scene Times and Mortality in Penetrating Trauma Patients: Improving Transport Standards and Patient Outcomes. Am Surg 2024; 90:46-54. [PMID: 37489560 DOI: 10.1177/00031348231191224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
BACKGROUND This study aimed to determine the impact of emergency medical service (EMS) scene time variability on adult and pediatric trauma patient outcomes with moderate or severe penetrating injuries. METHODS This retrospective study analyzed the American College of Surgeons (ACS) Trauma Quality Improvement Program (TQIP) database between 2017 and 2020 to evaluate the relationship between EMS scene time on adult and pediatric patients with moderate to severe injuries. Primary outcomes included Dead on Arrival (DOA) to the Emergency Department (ED), ED mortality, 24-hour mortality, and in-hospital mortality. Multivariable logistic regression models were used to examine the association of each EMS scene time category and mortality. RESULTS Adult patients with 10-30 minutes of EMS scene time had increased odds of experiencing ED mortality, 24-hour mortality, and in-hospital mortality. Adults with >30 minutes of EMS scene time were more likely to be DOA to the ED. There was no significant association with mortality for patients with <10 minutes of EMS scene time. In the pediatric subset of patients, those with 10-30 minutes of EMS scene time were more likely to experience ED mortality and in-hospital mortality. CONCLUSION EMS scene times less than 10 minutes were associated with the greatest odds of survival, supporting the "load and go" theory for penetrating trauma. Our study suggests that even an EMS scene time of 10-30 minutes results in a significantly increased risk of mortality, and further efforts are needed to improve scene time through improved EMS and hospital policies.
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Affiliation(s)
- Tessa Breeding
- Dr. Kiran C. Patel College of Allopathic Medicine, NOVA Southeastern University, Fort Lauderdale, FL, USA
| | - Abigail Rosander
- Arizona College of Osteopathic Medicine, Midwestern University, Glendale, AZ, USA
| | | | - Brian Martinez
- Dr. Kiran C. Patel College of Allopathic Medicine, NOVA Southeastern University, Fort Lauderdale, FL, USA
| | - Piueti Maka
- John A. Burns School of Medicine, Honolulu, HI, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Orlando Regional Medical Center, Orlando, FL, USA
- Department of Surgical Education, Orlando Regional Medical Center, Orlando, FL, USA
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Al-Eyadhy A, Almazyad M, Hasan G, AlKhudhayri N, AlSaeed AF, Habib M, Alhaboob AAN, AlAyed M, AlSehibani Y, Alsohime F, Alabdulhafid M, Temsah MH. Outcomes of Cardiopulmonary Resuscitation in the Pediatric Intensive Care of a Tertiary Center. J Pediatr Intensive Care 2023; 12:303-311. [PMID: 37970137 PMCID: PMC10631842 DOI: 10.1055/s-0041-1733855] [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: 05/04/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022] Open
Abstract
Understanding the factors affecting survival and modifying the preventable factors may improve patient outcomes following cardiopulmonary resuscitation (CPR). The aim of this study was to assess the prevalence and outcomes of cardiac arrest and CPR events in a tertiary pediatric intensive care unit (PICU). Outcomes of interest were the return of spontaneous circulation (ROSC) lasting more than 20 minutes, survival for 24 hours post-CPR, and survival to hospital discharge. We analyzed data from the PICU CPR registry from January 1, 2011 to January 1, 2018. All patients who underwent at least 2 minutes of CPR in the PICU were included. CPR was administered in 65 PICU instances, with a prevalence of 1.85%. The mean patient age was 32.7 months. ROSC occurred in 38 (58.5%) patients, 30 (46.2%) achieved 24-hour survival, and 21 (32.3%) survived to hospital discharge. Younger age ( p < 0.018), respiratory cause ( p < 0.001), bradycardia ( p < 0.018), and short duration of CPR ( p < 0.001) were associated with better outcomes, while sodium bicarbonate, norepinephrine, and vasopressin were associated with worse outcome ( p < 0.009). The off-hour CPR had no impact on the outcome. The patients' cumulative predicted survival declined by an average of 8.7% for an additional 1 minute duration of CPR ( p = 0.001). The study concludes that the duration of CPR, therefore, remains one of the crucial factors determining CPR outcomes and needs to be considered in parallel with the guideline emphasis on CPR quality. The lower survival rate post-ROSC needs careful consideration during parental counseling. Better anticipation and prevention of CPR remain ongoing challenges.
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Affiliation(s)
- Ayman Al-Eyadhy
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pediatrics, Pediatric Intensive Care Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Almazyad
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pediatrics, Pediatric Intensive Care Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Gamal Hasan
- Department of Pediatrics, Pediatric Intensive Care Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Department of Pediatrics, Assiut Faculty of Medicine, Assiut University, Assiut, Egypt
- Department of Pediatrics, Pediatric Critical Care Unit, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | | | - Mohammed Habib
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ali A. N. Alhaboob
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pediatrics, Pediatric Intensive Care Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed AlAyed
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Fahad Alsohime
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pediatrics, Pediatric Intensive Care Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Majed Alabdulhafid
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pediatrics, Pediatric Intensive Care Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mohamad-Hani Temsah
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pediatrics, Pediatric Intensive Care Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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9
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Idrees S, Abdullah R, Anderson KK, Tijssen JA. Sociodemographic factors associated with paediatric out-of-hospital cardiac arrest: A systematic review. Resuscitation 2023; 192:109931. [PMID: 37562664 DOI: 10.1016/j.resuscitation.2023.109931] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/08/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Paediatric out-of-hospital cardiac arrest (POHCA) is associated with poor survival and severe neurological sequelae. We conducted a systematic review on the impact of sociodemographic factors across different stages of POHCA. METHODS We searched MEDLINE, EMBASE, and Web of Science from database inception to October 2022. We included studies examining the association between sociodemographic factors (i.e., race, ethnicity, migrant status and socioeconomic status [SES]) and POHCA risk, bystander cardiopulmonary resuscitation (CPR) provision, bystander automated external defibrillator (AED) application, survival (at or 30-days post-discharge), and neurological outcome. We synthesized the data qualitatively. RESULTS We screened 11,097 citations and included 18 articles (arising from 15 studies). There were 4 articles reporting on POHCA risk, 5 on bystander CPR provision, 3 on bystander AED application, 13 on survival, and 6 on neurological outcome. In all studies on POHCA risk, significant differences were found across racial groups, with minority populations being disproportionately impacted. There were no articles reporting on the association between SES and POHCA risk. Bystander CPR provision was consistently associated with race and ethnicity, with disparities impacting Black and Hispanic children. The association between bystander CPR provision and SES was variable. There was little evidence of socioeconomic or racial disparities in studies on bystander AED application, survival, and neurological outcome, particularly across adjusted analyses. CONCLUSIONS Race and ethnicity are likely associated with POHCA risk and bystander CPR provision. These findings highlight the importance of prioritizing at-risk groups in POHCA prevention and intervention efforts. Further research is needed to understand underlying mechanisms.
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Affiliation(s)
- Samina Idrees
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Ream Abdullah
- School of Interdisciplinary Science, Faculty of Science, McMaster University, Hamilton, ON, Canada
| | - Kelly K Anderson
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Janice A Tijssen
- Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
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10
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Li T, Koloden D, Berkowitz J, Luo D, Luan H, Gilley C, Kurgansky G, Barbara P. Prehospital transport and termination of resuscitation of cardiac arrest patients: A review of prehospital care protocols in the United States. Resusc Plus 2023; 14:100397. [PMID: 37252026 PMCID: PMC10213088 DOI: 10.1016/j.resplu.2023.100397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/26/2023] [Accepted: 04/29/2023] [Indexed: 05/31/2023] Open
Abstract
Background The objective was to describe emergency medical services (EMS) protocol variability in transport expectations for out-of-hospital cardiac arrest (OHCA) patients and the involvement of online medical control for on-scene termination of resuscitation in the United States. Whether other aspects of OHCA care were mentioned, including the definition of a "pediatric" patient, and use of end-tidal carbon dioxide monitoring, mechanical chest compression devices (MCCDs), and extracorporeal membrane oxygenation (ECMO), were also described. Methods and Results Review of EMS protocols publicly accessible from https://www.emsprotocols.org and through searches on the internet when protocols were unavailable on the website from June 2021 to January 2022. Frequencies and proportions were used to describe outcomes. Of 104 protocols reviewed, 51.9% state to initiate transport after return of spontaneous circulation (ROSC), 26.0% do not specify when to initiate transport, and 6.7% state to transport after ≥20 minutes of on-scene cardiopulmonary resuscitation for adults. For pediatric patients, 38.5% of protocols do not specify when to initiate transport, 32.7% state to transport after ROSC, and 10.6% state to transport as soon as possible. Most protocols (42.3%) did not specify the age that defines "pediatric" in cardiac arrest. More than half (51.9%) of the protocols require online medical control for termination of resuscitation. Most protocols mention the use of end-tidal carbon dioxide monitoring (81.7%), 50.0% mention the use of MCCDs, and 4.8% mention ECMO for cardiac arrest. Conclusions In the United States, EMS protocols for initiation of transport and termination of resuscitation for OHCA patients are highly variable.
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Affiliation(s)
- Timmy Li
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY, USA
| | - Daniel Koloden
- Center for Emergency Medical Services, Northwell Health, 15 Burke Lane, Syosset, NY, USA
| | - Jonathan Berkowitz
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY, USA
- Center for Emergency Medical Services, Northwell Health, 15 Burke Lane, Syosset, NY, USA
| | - Dee Luo
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 500 Hofstra Blvd, Hempstead, NY, USA
| | - Howard Luan
- Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, USA
| | - Charles Gilley
- Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, USA
| | - Gregory Kurgansky
- Feinstein Institutes for Medical Research, Northwell Health, 350 Community Drive, Manhasset, NY, USA
| | - Paul Barbara
- Department of Emergency Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, 300 Community Drive, Manhasset, NY, USA
- Center for Emergency Medical Services, Northwell Health, 15 Burke Lane, Syosset, NY, USA
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11
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Amagasa S, Utsumi S, Moriwaki T, Yasuda H, Kashiura M, Uematsu S, Kubota M. Advanced airway management for pediatric out-of-hospital cardiac arrest: A systematic review and network meta-analysis. Am J Emerg Med 2023; 68:161-169. [PMID: 37027937 DOI: 10.1016/j.ajem.2023.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/19/2023] [Accepted: 03/23/2023] [Indexed: 03/31/2023] Open
Abstract
OBJECTIVES Although airway management is important in pediatric resuscitation, the effectiveness of bag-mask ventilation (BMV) and advanced airway management (AAM), such as endotracheal intubation (ETI) and supraglottic airway (SGA) devices, for prehospital resuscitation of pediatric out-of-hospital cardiac arrest (OHCA) remains unclear. We aimed to determine the efficacy of AAM during prehospital resuscitation of pediatric OHCA cases. METHODS We searched four databases from their inception to November 2022 and included randomized controlled trials and observational studies with appropriate adjustments for confounders that evaluated prehospital AAM for OHCA in children aged <18 years in quantitative synthesis. We compared three interventions (BMV, ETI, and SGA) via network meta-analysis using the GRADE Working Group approach. The outcome measures were survival and favorable neurological outcomes at hospital discharge or 1 month after cardiac arrest. RESULTS Five studies (including one clinical trial and four cohort studies with rigorous confounding adjustment) involving 4852 patients were analyzed in our quantitative synthesis. Compared with ETI, BMV was associated with survival (relative risk [RR] 0.44 [95% confidence intervals (CI) 0.25-0.77]) (very low certainty). There were no significant association with survival in the other comparisons (SGA vs. BMV: RR 0.62 [95% CI 0.33-1.15] [low certainty], ETI vs. SGA: RR 0.71 [95% CI 0.39-1.32] [very low certainty]). There was no significant association with favorable neurological outcomes in any comparison (ETI vs. BMV: RR 0.33 [95% CI 0.11-1.02]; SGA vs. BMV: RR 0.50 [95% CI 0.14-1.80]; ETI vs. SGA: RR 0.66 [95% CI 0.18-2.46]) (all very low certainty). In the ranking analysis, the hierarches for efficacy for survival and favorable neurological outcome were BMV > SGA > ETI. CONCLUSION Although the available evidence is from observational studies and its certainty is low to very low, prehospital AAM for pediatric OHCA did not improve outcomes.
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12
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Global burden of out-of-hospital cardiac arrest in children: a systematic review, meta-analysis, and meta-regression. Pediatr Res 2023:10.1038/s41390-022-02462-5. [PMID: 36646884 DOI: 10.1038/s41390-022-02462-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 11/18/2022] [Accepted: 12/15/2022] [Indexed: 01/18/2023]
Abstract
The incidence of out-of-hospital cardiac arrest (OHCA) and its mortality among children decreased globally over the years. However, the incidence, mortality, and its determinants are heterogeneous globally. The current study was designed to investigate the incidence of OHCA, mortality, and its determinants based on a systematic review of published literature. A comprehensive search was conducted in PubMed/Medline; Science Direct, Cochrane Library, Hinari, and LILACS without language and date restrictions. The data were extracted with two independent authors in a customized format. The methodological quality of the included studies was evaluated using the Newcastle-Ottawa appraisal tool. A total of 2526 articles were identified from different databases with an initial search. Forty-eight articles with 138.3 million participants were included in the systematic review. The meta-analysis showed that the pooled rate of mortality was found to be 70% (95% CI: 57-81%, 42 studies, 28,345 participants). The incidence of OHCA and mortality among children was very high among children with significant regional disparity. Those children with cardiovascular causes of arrest, and initial nonshockable rhythm were independent predictors of OHCA-related mortality. This systematic review and meta-analysis is registered in Prospero (CRD42022316602). IMPACT: This systematic review addresses a significant health problem in a global context from 1995 to 2022. The meta-regression revealed that the incidence of OHCA and mortality of children decline over the years in high-income countries despite regional dispraises among individual studies. Body of evidence on the incidence of OHCA and mortality is lacking in low- and middle-income countries.
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13
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Shin SJ, Bae HS, Moon HJ, Kim GW, Cho YS, Lee DW, Jeong DK, Kim HJ, Lee HJ. Evaluation of optimal scene time interval for out-of-hospital cardiac arrest using a deep neural network. Am J Emerg Med 2023; 63:29-37. [PMID: 36544293 DOI: 10.1016/j.ajem.2022.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 10/03/2022] [Accepted: 10/09/2022] [Indexed: 12/07/2022] Open
Abstract
AIM This study aims to develop a cardiac arrest prediction model using deep learning (CAPD) algorithm and to validate the developed algorithm by evaluating the change in out-of-hospital cardiac arrest patient prognosis according to the increase in scene time interval (STI). METHODS We conducted a retrospective cohort study using smart advanced life support trial data collected by the National Emergency Center from January 2016 to December 2019. The smart advanced life support data were randomly partitioned into derivation and validation datasets. The performance of the CAPD model using the patient's age, sex, event witness, bystander cardiopulmonary resuscitation (CPR), administration of epinephrine, initial shockable rhythm, prehospital defibrillation, provision of advanced life support, response time interval, and STI as prediction variables for prediction of a patient's prognosis was compared with conventional machine learning methods. After fixing other values of the input data, the changes in prognosis of the patient with respect to the increase in STI was observed. RESULTS A total of 16,992 patients were included in this study. The area under the receiver operating characteristic curve values for predicting prehospital return of spontaneous circulation (ROSC) and favorable neurological outcomes were 0.828 (95% confidence interval 0.826-0.830) and 0.907 (0.914-0.910), respectively. Our algorithm significantly outperformed other artificial intelligence algorithms and conventional methods. The neurological recovery rate was predicted to decrease to 1/3 of that at the beginning of cardiopulmonary resuscitation when the STI was 28 min, and the prehospital ROSC was predicted to decrease to 1/2 of its initial level when the STI was 30 min. CONCLUSION The CAPD exhibits potential and effectiveness in identifying patients with ROSC and favorable neurological outcomes for prehospital resuscitation.
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Affiliation(s)
- Seung Jae Shin
- Department of Industrial and System Engineering, Korea Advanced Institute of Science and Technology, Republic of Korea
| | - Hee Sun Bae
- Department of Industrial and System Engineering, Korea Advanced Institute of Science and Technology, Republic of Korea
| | - Hyung Jun Moon
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Republic of Korea.
| | - Gi Woon Kim
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Republic of Korea
| | - Young Soon Cho
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Republic of Korea
| | - Dong Wook Lee
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Republic of Korea
| | - Dong Kil Jeong
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Republic of Korea
| | - Hyun Joon Kim
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Republic of Korea
| | - Hyun Jung Lee
- Department of Emergency Medicine, College of Medicine, Soonchunhyang University, Republic of Korea
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14
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Lanyi M, Elmer J, Guyette FX, Martin-Gill C, Venkat A, Traynor O, Walker H, Seaman K, Kochanek PM, Fink EL. Survival Rates After Pediatric Traumatic Out-of-Hospital Cardiac Arrest Suggest an Underappreciated Therapeutic Opportunity. Pediatr Emerg Care 2022; 38:417-422. [PMID: 35947060 PMCID: PMC9427720 DOI: 10.1097/pec.0000000000002806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Children with traumatic arrests represent almost one third of annual pediatric out-of-hospital cardiac arrests (OHCAs). However, traumatic arrests are often excluded from study populations because survival posttraumatic arrest is thought to be negligible. We hypothesized that children treated and transported by emergency medical services (EMS) personnel after traumatic OHCA would have lower survival compared with children treated after medical OHCA. METHODS We performed a secondary, observational study of children younger than 18 years treated and transported by 78 EMS agencies in southwestern Pennsylvania after OHCA from 2010 to 2014. Etiology was determined as trauma or medical by EMS services. We analyzed patient, cardiac arrest, and resuscitation characteristics and ascertained vital status using the National Death Index. We used multivariable logistic regression to test the association of etiology with mortality after covariate adjustment. RESULTS Forty eight of 209 children (23%) had traumatic OHCA. Children with trauma were older than those with medical OHCA (13.2 [3.8-15.9] vs 0.5 [0.2-2.4] years, P < 0.001). Prehospital return of spontaneous circulation frequency for trauma versus medical etiology was similar (90% vs 87%, P = 0.84). Patients with trauma had higher mortality (69% vs 45% P = 0.004). CONCLUSIONS More than 8 of 10 children with EMS treated and transported OHCA achieved return of spontaneous circulation. Despite lower survival rates than medical OHCA patients, almost one third of children with a traumatic etiology survived throughout the study period. Future research programs warrant inclusion of children with traumatic OHCA to improve outcomes.
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Affiliation(s)
- Maria Lanyi
- From the University of Pittsburgh Medical School
| | | | - Francis X Guyette
- Department of Emergency Medicine, University of Pittsburgh School of Medicine
| | | | - Arvind Venkat
- Department of Emergency Medicine, Allegheny Health Network
| | - Owen Traynor
- Department of Emergency Medicine, St Clair Hospital, Pittsburgh
| | - Heather Walker
- Department of Emergency Medicine, Excela Health, Greensburg
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15
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Peng Tham L, Fook-Chong S, Shahidah N, Fu-Wah Ho A, Tanaka H, Do Shin S, Chow-In Ko P, Darin Wong K, Jirapong S, Ramana Rao GV, Cai W, Al Qahtani S, Eng Hock Ong M. PRE-HOSPITAL AIRWAY MANAGEMENT AND SURVIVAL OUTCOMES AFTER PAEDIATRIC OUT-OF-HOSPITAL CARDIAC ARRESTS. Resuscitation 2022; 176:9-18. [PMID: 35483494 DOI: 10.1016/j.resuscitation.2022.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Paediatric out-of-hospital cardiac arrest (OHCA) results in high mortality and poor neurological outcomes. We conducted this study to describe and compare the effects of pre-hospital airway management on survival outcomes for paediatric OHCA in the Asia-pacific region. METHODS We performed a retrospective analysis of the Pan Asian Resuscitation Outcomes Study (PAROS) data from January 2009 to June 2018. PAROS is a prospective, observational, multi-centre cohort study from eleven countries. The primary outcomes were one-month survival and survival with favourable neurological status, defined as Cerebral Performance Category1 or 2. We performed multivariate analyses of the unmatched and propensity matched cohort. RESULTS We included 3131 patients less than 18 years in the study. 2679 (85.6%) children received bag-valve-mask (BVM) ventilations, 81 (2.6%) endotracheal intubations (ETI) and 371 (11.8%) supraglottic airways (SGA). 792 patients underwent propensity score matching. In the matched cohort, advanced airway management (AAM: SGA and ETI) when compared with BVM group was associated with decreased one-month survival [AAM: 28/396 (7.1%) versus BVM: 55/396 (13.9%); adjusted odds ratio (aOR), 0.46 (95% CI, 0.29 - 0.75); p = 0.002] and survival with favourable neurological status [AAM: 8/396 (2.0%) versus BVM: 31/396 (7.8%); aOR, 0.22 (95% CI, 0.10 - 0.50); p < 0.001]. For SGA group, we observed less 1-month survival [SGA: 24/337 (7.1%) versus BVM: 52/337 (15.4%); aOR, 0.41 (95%CI, 0.25 - 0.69), p = 0.001] and survival with favourable neurological status. CONCLUSION In children with OHCA in the Asia-Pacific region, pre-hospital AAM was associated with decreased one-month survival and less favourable neurological status.
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Affiliation(s)
- Lai Peng Tham
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore.
| | - Stephanie Fook-Chong
- Prehospital Emergency & Research Centre, Duke- NUS Medical School, Singapore, Singapore
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Andrew Fu-Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Pre-hospital & Emergency Research Centre, Duke-NUS Medical School, Singapore, Singapore; National Heart Research Institute Singapore, National Heart Centre, Singapore, Singapore
| | - Hideharu Tanaka
- Department of EMS System, Graduate School, Kokushikan University, Tokyo, Japan
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea
| | - Patrick Chow-In Ko
- Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan
| | | | | | - G V Ramana Rao
- GVK Emergency Management and Research Institute (GVK EMRI), Secunderabad, Telangana, India
| | - Wenwei Cai
- Department of Emergency Medicine, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
| | | | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Health Services and Systems Research, Duke-NUS Medical School, Singapore
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16
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McKenzie K, Cameron S, Odoardi N, Gray K, Miller MR, Tijssen JA. Evaluation of Local Pediatric Out-of-Hospital Cardiac Arrest and Emergency Services Response. Front Pediatr 2022; 10:826294. [PMID: 35273929 PMCID: PMC8901601 DOI: 10.3389/fped.2022.826294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/24/2022] [Indexed: 11/30/2022] Open
Abstract
Background Survival after pediatric out-of-hospital cardiac arrest is poor. Paramedic services provide critical interventions that impact survival outcomes. We aimed to describe local pediatric out-of-hospital cardiac arrest (POHCA) events and evaluate the impact of the paramedic service response to POHCA. Methods The Canadian Resuscitation Outcomes Consortium and corresponding ambulance call records were used to evaluate deviations from best practice by paramedics for patients aged 1 day to <18 years who had an atraumatic out-of-hospital cardiac arrest between 2012 and 2020 in Middlesex-London County. Deviations were any departure from protocol as defined by Middlesex-London Paramedic Services. Results Fifty-one patients were included in this study. All POHCA events had at least one deviation, with a total of 188 deviations for the study cohort. Return of spontaneous circulation (ROSC) was achieved in 35.3% of patients and 5.8% survived to hospital discharge. All survivors developed a new, severe neurological impairment. Medication deviations were most common (n = 40, 21.3%) followed by process timing (n = 38, 20.2%), vascular access (n = 27, 14.4%), and airway (n = 27, 14.4%). A delay in vascular access was the most common deviation (n = 25, 49.0%). The median (IQR) time to epinephrine administration was 8.6 (5.90-10.95) min from paramedic arrival. Cardiac arrests occurring in public settings had more deviations than private settings (p = 0.04). ROSC was higher in events with a deviation in any circulation category (p = 0.03). Conclusion Patient and arrest characteristics were similar to other POHCA studies. This cohort exhibited high rates of ROSC and bystander cardiopulmonary resuscitation but low survival to hospital discharge. The study was underpowered for its primary outcome of survival. The total deviations scored was low relative to the total number of tasks in a resuscitation. Epinephrine was frequently administered outside of the recommended timeframe, highlighting an important quality improvement opportunity.
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Affiliation(s)
- Kate McKenzie
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Saoirse Cameron
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Natalya Odoardi
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Katelyn Gray
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Michael R. Miller
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada
| | - Janice A. Tijssen
- Department of Paediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Children's Health Research Institute, Lawson Health Research Institute, London, ON, Canada
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17
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Harris M, Lyng JW, Mandt M, Moore B, Gross T, Gausche-Hill M, Donofrio-Odmann JJ. Prehospital Pediatric Respiratory Distress and Airway Management Interventions: An NAEMSP Position Statement and Resource Document. PREHOSP EMERG CARE 2022; 26:118-128. [PMID: 35001823 DOI: 10.1080/10903127.2021.1994675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Devices and techniques such as bag-valve-mask ventilation, endotracheal intubation, supraglottic airway devices, and noninvasive ventilation offer important tools for airway management in critically ill EMS patients. Over the past decade the tools, technology, and strategies used to assess and manage pediatric respiratory and airway emergencies have evolved, and evidence regarding their use continues to grow.NAEMSP recommends:Methods and tools used to properly size pediatric equipment for ages ranging from newborns to adolescents should be available to all EMS clinicians. All pediatric equipment should be routinely checked and clearly identifiable in EMS equipment supply bags and vehicles.EMS agencies should train and equip their clinicians with age-appropriate pulse oximetry and capnography equipment to aid in the assessment and management of pediatric respiratory distress and airway emergencies.EMS agencies should emphasize noninvasive positive pressure ventilation and effective bag-valve-mask ventilation strategies in children.Supraglottic airways can be used as primary or secondary airway management interventions for pediatric respiratory failure and cardiac arrest in the EMS setting.Pediatric endotracheal intubation has unclear benefit in the EMS setting. Advanced approaches to pediatric ETI including drug-assisted airway management, apneic oxygenation, and use of direct and video laryngoscopy require further research to more clearly define their risks and benefits prior to widespread implementation.If considering the use of pediatric endotracheal intubation, the EMS medical director must ensure the program provides pediatric-specific initial training and ongoing competency and quality management activities to ensure that EMS clinicians attain and maintain mastery of the intervention.Paramedic use of direct laryngoscopy paired with Magill forceps to facilitate foreign body removal in the pediatric patient should be maintained even when pediatric endotracheal intubation is not approved as a local clinical intervention.
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18
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The Casualty Stabilization–Transportation Problem in a Large-Scale Disaster. SUSTAINABILITY 2022. [DOI: 10.3390/su14020621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We address the problem of picking up, stabilizing, and transporting casualties in response to mass-injury disasters. Our proposed methodology establishes the itinerary for collecting, on-site stabilization, and transporting victims considering capacitated vehicles and medical care centers. Unlike previous works, we minimize the time required to achieve on-site stabilization of each victim according to his age and level of severity of the injuries for their subsequent transfer to specialized medical centers. Thus, more critical patients will be the first to be stabilized, maximizing their chances of survival. In our methodology, the victims’ age, the injuries’ severity level, and their deterioration over time are considered critical factors in prioritizing care for each victim. We tested our approach using simulated earthquake scenarios in the city of Iquique, Chile, with multiple injuries. The results show that explicitly considering the on-site stabilization of the vital functions of the prioritized victims as an objective, before their transfer to a specialized medical center, allows treating and stabilizing patients earlier than with traditional objectives.
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Gray K, Cameron S, McKenzie K, Miller M, Odoardi N, Tijssen JA. Validation of ICD-10 Codes for the Identification of Paediatric Out-of-Hospital Cardiac Arrest Patients. Resuscitation 2021; 171:73-79. [PMID: 34952178 DOI: 10.1016/j.resuscitation.2021.12.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/14/2021] [Accepted: 12/15/2021] [Indexed: 11/28/2022]
Abstract
AIM There is a need for large-scale epidemiological studies of paediatric out-of-hospital cardiac arrest (POHCA). To enable this, we developed and validated international classification of disease (ICD-10) search algorithms for the identification of POHCA patients from health administrative data. METHODS We validated the algorithms with a registry of POHCA (CanRoc) as the reference standard. The reference standard included all atraumatic POHCA in Middlesex-London region for January 2012-June 2020. All algorithms included 1 day to <18-year-old patients transported to emergency department (ED) by ambulance and excluded trauma. We tested three algorithms, which were applied to the National Ambulatory Care Reporting System and Discharge Abstract Database. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (PLR) and negative likelihood ration (NLR) were calculated for each algorithm. RESULTS During the study period, 17,688 children presented to the ED by ambulance. The reference standard included 51 POHCA patients. The algorithm using only ICD-10 code for cardiac arrest had a sensitivity of 65.5% and PPV of 90%. The algorithm with the highest sensitivity of 87.3% added sudden infant death syndrome, drowning or asphyxiation with CPR in addition to the cardiac arrest codes for inpatient and ED records. This algorithm had a specificity of 99.9%, PPV of 81.4% and NPV of ∼100.0%. CONCLUSION It is important that algorithms used for cohort identification are validated prior to use. The ICD-10 code for cardiac arrest alone misses many POHCA cases but the use of additional codes can improve the sensitivity while maintaining specificity.
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Affiliation(s)
- Katelyn Gray
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, Canada, N6A 5C1
| | - Saoirse Cameron
- Paediatric Critical Care Medicine, Children's Hospital, London Health Sciences Centre, 800 Commissioners Rd E, London, ON, Canada, N6A 5W9
| | - Kate McKenzie
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, Canada, N6A 5C1
| | - Michael Miller
- Paediatric Critical Care Medicine, Children's Hospital, London Health Sciences Centre, 800 Commissioners Rd E, London, ON, Canada, N6A 5W9; Children's Health Research Institute, 800 Commissioners Rd E, London, ON, Canada, N6A 5W9; Lawson Health Research Institute, 750 Base Line Rd E, London, ON, Canada, N6C 2R5
| | - Natalya Odoardi
- Faculty of Medicine, University of Toronto, 1 King's College Cir, Toronto, ON, Canada, M5S 1A8
| | - Janice A Tijssen
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond St, London, ON, Canada, N6A 5C1; Paediatric Critical Care Medicine, Children's Hospital, London Health Sciences Centre, 800 Commissioners Rd E, London, ON, Canada, N6A 5W9; Children's Health Research Institute, 800 Commissioners Rd E, London, ON, Canada, N6A 5W9; Lawson Health Research Institute, 750 Base Line Rd E, London, ON, Canada, N6C 2R5.
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20
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Harris MI, Crowe RP, Anders J, D'Acunto S, Adelgais KM, Fishe J. Applying a set of termination of resuscitation criteria to paediatric out-of-hospital cardiac arrest. Resuscitation 2021; 169:175-181. [PMID: 34555488 DOI: 10.1016/j.resuscitation.2021.09.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Prehospital Termination of Resuscitation (TOR) protocols for adults can reduce the number of futile transports of patients in cardiac arrest, yet similar protocols are not widely available for paediatric out-of-hospital cardiac arrest (POHCA). The objective of this study was to apply a set of criteria for paediatric TOR (pTOR) from the Maryland Institute for Emergency Medical Services Systems (MIEMSS) to a large national cohort and determine its association with return of spontaneous circulation (ROSC) after POHCA. METHODS We identified patients ages 0-17 treated by Emergency Medical Services (EMS) with cardiac arrest in 2019 from the ESO dataset and and applied the applicable pTOR certeria for medical or traumatic arrests. We calculated predictive test characteristics for the outcome of prehospital ROSC, stratified by medical and traumatic cause of arrest. RESULTS We analyzed records for 1595 POHCA patients. Eighty-eight percent (n = 1395) were classified as medical. ROSC rates were 23% among medical POHCA and 27% among traumatic POHCA. The medical criteria correctly classified >99% (322/323) of patients who achieved ROSC as ineligible for TOR. The trauma criteria correctly classified 93% (50/54) of patients with ROSC as ineligible for TOR. Of the five misclassified patients, three were involved in drowning incidents. CONCLUSIONS The Maryland pTOR criteria identified eligible patients who did not achieve prehospital ROSC, while reliably excluding those who did achieve prehospital ROSC. As most misclassified patients were victims of drowning, we recommend considering the exclusion of drowning patients from future pTOR guidelines. Further studies are needed to evaluate the long-term survival and neurologic outcome of patients misclassified by pTOR criteria.
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Affiliation(s)
- Matthew I Harris
- Northwell Hofstra School of Medicine, Departments of Paediatrics and Emergency, Medicine, New Hyde Park, NY, United States.
| | | | - Jennifer Anders
- Johns Hopkins School of Medicine, Department of Paediatrics, Baltimore, MD, United States
| | - Salvatore D'Acunto
- University of Florida College of Medicine - Jacksonville, Center for Data Solutions, Jacksonville, FL United States
| | - Kathleen M Adelgais
- University of Colorado School of Medicine, Department of Paediatrics, Section of Paediatric Emergency Medicine, Aurora, CO, United States
| | - Jennifer Fishe
- University of Florida College of Medicine - Jacksonville, Center for Data Solutions, Jacksonville, FL United States; University of Florida College of Medicine - Jacksonville, Department of Emergency Medicine, Jacksonville, FL, United States
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21
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Pediatric Prehospital Advanced Airway Management by Anesthesiologist and Nurse Anesthetist Staffed Critical Care Teams. Prehosp Disaster Med 2021; 36:547-552. [PMID: 34254579 DOI: 10.1017/s1049023x21000637] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Prehospital pediatric tracheal intubation (TI) is a possible life-saving intervention that requires adequate experience to mitigate associated complications. The pediatric airway and respiratory physiology present challenges in addition to a relatively rare incidence of prehospital pediatric TI. STUDY OBJECTIVE The aim of this study was to describe characteristics and outcomes of prehospital TI in pediatric patients treated by critical care teams. METHODS This is a sub-group analysis of all pediatric (<16 years old) patients from a prospective, observational, multi-center study on prehospital advanced airway management in the Nordic countries from May 2015 through November 2016. The TIs were performed by anesthesiologists and nurse anesthetists staffing six helicopter and six Rapid Response Car (RRC) prehospital critical care teams. RESULTS In the study, 74 children were tracheal intubated, which corresponds to 3.7% (74/2,027) of the total number of patients. The pediatric patients were intubated by very experienced providers, of which 80% had performed ≥2,500 TIs. The overall TI success rate, first pass success rate, and airway complication rate were in all children (<16 years) 98%, 82%, and 12%. The corresponding rates among infants (<2 years) were 94%, 67%, and 11%. The median time on scene was 30 minutes. CONCLUSION This study observed a high overall prehospital TI success rate in children with relatively few associated complications and short time on scene, despite the challenges presented by the pediatric prehospital TI.
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22
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"Shockingly" good long-term outcomes after pediatric OHCA, paired with high quality CPR can maximize pediatric survival outcomes. Resuscitation 2021; 166:137-138. [PMID: 34256092 DOI: 10.1016/j.resuscitation.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 06/25/2021] [Indexed: 11/22/2022]
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23
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Albrecht M, de Jonge RCJ, Nadkarni VM, de Hoog M, Hunfeld M, Kammeraad JAE, Moors XRJ, van Zellem L, Buysse CMP. Association between shockable rhythms and long-term outcome after pediatric out-of-hospital cardiac arrest in Rotterdam, the Netherlands: An 18-year observational study. Resuscitation 2021; 166:110-120. [PMID: 34082030 DOI: 10.1016/j.resuscitation.2021.05.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/06/2021] [Accepted: 05/23/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Shockable rhythm following pediatric out-of-hospital cardiac arrest (pOHCA) is consistently associated with hospital and short-term survival. Little is known about the relationship between shockable rhythm and long-term outcomes (>1 year) after pOHCA. The aim was to investigate the association between first documented rhythm and long-term outcomes in a pOHCA cohort over 18 years. METHODS All children aged 1 day-18 years who experienced non-traumatic pOHCA between 2002-2019 and were subsequently admitted to the emergency department (ED) or pediatric intensive care unit (PICU) of Erasmus MC-Sophia Children's Hospital were included. Data was abstracted retrospectively from patient files, (ground) ambulance and Helicopter Emergency Medical Service (HEMS) records, and follow-up clinics. Long-term outcome was determined using a Pediatric Cerebral Performance Category (PCPC) score at the longest available follow-up interval through august 2020. The primary outcome measure was survival with favorable neurologic outcome, defined as PCPC 1-2 or no difference between pre- and post-arrest PCPC. The association between first documented rhythm and the primary outcome was calculated in a multivariable regression model. RESULTS 369 children were admitted, nine children were lost to follow-up. Median age at arrest was age 3.4 (IQR 0.8-9.9) years, 63% were male and 14% had a shockable rhythm (66% non-shockable, 20% unknown or return of spontaneous circulation (ROSC) before emergency medical service (EMS) arrival). In adolescents (aged 12-18 years), 39% had shockable rhythm. 142 (39%) of children survived to hospital discharge. On median follow-up interval of 25 months (IQR 5.1-49.6), 115/142 (81%) of hospital survivors had favorable neurologic outcome. In multivariable analysis, shockable rhythm was associated with survival with favorable long-term neurologic outcome (OR 8.9 [95%CI 3.1-25.9]). CONCLUSION In children with pOHCA admitted to ED or PICU shockable rhythm had significantly higher odds of survival with long-term favorable neurologic outcome compared to non-shockable rhythm. Survival to hospital discharge after pOHCA was 39% over the 18-year study period. Of survivors to discharge, 81% had favorable long-term (median 25 months, IQR 5.1-49.6) neurologic outcome. Efforts for improving outcome of pOHCA should focus on early recognition and treatment of shockable pOHCA at scene.
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Affiliation(s)
- M Albrecht
- Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - R C J de Jonge
- Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - V M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - M de Hoog
- Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - M Hunfeld
- Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Pediatric Neurology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - J A E Kammeraad
- Department of Pediatric Cardiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - X R J Moors
- Department of Pediatric Anesthesiology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands; Helicopter Emergency Medical Services, Erasmus MC, Rotterdam, The Netherlands
| | - L van Zellem
- Department of Youth Health Care, Public Health Service (GGD), Amsterdam, The Netherlands
| | - C M P Buysse
- Pediatric Intensive Care Unit, Department of Pediatrics and Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
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24
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Gugelmin-Almeida D, Clark C, Rolfe U, Jones M, Williams J. Dominant versus non-dominant hand during simulated infant CPR using the two-finger technique: a randomised study. Resusc Plus 2021; 7:100141. [PMID: 34223397 PMCID: PMC8244244 DOI: 10.1016/j.resplu.2021.100141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 05/10/2021] [Accepted: 05/16/2021] [Indexed: 11/28/2022] Open
Abstract
Aims The aim of this randomised study was to compare the two-finger technique (TFT) performance using dominant hand (DH) and non-dominant hand (NH) during simulated infant CPR (iCPR). Methods 24 participants performed 3-min iCPR using TFT with DH or NH followed by 3-min iCPR with their other hand. Perceived fatigue was rated using visual analogue scale. Primary outcomes - (i) difference between DH and NH for compression depth (CCD), compression rate (CCR), residual leaning (RL) and duty cycle (DC); (ii) difference between first and last 30 s of iCPR performance with DH and NH. Secondary outcomes - (i) perception of fatigue between DH and NH; (ii) relationship between perception of fatigue and iCPR performance. Results No significant difference between DH and NH for any iCPR metric. CCR (DH: P = 0.02; NH: P = 0.004) and DC (DH: P = 0.04; NH: P < 0.001) were significantly different for the last 30 s for DH and NH. Perception of fatigue for NH (76.8 ± 13.4 mm) was significantly higher (t = -3.7, P < 0.001) compared to DH (62.8 ± 12.5 mm). No significant correlation between iCPR metrics and perception of fatigue for DH. However, a significant correlation was found for CCR (r = 0.43; P = 0.04) and RL (r = -0.48; P = 0.02) for NH. Conclusion No difference in performance of iCPR with DH versus NH was determined. However, perception of fatigue is higher in NH and was related to CCR and RL, with no effect on quality of performance. Based on our results, individuals performing iCPR can offer similar quality of infant chest compressions regardless of the hand used or the perception of fatigue, under the conditions explored in this study.
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Affiliation(s)
- Debora Gugelmin-Almeida
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth Gateway Building, St. Pauls Lane, Bournemouth, BH8 8GP, England.,Department of Anaesthesiology, Main Theatres, Royal Bournemouth and Christchurch Hospitals, Castle Lane East, Bournemouth, BH7 7DW, England
| | - Carol Clark
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth Gateway Building, St. Pauls Lane, Bournemouth, BH8 8GP, England
| | - Ursula Rolfe
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth Gateway Building, St. Pauls Lane, Bournemouth, BH8 8GP, England
| | - Michael Jones
- Cardiff School of Engineering, Cardiff University, Cardiff, CF23 3AA, Wales
| | - Jonathan Williams
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth Gateway Building, St. Pauls Lane, Bournemouth, BH8 8GP, England
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25
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Kingsley P, Merefield J, Walker RG, Chapman FW, Faulkner M. Out-of-hospital resuscitation of a 3 month old boy presenting with recurrent ventricular fibrillation cardiac arrest: a case report. Scand J Trauma Resusc Emerg Med 2021; 29:58. [PMID: 33849626 PMCID: PMC8045223 DOI: 10.1186/s13049-021-00871-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/31/2021] [Indexed: 11/22/2022] Open
Abstract
A 3 month old boy, with no known health conditions, suffered a sudden collapse at home. On first EMS arrival, ventricular fibrillation (VF) cardiac arrest was identified and resuscitation following UK national guidelines was initiated. He remained in cardiac arrest for over 25 min, during which he received 10 defibrillation shocks, each effective, but with VF reoccurring within a few seconds of each of the first 9. A return of spontaneous circulation (ROSC) was achieved after the 10th shock. The resuscitation was conducted fully in his home, with the early involvement of Advanced Paramedic Practitioners specialising in critical care (APP- CC). Throughout his resuscitation, there remained a strong focus on delivering quality resuscitation in situ, rather than a ‘load and go’ approach that would have resulted in very early conveyance to hospital with on-going CPR. The patient was subsequently discharged home and is making an excellent recovery. The arrest was later determined to have been caused by a primary arrhythmia as a result of a previously unidentified non-obstructive variant hypertrophic cardiomyopathy. We present data downloaded from the defibrillator used during the resuscitation that illustrates clearly the recurrent nature of his fibrillation.
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Affiliation(s)
- Peter Kingsley
- London Ambulance Service NHS Trust, London Ambulance Service, 220 Waterloo Road, London, SE1 8SD, UK.
| | - Jonathan Merefield
- London Ambulance Service NHS Trust, London Ambulance Service, 220 Waterloo Road, London, SE1 8SD, UK
| | - Robert G Walker
- Stryker Emergency Care, 11811 Willows Road NE, Redmond, WA, 98052, USA
| | - Fred W Chapman
- Stryker Emergency Care, 11811 Willows Road NE, Redmond, WA, 98052, USA
| | - Mark Faulkner
- London Ambulance Service NHS Trust, London Ambulance Service, 220 Waterloo Road, London, SE1 8SD, UK
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26
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Kiyohara K, Okubo M, Komukai S, Izawa J, Gibo K, Matsuyama T, Kiguchi T, Iwami T, Kitamura T. Association Between Resuscitative Time on the Scene and Survival After Pediatric Out-of-Hospital Cardiac Arrest. Circ Rep 2021; 3:211-216. [PMID: 33842726 PMCID: PMC8024189 DOI: 10.1253/circrep.cr-21-0021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background:
The optimal timing for transporting pediatric patients with out-of-hospital cardiac arrest (OHCA) who do not achieve return of spontaneous circulation (ROSC) is unclear. Therefore, we assessed the association between resuscitation time on the scene and 1-month survival. Methods and Results:
Data from the All-Japan Utstein Registry from 2013 through 2015 for 3,756 pediatric OHCA patients (age <18 years) who did not achieve ROSC prior to departing the scene were analyzed. Overall, the proportion of 1-month survival for on-scene resuscitation time <5, 5–9, 10–14, and ≥15 min was 13.6% (104/767), 10.2% (170/1,666), 8.6% (75/870), and 4.0% (18/453), respectively. Among specific age groups, the proportion of 1-month survival for on-scene resuscitation time of <5, 5–9, 10–14, and ≥15 min was 12.6% (54/429), 8.7% (59/680), 8.6% (23/267), and 6.8% (8/118), respectively, for patients aged 0 years; 16.4% (38/232), 11.0% (52/473), 11.9% (23/194), and 7.1% (6/85), respectively, for those aged 1–7 years; and 11.3% (12/106), 11.5% (59/513), 7.1% (29/409), and 1.6% (4/250), respectively, for those aged 8–17 years. Conclusions:
Longer on-scene resuscitation was associated with decreased chance of 1-month survival among pediatric OHCA patients without ROSC. For patients aged <8 years, earlier departure from the scene, within 5 min, may increase the chances of 1-month survival. Conversely, for patients aged ≥8 years, continuing on-scene resuscitation for up to 10 min would be reasonable.
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Affiliation(s)
- Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women's University Tokyo Japan
| | - Masashi Okubo
- Department of Emergency Medicine, University of Pittsburgh School of Medicine Pittsburgh, PA USA
| | - Sho Komukai
- Division of Biomedical Statistics, Department of Integrated Medicine, Osaka University Graduate School of Medicine Osaka Japan
| | - Junichi Izawa
- Department of Internal Medicine, Okinawa Prefectural Yaeyama Hospital Okinawa Japan
| | - Koichiro Gibo
- Department of Emergency Medicine, Okinawa Prefectural Chubu Hospital Okinawa Japan
| | - Tasuku Matsuyama
- Department of Emergency Medicine, Kyoto Prefectural University of Medicine Kyoto Japan
| | | | - Taku Iwami
- Kyoto University Health Service Kyoto Japan
| | - Tetsuhisa Kitamura
- Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine Osaka Japan
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27
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Guerguerian AM, Sano M, Todd M, Honjo O, Alexander P, Raman L. Pediatric Extracorporeal Cardiopulmonary Resuscitation ELSO Guidelines. ASAIO J 2021; 67:229-237. [PMID: 33627593 DOI: 10.1097/mat.0000000000001345] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Anne-Marie Guerguerian
- From the Department of Critical Care Medicine, The Hospital for Sick Kids, University of Toronto, Toronto
| | - Minako Sano
- Department of Anesthesiology, Division of Cardiac Anesthesiology, The Hospital for Sick Kids, University of Toronto, Toronto
| | - Mark Todd
- From the Department of Critical Care Medicine, The Hospital for Sick Kids, University of Toronto, Toronto
| | - Osami Honjo
- Department of Surgery, Division of Cardiothoracic Surgery, The Hospital for Sick Kids, University of Toronto, Toronto
| | - Peta Alexander
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Lakshmi Raman
- Department of Pediatrics, UTSouthwestern Medical Center, Dallas, Texas
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28
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Intraosseous or Peripheral IV Access in Pediatric Cardiac Arrest? Results From the French National Cardiac Arrest Registry. Pediatr Crit Care Med 2021; 22:286-296. [PMID: 33433156 DOI: 10.1097/pcc.0000000000002659] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Despite the evolving recommendations that favor the use of intraosseous access in pediatric resuscitation, the impact of vascular access type on survival in young children has not been demonstrated. The aim of this study was to assess the impact of the intravascular injection route on the return on spontaneous circulation, survival to hospital admission (0 day), and 30 days or survival to hospital discharge, by comparing survival rates in young children having intraosseous and peripheral IV access. The second aim was to compare the rates of favorable neurologic outcome after 30 days or survival to hospital discharge. DESIGN This was a multicenter retrospective comparative study between July 2011 and October 2018. SETTING Based on the French cardiac arrest registry data. PATIENTS All prepubescent (males < 12 yr old, females < 10 yr old) victims of an out-of-hospital cardiac arrest. INTERVENTIONS Patients with adrenaline administration by intraosseous versus peripheral venous technique were compared, using propensity score matching. MEASUREMENTS AND MAIN RESULTS The analysis included 603 prepubescent patients, 351 (58%) in the intraosseous group and 252 (42%) in the peripheral IV group. Intraosseous group patients were younger, lighter, with more medical cause for arrest. The intraosseous group had lower survival rates at 30 days or hospital discharge (n = 6; 1.7%) than the peripheral IV group (n = 12; 4.8%) (p = 0.030). After matching, 101 pairs of patients were created. No difference was observed on return of spontaneous circulation or 0-day survival rates (odds ratio = 1.000 [95% CI, 0.518-1.930]; odds ratio = 0.946 [95% CI, 0.492-1.817], respectively) and on 30 days or hospital discharge survival (n = 3 in both groups) (odds ratio = 1.000 [95% CI, 0.197-5.076]). Meaningful statistical evaluation of neurologic status among survivors was precluded by inadequate numbers. CONCLUSIONS The type of injection route (intraosseous or peripheral venous access) does not appear to have an impact on survival of out-of-hospital cardiac arrest in a prepubescent population, but limitations of propensity matching limit a definitive conclusion.
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Ton HT, Raffensperger K, Shoykhet M. Early Thalamic Injury After Resuscitation From Severe Asphyxial Cardiac Arrest in Developing Rats. Front Cell Dev Biol 2021; 9:737319. [PMID: 34950655 PMCID: PMC8688916 DOI: 10.3389/fcell.2021.737319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 11/22/2021] [Indexed: 11/13/2022] Open
Abstract
Children who survive cardiac arrest often develop debilitating sensorimotor and cognitive deficits. In animal models of cardiac arrest, delayed neuronal death in the hippocampal CA1 region has served as a fruitful paradigm for investigating mechanisms of injury and neuroprotection. Cardiac arrest in humans, however, is more prolonged than in most experimental models. Consequently, neurologic deficits in cardiac arrest survivors arise from injury not solely to CA1 but to multiple vulnerable brain structures. Here, we develop a rat model of prolonged pediatric asphyxial cardiac arrest and resuscitation, which better approximates arrest characteristics and injury severity in children. Using this model, we characterize features of microglial activation and neuronal degeneration in the thalamus 24 h after resuscitation from 11 and 12 min long cardiac arrest. In addition, we test the effect of mild hypothermia to 34°C for 8 h after 12.5 min of arrest. Microglial activation and neuronal degeneration are most prominent in the thalamic Reticular Nucleus (nRT). The severity of injury increases with increasing arrest duration, leading to frank loss of nRT neurons at longer arrest times. Hypothermia does not prevent nRT injury. Interestingly, injury occurs selectively in intermediate and posterior nRT segments while sparing the anterior segment. Since all nRT segments consist exclusively of GABA-ergic neurons, we asked if GABA-ergic neurons in general are more susceptible to hypoxic-ischemic injury. Surprisingly, cortical GABA-ergic neurons, like their counterparts in the anterior nRT segment, do not degenerate in this model. Hence, we propose that GABA-ergic identity alone is not sufficient to explain selective vulnerability of intermediate and posterior nRT neurons to hypoxic-ischemic injury after cardiac arrest and resuscitation. Our current findings align the animal model of pediatric cardiac arrest with human data and suggest novel mechanisms of selective vulnerability to hypoxic-ischemic injury among thalamic GABA-ergic neurons.
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30
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Prehospital Life-Saving Interventions Performed on Pediatric Patients in a Combat Zone: A Multicenter Prospective Study. Pediatr Crit Care Med 2020; 21:e407-e413. [PMID: 32150122 DOI: 10.1097/pcc.0000000000002317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We aimed to describe and evaluate prehospital life-saving interventions performed in a pediatric population in the Afghanistan theater of operations. DESIGN Our study was a post hoc, subanalysis of a larger multicenter, prospective, observational study. SETTING We evaluated casualties enrolled upon admission to one of the nine military medical facilities in Afghanistan between January 2009 and March 2014. PATIENTS Adult and pediatric (<17 yr old) patients. MEASUREMENTS We conducted initial descriptive analyses followed by comparative tests. For comparative analysis, we stratified the study population (adult vs pediatric), and subsequently, we compared injury descriptions and the interventions performed. Following tests for normality, we used the t test or Wilcoxon rank-sum test (nonparametric) for continuous variables and chi-square or Fisher exact for categorical variables. We reported percentages and 95% CIs. MAIN RESULTS We enrolled 2,106 patients, of which 5.6% (n = 118) were pediatric. Eighty-two percent of the pediatric patients were male, and 435 had blast related injuries. A total of 295 prehospital life-saving interventions were performed on 118 pediatric patients, for an average of 2.5 life-saving interventions per patient. Vascular access (IV 96%, intraosseous 91%) and hypothermia prevention-related interventions (69%) were the most common. Incorrectly performed life-saving interventions in pediatric patients were rare (98% of life-saving interventions performed correctly) and n equals to 24 life-saving interventions over the 6-year period were missed. The most common incorrectly performed and missed life-saving interventions were related to vascular access. When compared with adult life-saving interventions received in the prehospital environment, pediatric patients were more likely to receive intraosseous access (p < 0.0001), whereas adult patients were more likely to have a tourniquet placed (p = 0.0019), receive wound packing with a hemostatic agent (p = 0.0091), and receive chest interventions (p = 0.0003). CONCLUSIONS In our study, the most common intervention was vascular access followed by hypothermia prevention and hemorrhage control. The occurrence of missed or incorrectly performed life-saving interventions were rare.
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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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32
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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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33
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Williams CN, Eriksson CO, Kirby A, Piantino JA, Hall TA, Luther M, McEvoy CT. Hospital Mortality and Functional Outcomes in Pediatric Neurocritical Care. Hosp Pediatr 2020; 9:958-966. [PMID: 31776167 DOI: 10.1542/hpeds.2019-0173] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Pediatric neurocritical care (PNCC) outcomes research is scarce. We aimed to expand knowledge about outcomes in PNCC by evaluating death and changes in Functional Status Scale (FSS) from baseline among PNCC diagnoses. METHODS We conducted a 2-year observational study of children aged 0 to 18 years admitted to the ICU with a primary neurologic diagnosis (N = 325). Primary outcomes were death and change in FSS from preadmission baseline to discharge. New disability was defined as an FSS change of ≥1 from baseline, and severe disability was defined as an FSS change of ≥3. Categorical results are reported as relative risk (RR) with 95% confidence interval (CI). RESULTS Thirty (9%) patients died. New disability (n = 103; 35%) and severe disability (n = 37; 13%) were common in PNCC survivors. New disability (range 14%-54%) and severe disability (range 3%-33%) outcomes varied significantly among primary diagnoses (lowest in status epilepticus; highest in infectious and/or inflammatory and stroke cohorts). Disability occurred in all FSS domains: mental status (15%), sensory (52%), communication (38%), motor (48%), feeding (40%), and respiratory (12%). Most (64%) patients with severe disability had changes in ≥3 domains. Requiring critical care interventions (RR 2.1; 95% CI 1.5-3.1) and having seizures (RR 1.5; 95% CI 1.1-2.0) during hospitalization were associated with new disability. CONCLUSIONS PNCC patients have high rates of death and new disability at discharge, varying significantly between PNCC diagnoses. Multiple domains of disability are affected, underscoring the ongoing multidisciplinary health care needs of survivors. Our study quantified hospital outcomes of PNCC patients that can be used to advance future research in this vulnerable population.
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Affiliation(s)
- Cydni N Williams
- Pediatric Critical Care and Neurotrauma Recovery Program and .,Divisions of Pediatric Critical Care
| | | | | | - Juan A Piantino
- Pediatric Critical Care and Neurotrauma Recovery Program and.,Pediatric Neurology
| | - Trevor A Hall
- Pediatric Critical Care and Neurotrauma Recovery Program and.,Pediatric Psychology, and
| | | | - Cindy T McEvoy
- Neonatology, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
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Duff JP, Topjian AA, Berg MD, Chan M, Haskell SE, Joyner BL, Lasa JJ, Ley SJ, Raymond TT, Sutton RM, Hazinski MF, Atkins DL. 2019 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics 2020; 145:peds.2019-1361. [PMID: 31727859 DOI: 10.1542/peds.2019-1361] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This 2019 focused update to the American Heart Association pediatric advanced life support guidelines follows the 2018 and 2019 systematic reviews performed by the Pediatric Life Support Task Force of the International Liaison Committee on Resuscitation. It aligns with the continuous evidence review process of the International Liaison Committee on Resuscitation, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update provides the evidence review and treatment recommendations for advanced airway management in pediatric cardiac arrest, extracorporeal cardiopulmonary resuscitation in pediatric cardiac arrest, and pediatric targeted temperature management during post-cardiac arrest care. The writing group analyzed the systematic reviews and the original research published for each of these topics. For airway management, the writing group concluded that it is reasonable to continue bag-mask ventilation (versus attempting an advanced airway such as endotracheal intubation) in patients with out-of-hospital cardiac arrest. When extracorporeal membrane oxygenation protocols and teams are readily available, extracorporeal cardiopulmonary resuscitation should be considered for patients with cardiac diagnoses and in-hospital cardiac arrest. Finally, it is reasonable to use targeted temperature management of 32°C to 34°C followed by 36°C to 37.5°C, or to use targeted temperature management of 36°C to 37.5°C, for pediatric patients who remain comatose after resuscitation from out-of-hospital cardiac arrest or in-hospital cardiac arrest.
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Soar J, Maconochie I, Wyckoff MH, Olasveengen TM, Singletary EM, Greif R, Aickin R, Bhanji F, Donnino MW, Mancini ME, Wyllie JP, Zideman D, Andersen LW, Atkins DL, Aziz K, Bendall J, Berg KM, Berry DC, Bigham BL, Bingham R, Couto TB, Böttiger BW, Borra V, Bray JE, Breckwoldt J, Brooks SC, Buick J, Callaway CW, Carlson JN, Cassan P, Castrén M, Chang WT, Charlton NP, Cheng A, Chung SP, Considine J, Couper K, Dainty KN, Dawson JA, de Almeida MF, de Caen AR, Deakin CD, Drennan IR, Duff JP, Epstein JL, Escalante R, Gazmuri RJ, Gilfoyle E, Granfeldt A, Guerguerian AM, Guinsburg R, Hatanaka T, Holmberg MJ, Hood N, Hosono S, Hsieh MJ, Isayama T, Iwami T, Jensen JL, Kapadia V, Kim HS, Kleinman ME, Kudenchuk PJ, Lang E, Lavonas E, Liley H, Lim SH, Lockey A, Lofgren B, Ma MHM, Markenson D, Meaney PA, Meyran D, Mildenhall L, Monsieurs KG, Montgomery W, Morley PT, Morrison LJ, Nadkarni VM, Nation K, Neumar RW, Ng KC, Nicholson T, Nikolaou N, Nishiyama C, Nuthall G, Ohshimo S, Okamoto D, O’Neil B, Yong-Kwang Ong G, Paiva EF, Parr M, Pellegrino JL, Perkins GD, Perlman J, Rabi Y, Reis A, Reynolds JC, Ristagno G, Roehr CC, Sakamoto T, Sandroni C, Schexnayder SM, Scholefield BR, Shimizu N, Skrifvars MB, Smyth MA, Stanton D, Swain J, Szyld E, Tijssen J, Travers A, Trevisanuto D, Vaillancourt C, Van de Voorde P, Velaphi S, Wang TL, Weiner G, Welsford M, Woodin JA, Yeung J, Nolan JP, Fran Hazinski M. 2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations: Summary From the Basic Life Support; Advanced Life Support; Pediatric Life Support; Neonatal Life Support; Education, Implementation, and Teams; and First Aid Task Forces. Circulation 2019; 140:e826-e880. [DOI: 10.1161/cir.0000000000000734] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research.
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2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2019; 145:95-150. [DOI: 10.1016/j.resuscitation.2019.10.016] [Citation(s) in RCA: 85] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Duff JP, Topjian AA, Berg MD, Chan M, Haskell SE, Joyner BL, Lasa JJ, Ley SJ, Raymond TT, Sutton RM, Hazinski MF, Atkins DL. 2019 American Heart Association Focused Update on Pediatric Advanced Life Support: An Update to the American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2019; 140:e904-e914. [PMID: 31722551 DOI: 10.1161/cir.0000000000000731] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This 2019 focused update to the American Heart Association pediatric advanced life support guidelines follows the 2018 and 2019 systematic reviews performed by the Pediatric Life Support Task Force of the International Liaison Committee on Resuscitation. It aligns with the continuous evidence review process of the International Liaison Committee on Resuscitation, with updates published when the International Liaison Committee on Resuscitation completes a literature review based on new published evidence. This update provides the evidence review and treatment recommendations for advanced airway management in pediatric cardiac arrest, extracorporeal cardiopulmonary resuscitation in pediatric cardiac arrest, and pediatric targeted temperature management during post-cardiac arrest care. The writing group analyzed the systematic reviews and the original research published for each of these topics. For airway management, the writing group concluded that it is reasonable to continue bag-mask ventilation (versus attempting an advanced airway such as endotracheal intubation) in patients with out-of-hospital cardiac arrest. When extracorporeal membrane oxygenation protocols and teams are readily available, extracorporeal cardiopulmonary resuscitation should be considered for patients with cardiac diagnoses and in-hospital cardiac arrest. Finally, it is reasonable to use targeted temperature management of 32°C to 34°C followed by 36°C to 37.5°C, or to use targeted temperature management of 36°C to 37.5°C, for pediatric patients who remain comatose after resuscitation from out-of-hospital cardiac arrest or in-hospital cardiac arrest.
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Naim MY, Zinna SS. To intubate or not to intubate for pediatric out of hospital cardiac arrest? That is the question. Resuscitation 2019; 145:196-197. [PMID: 31639464 DOI: 10.1016/j.resuscitation.2019.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Maryam Y Naim
- The Cardiac Center, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States; Departments of Anesthesiology and Critical Care Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States.
| | - Shairbanu S Zinna
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United States
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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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Yurtseven A, Turan C, Akarca FK, Saz EU. Pediatric cardiac arrest in the emergency department: Outcome is related to the time of admission. Pak J Med Sci 2019; 35:1434-1440. [PMID: 31489021 PMCID: PMC6717451 DOI: 10.12669/pjms.35.5.487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives: Nights and weekends represent a potentially high-risk time for pediatric cardiac arrest (CA) patients in emergency departments. Data regarding night or weekend arrest and its impact on outcomes is controversial. The purpose of this study was to determine the relationship between cardiopulmonary resuscitation during the various emergency department shifts and survival to discharge. Methods: We conducted a retrospective, observational study of patients who had visited our Emergency Department for CAs from January 2014 to December 2016. Medical records and patient characteristics of 67 children with CA were retrieved from patient admission files. Results: The mean age was 54.7±7.3 months and 59% were male. Rates of survival to discharge 35% (11/31) within working hours’ vs. out of working hours 3% (1/36). Among the CAs presenting to the emergency department, the survival rates were higher for working hours than for non-working hours (OR: 37.6 (2.62-539.7), p: 008). The rate of return of spontaneous circulation within working hours was higher than that of non-working hours (71% vs.19%) (p<0.001). Patients who received chest compression for more than 10 minutes had the lowest survival rate (2%) (p<0.001), whereas better outcome was associated with in-hospital CA, younger age (less than 12 months) and respiratory failure. Conclusion: Survival rates from pediatric CAs were significantly lower during non-working hours. Poor outcome was associated with prolonged cardiopulmonary resuscitation, out of hospital CA and older age.
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Affiliation(s)
- Ali Yurtseven
- Ali Yurtseven, MD. Department of Pediatrics, Division of Emergency Medicine, Ege University School of Medicine, Izmir, Turkey
| | - Caner Turan
- Caner Turan, MD. Department of Pediatrics, Division of Emergency Medicine, Ege University School of Medicine, Izmir, Turkey
| | - Funda Karbek Akarca
- Funda Karbek Akarca, MD. Associate Professor, Department of Emergency Medicine, Ege University School of Medicine, Izmir, Turkey
| | - Eylem Ulas Saz
- Prof. Eylem Ulas Saz, MD. Department of Pediatrics, Division of Emergency Medicine, Ege University School of Medicine, Izmir, Turkey
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Lupton JR, Schmicker R, Daya MR, Aufderheide TP, Stephens S, Le N, May S, Puyana JC, Idris A, Nichol G, Wang H, Hansen M. Effect of initial airway strategy on time to epinephrine administration in patients with out-of-hospital cardiac arrest. Resuscitation 2019; 139:314-320. [PMID: 30902690 DOI: 10.1016/j.resuscitation.2019.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 03/05/2019] [Accepted: 03/11/2019] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Epinephrine and advanced airway management are commonly used during treatment of out-of-hospital cardiac arrest (OHCA). Recent studies suggest that early but not late administration of epinephrine is associated with improved survival. The purpose of this study was to evaluate the effect of initial airway strategy on timing to the first epinephrine dose in OHCA. METHODS This is a secondary analysis of patients enrolled in the Pragmatic Airway Resuscitation Trial who had an advanced airway attempted. We examined differences in time to epinephrine administration by randomly assigned airway strategy, laryngeal tube (LT) or endotracheal tube (ETI); by the duration of airway attempt; and by number of attempts. We used survival methods to account for interval censoring due to unknown administration time. We also examined the association of epinephrine administration timing with survival to hospital discharge. RESULTS Among 2652 subjects (1299 ETI and 1353 LT), 2579 received epinephrine.There were no significant differences between ETI and LT in median time to initial epinephrine administration (min) (ETI - 9.0 vs. LT - 8.6, p = 0.55). There was no significant association between the duration of airway attempt or number of attempts and time to initial epinephrine administration (p = 0.12 and 0.66, respectively). Early administration of epinephrine (<10 min from EMS arrival) was significantly associated with survival compared to administration ≥10 min (OR 1.36, 95% CI: 1.05, 1.77). CONCLUSIONS There was no significant association between airway strategy and time to initial epinephrine administration. Earlier administration of epinephrine (< 10 min from EMS arrival) was associated with improved survival.
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Affiliation(s)
| | | | | | | | | | - Nancy Le
- Oregon Health and Science University United States.
| | | | | | | | | | - Henry Wang
- University of Texas Health Science Center United States.
| | - Matt Hansen
- Oregon Health and Science University United States.
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Lavonas EJ, Ohshimo S, Nation K, Van de Voorde P, Nuthall G, Maconochie I, Torabi N, Morrison LJ. Advanced airway interventions for paediatric cardiac arrest: A systematic review and meta-analysis. Resuscitation 2019; 138:114-128. [PMID: 30862528 DOI: 10.1016/j.resuscitation.2019.02.040] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 02/19/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022]
Abstract
AIM To assess the use of advanced airway interventions (tracheal intubation (TI) or supraglottic airway (SGA) placement), compared with bag mask ventilation (BMV) alone, for resuscitation of children in cardiac arrest. METHODS We searched Medline, EMBASE, and Cochrane Controlled Register of Trials (CENTRAL) for human trials and observational studies published before September 24, 2018 for clinical trials and observational studies with a comparison group. Two investigators reviewed studies for relevance, extracted data, and assessed risk of bias using the GRADE and CLARITY frameworks. Study authors were contacted when necessary to obtain additional data. Critically important outcomes included survival to hospital discharge and survival with good neurological outcome. RESULTS We identified 14 studies, including 1 pseudorandomised clinical trial, 3 observational cohort studies using propensity matching, and 8 simple cohort studies suitable for meta-analysis. The overall certainty of evidence was low to very low. For the critically important outcomes of survival to hospital discharge with good neurologic outcome and survival to hospital discharge results suggested better outcomes achieved with BMV than either TI or SGA; limited data favored SGA over TI. The majority of studies involved out-of-hospital cardiac arrest, with few studies of in-hospital cardiac arrest. CONCLUSIONS TI or SGA are not superior to BMV for resuscitation of children in cardiac arrest, but the overall certainty of evidence is low to very low. Well designed randomised efficacy trials are needed to address this important question.
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Affiliation(s)
- Eric J Lavonas
- Department of Emergency Medicine, Denver Health and Hospital Authority, Denver, Colorado, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.
| | - Shinichiro Ohshimo
- Departments of Emergency and Critical Care Medicine, Hiroshima University, Hiroshima, Japan.
| | - Kevin Nation
- New Zealand Resuscitation Council, Wellington, New Zealand.
| | - Patrick Van de Voorde
- Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium; EMS Dispatch Center Eastern Flanders, Federal Department of Health, Belgium.
| | - Gabrielle Nuthall
- Department of Paediatric Intensive Care Medicine, Starship Child Health, Central Auckland, New Zealand.
| | - Ian Maconochie
- Department of Paediatric Emergency Medicine, St. Mary's Hospital, London, United Kingdom.
| | - Nazi Torabi
- Scotiabank Health Sciences Library, St. Michael's Hospital, Li Ka Shing International Healthcare Education Centre, Toronto, Ontario, Canada.
| | - Laurie J Morrison
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Rescu, Li Ka Shing Knowledge Institute, St. Michael's Hospital,Toronto, Ontario, Canada.
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Amagasa S, Kashiura M, Moriya T, Uematsu S, Shimizu N, Sakurai A, Kitamura N, Tagami T, Takeda M, Miyake Y. Relationship between institutional case volume and one-month survival among cases of paediatric out-of-hospital cardiac arrest. Resuscitation 2019; 137:161-167. [PMID: 30802557 DOI: 10.1016/j.resuscitation.2019.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/11/2019] [Accepted: 02/12/2019] [Indexed: 10/27/2022]
Abstract
AIM To evaluate volume-outcome relationship in paediatric out-of-hospital cardiac arrest (OHCA). METHODS This post hoc analysis of the SOS-KANTO 2012 study included data of paediatric OHCA patients <18 years old who were transported to the 53 emergency hospitals in the Kanto region of Japan between January 2012 and March 2013. Based on the paediatric OHCA case volume, the higher one-third of institutions (more than 10 paediatric OHCA cases during the study period) were defined as high-volume centres, the middle one-third institutions (6-10 cases) were defined as middle-volume centres and the lower one-third of institutions (less than 6 cases) were defined as low-volume centres. The primary outcome measurement was survival at 1 month after cardiac arrest. Multivariate logistic regression analysis for 1-month survival and paediatric OHCA case volume were performed after adjusting for multiple propensity scores. To estimate the multiple propensity score, we fitted a multinomial logistic regression model, which fell into one of the three groups as patient demographics and prehospital factors. RESULTS Among the eligible 282 children, 112, 82 and 88 patients were transported to the low-volume (36 institutions), middle-volume (11 institutions) and high-volume (6 institutions) centres, respectively. Transport to a high-volume centre was significantly associated with a better 1-month survival after adjusting for multiple propensity score (adjusted odds ratio, 2.55; 95% confidence interval, 1.05-6.17). CONCLUSION There may be a relationship between institutional case volume and survival outcomes in paediatric OHCA.
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Affiliation(s)
- Shunsuke Amagasa
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan; Division of Emergency and Transport Services, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Masahiro Kashiura
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan
| | - Takashi Moriya
- Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama City, Saitama, 330-8503, Japan
| | - Satoko Uematsu
- Division of Emergency and Transport Services, National Center for Child Health and Development, 2-10-1, Okura, Setagaya-ku, Tokyo, 157-8535, Japan
| | - Naoki Shimizu
- Department of Critical Care and Emergency Medicine, Tokyo Metropolitan Children's Medical Center, 2-8-29, Musashidai, Fuchu, Tokyo, 183-8561, Japan
| | - Atsushi Sakurai
- Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, 30-1, Oyagutikamichou, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Nobuya Kitamura
- Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, 1010, Sakurai, Kisarazushi, Chiba, 292-8535, Japan
| | - Takashi Tagami
- Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, 1-7-1, Nagayama, Tama-shi, Tokyo, 206-8512, Japan
| | - Munekazu Takeda
- Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Yasufumi Miyake
- Department of Emergency Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-Ku, Tokyo, 173-8606, Japan
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Williams CN, Piantino J, McEvoy C, Fino N, Eriksson CO. The Burden of Pediatric Neurocritical Care in the United States. Pediatr Neurol 2018; 89:31-38. [PMID: 30327237 PMCID: PMC6349248 DOI: 10.1016/j.pediatrneurol.2018.07.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/23/2018] [Accepted: 07/31/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Disorders requiring pediatric neurocritical care (PNCC) affect thousands of children annually. We aimed to quantify the burden of PNCC through generation of national estimates of disease incidence, utilization of critical care interventions (CCI), and hospital outcomes. METHODS We performed a retrospective cohort analysis of the Kids Inpatient Database over three years to evaluate pediatric traumatic brain injury, neuro-infection or inflammatory diseases, status epilepticus, stroke, hypoxic ischemic injury after cardiac arrest, and spinal cord injury. We evaluated use of CCI, death, length of stay, hospital charges, and poor functional outcome defined as receipt of tracheostomy or gastrostomy or discharge to a medical care facility. RESULTS At least one CCI was recorded in 67,058 (23%) children with a primary neurological diagnosis, and considered a PNCC admission. Over half of PNCC admissions had at least one chronic condition, and 23% were treated in children's hospitals. Mechanical ventilation was the most common CCI, but utilization of CCIs varied significantly by diagnosis. Among PNCC admissions, 8110 (12%) children died during hospitalization and 14,067 (21%) children had poor functional outcomes. PNCC admissions cumulatively accounted for over 1.5 million hospital days and over $4 billion in hospital costs in the study years. Most PNCC admissions, across all diagnoses, had prolonged hospitalizations (more than one week) with an average cost of $39.9 thousand per admission. CONCLUSIONS This large, nationally representative study shows PNCC diseases are a significant public health burden with substantial risk to children's health. More research is needed to improve outcomes in these vulnerable children.
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Affiliation(s)
- Cydni N. Williams
- Oregon Health and Science University, Department of Pediatrics, Division of Pediatric Critical Care
| | - Juan Piantino
- Division of Pediatric Neurology, Oregon Health and Science University
| | - Cynthia McEvoy
- Division of Neonatology, Oregon Health and Science University
| | - Nora Fino
- Biostatistics and Design Program, Oregon Health and Science University
| | - Carl O. Eriksson
- Oregon Health and Science University, Department of Pediatrics, Division of Pediatric Critical Care
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Early On-Scene Management of Pediatric Out-of-Hospital Cardiac Arrest Can Result in Improved Likelihood for Neurologically-Intact Survival. Resuscitation 2018; 135:162-167. [PMID: 30412719 DOI: 10.1016/j.resuscitation.2018.11.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 10/08/2018] [Accepted: 11/02/2018] [Indexed: 11/22/2022]
Abstract
AIM To evaluate the frequency of neurologically-intact survival (SURV) following pediatric out-of-hospital cardiac arrest (POHCA) when comparing traditional early evacuation strategies to those emphasizing resuscitation efforts being performed immediately on-scene. METHODS Before 2014, emergency medical services (EMS) crews in a county-wide EMS agency provided limited treatment for POHCA on-scene and rapidly transported patients to appropriate hospitals. After 2014, training strongly concentrated upon EMS provider comfort levels with on-scene resuscitation efforts including methods to expedite protocols on-site and control positive-pressure ventilation. Frequency of SURV (hospital discharge) was compared for the two years prior to initiating the immediate on-scene care strategy to the ensuing two years following implementation. RESULTS Between 01/01/2012 and 12/31/2015, 94 children experienced POHCA. There were no significant differences before and after the on-scene focus in terms of age, sex, etiology, presenting electrocardiograph, drug infusions or bystander-performed cardiopulmonary resuscitation and total scene times actually remained similar (14.3 vs. 17.67 minutes). SURV increased significantly upon implementation of the immediate on-scene management strategy and was sustained over the next two years (0.0% to 23%; p = 0.0013). Though statistically-indeterminate in this analysis, the improvement was associated with a shorter mean time to epinephrine administration among resuscitated patients (16.6 vs. 7.65 minutes). CONCLUSION Facilitating immediate on-scene management of POHCA can result in improvements in life-saving. Although a historically-controlled evaluation, the compelling appearance of neurologically-intact survivors was immediate and sustained. Targeted training, more efficient, physiologically-driven procedures, and trusted encouragement from supervisors, likely played the most significant roles and not necessarily extended scene times.
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Moloney J. A new paradigm for retrieval medicine. Emerg Med Australas 2018; 30:725-726. [DOI: 10.1111/1742-6723.13115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 11/30/2022]
Affiliation(s)
- John Moloney
- Department of Anaesthesia and Perioperative Medicine; Monash University; Melbourne Victoria Australia
- Department of Community Emergency Health and Paramedic Practice; Monash University; Melbourne Victoria Australia
- Ambulance Victoria; Melbourne Victoria Australia
- Trauma Anaesthesia; The Alfred; Melbourne Victoria Australia
- Field Emergency Medical Officer Program; St Vincent's Hospital; Melbourne Victoria Australia
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de Caen A, Tijssen JA. Is It Time to Stop Teaching Bystanders Ventilation as Part of Pediatric Cardiopulmonary Resuscitation? Circulation 2018; 134:2071-2073. [PMID: 27994025 DOI: 10.1161/circulationaha.116.025723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Allan de Caen
- From Pediatric Critical Care Medicine, Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada (A.d.C.); and Pediatric Critical Care Medicine, Department of Pediatrics, Western University, Children's Hospital, London Health Sciences Centre, London, ON, Canada (J.A.T.).
| | - Janice A Tijssen
- From Pediatric Critical Care Medicine, Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada (A.d.C.); and Pediatric Critical Care Medicine, Department of Pediatrics, Western University, Children's Hospital, London Health Sciences Centre, London, ON, Canada (J.A.T.)
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Wall JJ, Naim MY. Comment on Cardiac Arrest Survival in Pediatric and General Emergency Departments. Pediatrics 2018; 142:peds.2018-1567A. [PMID: 30065002 DOI: 10.1542/peds.2018-1567a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Jessica J Wall
- Pediatric Emergency Medicine, Children's Hospital of Philadelphia
| | - Maryam Y Naim
- Cardiac Critical Care, Children's Hospital of Philadelphia
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Kim TH, Lee K, Shin SD, Ro YS, Tanaka H, Yap S, Wong KD, Ng YY, Piyasuwankul T, Leong B. Association of the Emergency Medical Services-Related Time Interval with Survival Outcomes of Out-of-Hospital Cardiac Arrest Cases in Four Asian Metropolitan Cities Using the Scoop-and-Run Emergency Medical Services Model. J Emerg Med 2018; 53:688-696.e1. [PMID: 29128033 DOI: 10.1016/j.jemermed.2017.08.076] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/15/2017] [Accepted: 08/16/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Response time interval (RTI) and scene time interval (STI) are key time variables in the out-of-hospital cardiac arrest (OHCA) cases treated and transported via emergency medical services (EMS). OBJECTIVE We evaluated distribution and interactive association of RTI and STI with survival outcomes of OHCA in four Asian metropolitan cities. METHODS An OHCA cohort from Pan-Asian Resuscitation Outcome Study (PAROS) conducted between January 2009 and December 2011 was analyzed. Adult EMS-treated cardiac arrests with presumed cardiac origin were included. A multivariable logistic regression model with an interaction term was used to evaluate the effect of STI according to different RTI categories on survival outcomes. Risk-adjusted predicted rates of survival outcomes were calculated and compared with observed rate. RESULTS A total of 16,974 OHCA cases were analyzed after serial exclusion. Median RTI was 6.0 min (interquartile range [IQR] 5.0-8.0 min) and median STI was 12.0 min (IQR 8.0-16.1). The prolonged STI in the longest RTI group was associated with a lower rate of survival to discharge or of survival 30 days after arrest (adjusted odds ratio [aOR] 0.59; 95% confidence interval [CI] 0.42-0.81), as well as a poorer neurologic outcome (aOR 0.63; 95% CI 0.41-0.97) without an increasing chance of prehospital return of spontaneous circulation (aOR 1.12; 95% CI 0.88-1.45). CONCLUSIONS Prolonged STI in OHCA with a delayed response time had a negative association with survival outcomes in four Asian metropolitan cities using the scoop-and-run EMS model. Establishing an optimal STI based on the response time could be considered.
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Affiliation(s)
- Tae Han Kim
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Kyungwon Lee
- Department of Emergency Medicine, Inje University Seoul Paik Hospital, Seoul, Republic of Korea
| | - Sang Do Shin
- Department of Emergency Medicine, Seoul National University College of Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Young Sun Ro
- Laboratory of Emergency Medical Services, Biomedical Research Institute Seoul National University Hospital, Seoul, Republic of Korea
| | - Hideharu Tanaka
- Department of Emergency Medical System, Graduate School of Kokushikan University, Tokyo, Japan
| | - Susan Yap
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | | | - Yih Yng Ng
- Medical Department, Singapore Civil Defence Force, Singapore, Singapore
| | | | - Benjamin Leong
- Emergency Medicine Department, National University Hospital, Singapore, Singapore
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Castejón-de la Encina ME, Sanjuán Quiles Á, del Moral Vicente-Mazariegos I, García-Aracil N, Morales López B, Richart Martinez M. Therapeutic measures in a moving ambulance: Qualitative study of professional opinions regarding prehospital emergencies. HONG KONG J EMERG ME 2018. [DOI: 10.1177/1024907918784078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: current organization of the prehospital emergency teams, decreasing the prehospital times, given the possibility of working during the patient’s transport and, therefore, the consequences that may result from the same improving the prognostic. Objectives: To explore the opinion of professional healthcare experts regarding prehospital emergencies arising when forced to assist a critical patient in a moving vehicle, based on a high-fidelity clinical simulation, as well as the factors influencing them. Methods: An exploratory study of content analysis with qualitative methodology, via semi-structured questionnaires that are self-completed anonymously, before and after the clinical simulation intervention in which participants intubate a mannequin in a moving ambulance. The sample consisted of 36 experts in prehospital emergencies from the province of Alicante (Spain). Codification and assessment of the data obtained was carried out via triangulation, respecting the language and literal expressions of the participants. Results: Thirty-two pre- and post-intervention questionnaires were completed. Four different units of meaning or categories emerged which were organized based on two thematic structures, from the perspective of professional and patient needs. Twenty-three participants had never previously intubated in a moving vehicle. Discussion: Working in a moving vehicle may be yet another aspect to consider in the specialized teaching–learning process of prehospital emergency medicine. Conclusion: Based on the need to decrease prehospital assistance times, a new paradigm has been opened in prehospital emergencies with the possibility of being able to safely assist our patients during their transport on a moving ambulance or helicopter. It will be necessary further research in the future.
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Affiliation(s)
- María Elena Castejón-de la Encina
- Department of Nursing, Faculty of Health Sciences, University of Alicante, Alicante, Spain
- Emergency Medical Service (Alicante, Spain)
| | - Ángela Sanjuán Quiles
- Department of Nursing, Faculty of Health Sciences, University of Alicante, Alicante, Spain
| | | | - Noelia García-Aracil
- Department of Nursing, Faculty of Health Sciences, University of Alicante, Alicante, Spain
- Emergency Medical Service (Alicante, Spain)
| | - Beatriz Morales López
- Department of Nursing, Faculty of Health Sciences, University of Alicante, Alicante, Spain
- Emergency Medical Service (Alicante, Spain)
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