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Slovis JC, Bach A, Beaulieu F, Zuckerberg G, Topjian A, Kirschen MP. Neuromonitoring after Pediatric Cardiac Arrest: Cerebral Physiology and Injury Stratification. Neurocrit Care 2024; 40:99-115. [PMID: 37002474 PMCID: PMC10544744 DOI: 10.1007/s12028-023-01685-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 01/30/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Significant long-term neurologic disability occurs in survivors of pediatric cardiac arrest, primarily due to hypoxic-ischemic brain injury. Postresuscitation care focuses on preventing secondary injury and the pathophysiologic cascade that leads to neuronal cell death. These injury processes include reperfusion injury, perturbations in cerebral blood flow, disturbed oxygen metabolism, impaired autoregulation, cerebral edema, and hyperthermia. Postresuscitation care also focuses on early injury stratification to allow clinicians to identify patients who could benefit from neuroprotective interventions in clinical trials and enable targeted therapeutics. METHODS In this review, we provide an overview of postcardiac arrest pathophysiology, explore the role of neuromonitoring in understanding postcardiac arrest cerebral physiology, and summarize the evidence supporting the use of neuromonitoring devices to guide pediatric postcardiac arrest care. We provide an in-depth review of the neuromonitoring modalities that measure cerebral perfusion, oxygenation, and function, as well as neuroimaging, serum biomarkers, and the implications of targeted temperature management. RESULTS For each modality, we provide an in-depth review of its impact on treatment, its ability to stratify hypoxic-ischemic brain injury severity, and its role in neuroprognostication. CONCLUSION Potential therapeutic targets and future directions are discussed, with the hope that multimodality monitoring can shift postarrest care from a one-size-fits-all model to an individualized model that uses cerebrovascular physiology to reduce secondary brain injury, increase accuracy of neuroprognostication, and improve outcomes.
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Affiliation(s)
- Julia C Slovis
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, 6 Wood - 6105, Philadelphia, PA, 19104, USA.
| | - Ashley Bach
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, 6 Wood - 6105, Philadelphia, PA, 19104, USA
| | - Forrest Beaulieu
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, 6 Wood - 6105, Philadelphia, PA, 19104, USA
| | - Gabe Zuckerberg
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, 6 Wood - 6105, Philadelphia, PA, 19104, USA
| | - Alexis Topjian
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, 6 Wood - 6105, Philadelphia, PA, 19104, USA
| | - Matthew P Kirschen
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, 6 Wood - 6105, Philadelphia, PA, 19104, USA
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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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Almutairi NS, Alharthy NA, Almaziad AM, Alsalloum AT, AlHarbi RA, Almulhem SA, Yousif A, Othman F. Parental perceptions of the importance of pediatric out-of-hospital cardiopulmonary resuscitation for the survival rate in Saudi Arabia: a cross-sectional survey. Int J Emerg Med 2023; 16:76. [PMID: 37919656 PMCID: PMC10623816 DOI: 10.1186/s12245-023-00564-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/26/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Pediatric out-of-hospital cardiac arrest is associated with high morbidity and mortality rates. Cardiopulmonary resuscitation (CPR), the practice of chest compressions combined with rescue breathing, is crucial for the success of out-of-hospital resuscitation after sudden cardiac arrest. Thus, imparting the requisite knowledge and skills to parents/caregivers can significantly enhance survival rates. This study investigated parental awareness of the impact of out-of-hospital pediatric CPR on survival rates in Saudi Arabia. METHODS This cross-sectional study was conducted using an online questionnaire administered to Saudi parents from all regions of the Kingdom of Saudi Arabia. Data were collected using the convenience sampling method, as the questionnaire was distributed via social media platforms. The questionnaire consisted of five parts: (1) demographic data, (2) questions about parents' perception of basic life support (BLS), (3) evaluation of parents' knowledge of the impact of prehospital CPR on survival rates, (4) measurement of parents' competency in performing pediatric CPR, and (5) assessment of whether parents' confidence was affected by prior training. Statistical analyses were conducted using the chi-squared test or Fisher's exact test, and the t-test was used to compare the mean scores of the groups of parents with medical and non-medical professional backgrounds. RESULTS A total of 1,065 individuals responded to the survey. The respondents' mean age was 41 ± 0.2 years and 46.5% were men. We found that 73.9% of respondents had no prior experience with BLS, 87% had never taken a BLS course, and 61% did not know where to find one. The majority of participants agreed that bystander CPR contributes to overall survival rates, and 77% agreed to the importance of BLS training. Medical professionals showed a higher percentage of agreement on the importance of BLS than those from non-medical backgrounds (90% vs. 76%, p = 0.036), especially parents of high-risk children. CONCLUSION This study showed evidence of interest in CPR and BLS training in Saudi parents, despite the low levels of knowledge regarding BLS training.
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Affiliation(s)
- Nouf S Almutairi
- College of Medicine Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Nesrin A Alharthy
- College of Applied Medical Sciences-Riyadh, King Saud Bin Abdulaziz University for Health Sciences, PO Box 22490, 11426, Riyadh, Saudi Arabia.
- Pediatric Emergency Department, King Abdulaziz Medical City Ministry of National Guard Health Affairs, PO Box 22490, 11426, Riyadh, Saudi Arabia.
| | - AlAnoud M Almaziad
- College of Medicine Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - AlJazi T Alsalloum
- College of Medicine Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Rozanna A AlHarbi
- College of Medicine Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Shamayel A Almulhem
- College of Medicine Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Amal Yousif
- College of Applied Medical Sciences-Riyadh, King Saud Bin Abdulaziz University for Health Sciences, PO Box 22490, 11426, Riyadh, Saudi Arabia
- Pediatric Emergency Department, King Abdulaziz Medical City Ministry of National Guard Health Affairs, PO Box 22490, 11426, Riyadh, Saudi Arabia
| | - Fatmah Othman
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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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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Olson T, Anders M, Burgman C, Stephens A, Bastero P. Extracorporeal cardiopulmonary resuscitation in adults and children: A review of literature, published guidelines and pediatric single-center program building experience. Front Med (Lausanne) 2022; 9:935424. [PMID: 36479094 PMCID: PMC9720280 DOI: 10.3389/fmed.2022.935424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 11/04/2022] [Indexed: 09/19/2023] Open
Abstract
Extracorporeal cardiopulmonary resuscitation (ECPR) is an adjunct supportive therapy to conventional cardiopulmonary resuscitation (CCPR) employing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in the setting of refractory cardiac arrest. Its use has seen a significant increase in the past decade, providing hope for good functional recovery to patients with cardiac arrest refractory to conventional resuscitation maneuvers. This review paper aims to summarize key findings from the ECPR literature available to date as well as the recommendations for ECPR set forth by leading national and international resuscitation societies. Additionally, we describe the successful pediatric ECPR program at Texas Children's Hospital, highlighting the logistical, technical and educational features of the program.
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Affiliation(s)
- Taylor Olson
- Pediatric Critical Care Medicine, Children's National Hospital, Washington, DC, United States
| | - Marc Anders
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
- Pediatric Critical Care Medicine, Texas Children's Hospital, Houston, TX, United States
| | - Cole Burgman
- ECMO, Texas Children's Hospital, Houston, TX, United States
| | - Adam Stephens
- Department of Surgery, Baylor College of Medicine, Houston, TX, United States
- Congenital Heart Surgery, Texas Children's Hospital, Houston, TX, United States
| | - Patricia Bastero
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
- Pediatric Critical Care Medicine, Texas Children's Hospital, Houston, TX, United States
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6
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Tsuruda T, Hamahata T, Endo GJ, Tsuruda Y, Kaikita K. Bystander-witnessed cardiopulmonary resuscitation by nonfamily is associated with neurologically favorable survival after out-of-hospital cardiac arrest in Miyazaki City District. PLoS One 2022; 17:e0276574. [PMID: 36269785 PMCID: PMC9586377 DOI: 10.1371/journal.pone.0276574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 10/10/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Bystander intervention in cases of out-of-hospital cardiac arrest (OHCA) is a key factor in bridging the gap between the event and the arrival of emergency health services at the site. This study investigated the implementation rate of bystander cardiopulmonary resuscitation (CPR) and automated external defibrillator (AED) and 1-month survival after OHCA in Miyazaki prefecture and Miyazaki city district as well as compared them with those of eight prefectures in the Kyushu-Okinawa region in Japan. In addition, we analyzed prehospital factors associated with survival outcomes in Miyazaki city district. METHODS We used data from an annual report released by the Fire and Disaster Management Agency of Japan (n = 627,982) and the Utstein reporting database in Miyazaki city district (n = 1,686) from 2015 to 2019. RESULT Despite having the highest rate of bystander CPR (20.8%), the 1-month survival rate (15.7%) of witnessed OHCA cases of cardiac causes in Miyazaki city district was comparable with that in the eight prefectures between 2015 and 2019. However, rates of survival (10.7%) in Miyazaki prefecture were lower than those in other prefectures. In 1,686 patients with OHCA (74 ± 18 years old, 59% male) from the Utstein reporting database identical to the 5-year study period in Miyazaki city district, binary logistic regression analysis demonstrated that age of the recipient [odds ratio (OR) 0.979, 95% confidential interval (CI) 0.964-0.993, p = 0.004)], witness of the arrest event (OR 7.501, 95% CI 3.229-17.428, p < 0.001), AED implementation (OR 14.852, 95% CI 4.226-52.201, p < 0.001), and return of spontaneous circulation (ROSC) before transport (OR 31.070, 95% CI 16.585-58.208, p < 0.001) predicted the 1-month survival with favorable neurological outcomes. In addition, chest compression at a public place (p < 0.001) and by nonfamily members (p < 0.001) were associated with favorable outcomes (p = 0.015). CONCLUSIONS We found differences in 1-month survival rates after OHCA in the Kyushu-Okinawa region of Japan. Our results suggest that on-field ROSC with defibrillation performed by nonfamily bystanders who witnessed the event determines 1-month neurological outcomes after OHCA in Miyazaki city district. Continued education of citizens on CPR techniques and better access to AED devices may improve outcomes.
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Affiliation(s)
- Toshihiro Tsuruda
- Faculty of Medicine, Department of Hemo-Vascular Advanced Medicine, Cardiorenal Research Laboratory, University of Miyazaki, Miyazaki, Japan
- * E-mail:
| | | | - George J. Endo
- Faculty of Medicine, Endowed Department of Disaster/Emergency Medical Support, University of Miyazaki, Miyazaki, Japan
- Department of Emergency Medicine, Kobayashi City Hospital, Kobayashi, Japan
| | - Yuki Tsuruda
- Department of Clinical Pharmacy, Doshisha Women’s College of Liberal Arts, Kyotanabe, Japan
| | - Koichi Kaikita
- Faculty of Medicine, Division of Cardiovascular Medicine and Nephrology, Department of Internal Medicine, University of Miyazaki, Japan
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7
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Piantino JA, Ruzas CM, Press CA, Subramanian S, Balakrishnan B, Panigrahy A, Pettersson D, Maloney JA, Vossough A, Topjian A, Kirschen MP, Doughty L, Chung MG, Maloney D, Haller T, Fabio A, Fink EL. Use of Magnetic Resonance Imaging in Neuroprognostication After Pediatric Cardiac Arrest: Survey of Current Practices. Pediatr Neurol 2022; 134:45-51. [PMID: 35835025 PMCID: PMC9883065 DOI: 10.1016/j.pediatrneurol.2022.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/11/2022] [Accepted: 06/13/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Use of magnetic resonance imaging (MRI) as a tool to aid in neuroprognostication after cardiac arrest (CA) has been described, yet details of specific indications, timing, and sequences are unknown. We aim to define the current practices in use of brain MRI in prognostication after pediatric CA. METHODS A survey was distributed to pediatric institutions participating in three international studies. Survey questions related to center demographics, clinical practice patterns of MRI after CA, neuroimaging resources, and details regarding MRI decision support. RESULTS Response rate was 31% (44 of 143). Thirty-four percent (15 of 44) of centers have a clinical pathway informing the use of MRI after CA. Fifty percent (22 of 44) of respondents reported that an MRI is obtained in nearly all patients with CA, and 32% (14 of 44) obtain an MRI in those who do not return to baseline neurological status. Poor neurological examination was reported as the most common factor (91% [40 of 44]) determining the timing of the MRI. Conventional sequences (T1, T2, fluid-attenuated inversion recovery, and diffusion-weighted imaging/apparent diffusion coefficient) are routinely used at greater than 97% of centers. Use of advanced imaging techniques (magnetic resonance spectroscopy, diffusion tensor imaging, and functional MRI) were reported by less than half of centers. CONCLUSIONS Conventional brain MRI is a common practice for prognostication after CA. Advanced imaging techniques are used infrequently. The lack of standardized clinical pathways and variability in reported practices support a need for higher-quality evidence regarding the indications, timing, and acquisition protocols of clinical MRI studies.
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Affiliation(s)
- Juan A Piantino
- Division of Child Neurology, Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon
| | - Christopher M Ruzas
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Craig A Press
- Division of Neurology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Binod Balakrishnan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Ashok Panigrahy
- Department of Radiology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - David Pettersson
- Division of Neuroradiology, Department of Diagnostic Radiology, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, Oregon
| | - John A Maloney
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Arastoo Vossough
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alexis Topjian
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Matthew P Kirschen
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Lesley Doughty
- Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Melissa G Chung
- Divisions of Critical Care Medicine and Pediatric Neurology, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | - David Maloney
- Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Tamara Haller
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Anthony Fabio
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ericka L Fink
- Department of Critical Care Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania.
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Runkle AP, Gray J, Cabrera-Thurman MK, Frey M, Hoehn EF, Kerrey BT, Vukovic AA. Implementation of a Pediatric Emergency Department Cardiopulmonary Resuscitation Quality Bundle. Pediatrics 2022; 150:188524. [PMID: 35909151 DOI: 10.1542/peds.2021-055462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES We have previously demonstrated that standardized handoff from prehospital to hospital clinicians can improve cardiopulmonary resuscitation performance for out-of-hospital cardiac arrest (OHCA) patients in a pediatric emergency department (ED). We leveraged our previous quality improvement initiative to standardize performance of a bundle of 5 discrete aspects of resuscitation for OHCA patients: intravenous or intraosseous catheter (IV/IO) access, epinephrine administration, advanced airway placement, end-tidal capnography (ETCO2) application, and cardiac rhythm verbalization. We aimed to reduce time to completion of the bundle from 302 seconds at baseline to less than 120 seconds within 1 year. METHODS A multidisciplinary team performed video-based review of actual OHCA resuscitations in our pediatric ED. We designed interventions aimed at key drivers of bundle performance. Interventions included specific roles and responsibilities and a standardized choreography for each bundle element. To assess the effect of the interventions, time to performance of each bundle element was measured by standardized review of video recordings from our resuscitation bay. Balancing measures were time off the chest and time to defibrillator pad placement. RESULTS We analyzed 56 cases of OHCA from May 2019 through May 2021. Time to bundle completion improved from a baseline of 302 seconds to 147 seconds. Four of 5 individual bundle elements also demonstrated significant improvement. These improvements were sustained without any negative impact on balancing measures. CONCLUSIONS Standardized choreography for the initial minutes of ED cardiac arrest resuscitation shows promise to decrease time to crucial interventions in children presenting to the pediatric ED with OHCA.
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Affiliation(s)
- Anne P Runkle
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - James Gray
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Mary Frey
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Erin F Hoehn
- Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | | | - Adam A Vukovic
- Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Hunfeld M, Dulfer K, Rietman A, Pangalila R, van Gils-Frijters A, Catsman-Berrevoets C, Tibboel D, Buysse C. Longitudinal two years evaluation of neuropsychological outcome in children after out of hospital cardiac arrest. Resuscitation 2021; 167:29-37. [PMID: 34389455 DOI: 10.1016/j.resuscitation.2021.07.043] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/21/2021] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Abstract
AIM To investigate longitudinal functional and neuropsychological outcomes 3-6 and 24 months after paediatric out-of-hospital cardiac arrest (OHCA). Further, to explore the association between paediatric cerebral performance category (PCPC) and intelligence. METHODS Prospective longitudinal single center study including children (0-17 years) with OHCA, admitted to the PICU of a tertiary care hospital between 2012 and 2017. Survivors were assessed during an outpatient multidisciplinary follow-up program 3-6 and 24 months post-OHCA. Functional and neuropsychological outcomes were assessed through interviews, neurological exam, and validated neuropsychological testing. RESULTS The total eligible cohort consisted of 49 paediatric OHCA survivors. The most common cause of OHCA was arrhythmia (33%). Median age at time of OHCA was 48 months, 67% were males. At 3-6 and 24 months post-OHCA, respectively 74 and 73% had a good PCPC score, defined as 1-2. Compared with normative data, OHCA children obtained worse sustained attention and processing speed scores 3-6 (n = 26) and 24 (n = 27) months post-OHCA. At 24 months, they also obtained worse intelligence, selective attention and cognitive flexibility scores. In children tested at both time-points (n = 19), no significant changes in neuropsychological outcomes were found over time. Intelligence scores did not correlate with PCPC. CONCLUSION Although paediatric OHCA survivors had a good PCPC score 3-6 and 24 months post-OHCA, they obtained worse scores on important neuropsychological domains such as intelligence and executive functioning (attention and cognitive flexibility). Follow-up should continue over a longer life span in order to fully understand the long-term impact of OHCA in childhood.
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Affiliation(s)
- Maayke Hunfeld
- Intensive Care and Department of Paediatric Surgery, Erasmus MC, Sophia Children's Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands; Department of Paediatric Neurology, Erasmus MC, Sophia Children's Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
| | - Karolijn Dulfer
- Intensive Care and Department of Paediatric Surgery, Erasmus MC, Sophia Children's Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Andre Rietman
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, Sophia Children's Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Robert Pangalila
- Rijndam Rehabilitation - Paediatric Rehabilitation, Westersingel 300, 3015 LJ Rotterdam, the Netherlands
| | - Annabel van Gils-Frijters
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC, Sophia Children's Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Coriene Catsman-Berrevoets
- Department of Paediatric Neurology, Erasmus MC, Sophia Children's Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Dick Tibboel
- Intensive Care and Department of Paediatric Surgery, Erasmus MC, Sophia Children's Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
| | - Corinne Buysse
- Intensive Care and Department of Paediatric Surgery, Erasmus MC, Sophia Children's Hospital, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands
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10
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Robinson JA, LaPage MJ, Atallah J, Webster G, Miyake CY, Ratnasamy C, Ollberding NJ, Mohan S, Von Bergen NH, Johnsrude CL, Garnreiter JM, Spar DS, Czosek RJ. Outcomes of Pediatric Patients With Defibrillators Following Initial Presentation With Sudden Cardiac Arrest. Circ Arrhythm Electrophysiol 2021; 14:e008517. [PMID: 33401923 DOI: 10.1161/circep.120.008517] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Implantable cardioverter defibrillators (ICD) are recommended for secondary prevention after sudden cardiac arrest (SCA). The outcomes of pediatric patients receiving an ICD after SCA remain unclear. The objective of this study is to evaluate outcomes, future risk for appropriate shocks, and identify characteristics associated with appropriate ICD therapy during follow-up. METHODS Multicenter retrospective analysis of patients (age ≤21 years) without prior cardiac disease who received an ICD following SCA. Patient/device characteristics, cardiac function, and underlying diagnoses were collected, along with SCA event characteristics. Patient outcomes including complications and device therapies were analyzed. RESULTS In total, 106 patients were included, median age 14.7 years. Twenty (19%) received appropriate shocks and 16 (15%) received inappropriate shocks (median follow-up 3 years). First-degree relative with SCA was associated with appropriate shocks (P<0.05). In total, 40% patients were considered idiopathic. Channelopathy was the most frequent late diagnosis not made at time of presentation. Neither underlying diagnosis nor idiopathic status was associated with increased incidence of appropriate shock. Monomorphic ventricular tachycardia (hazard ratio, 4.6 [1.2-17.3]) and family history of sudden death (hazard ratio, 6.5 [1.4-29.8]) were associated with freedom from appropriate shock in a multivariable model (area under the receiver operating characteristic curve, 0.8). Time from diagnoses to evaluation demonstrated a nonlinear association with freedom from appropriate shock (P=0.015). In patients >2 years from implantation, younger age (P=0.02) and positive exercise test (P=0.04) were associated with appropriate shock. CONCLUSIONS The risk of future device therapy is high in pediatric patients receiving an ICD after SCA, irrelevant of underlying disease. Lack of a definitive diagnosis after SCA was not associated with lower risk of subsequent events and does not obviate the need for secondary prophylaxis.
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MESH Headings
- Adolescent
- Child
- Child, Preschool
- Death, Sudden, Cardiac/epidemiology
- Death, Sudden, Cardiac/prevention & control
- Defibrillators, Implantable
- Electric Countershock/instrumentation
- Female
- Humans
- Incidence
- Infant
- Infant, Newborn
- Male
- Primary Prevention/methods
- Retrospective Studies
- Risk Assessment/methods
- Risk Factors
- Secondary Prevention/methods
- Survival Rate/trends
- Tachycardia, Ventricular/mortality
- Tachycardia, Ventricular/physiopathology
- Tachycardia, Ventricular/therapy
- Treatment Outcome
- United States/epidemiology
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Affiliation(s)
- Jeffrey A Robinson
- The Heart Institute (J.A.R., D.S.S., R.J.C.), Cincinnati Children's Hospital Medical Center, OH
- Dr. C.C. & Mabel L. Criss Heart Center, Children's Hospital & Medical Center, University of Nebraska Medical Center, Omaha (J.A.R.)
| | - Martin J LaPage
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor (M.J.L.)
| | - Joseph Atallah
- Department of Pediatrics, University of Alberta, Edmonton, Canada (J.A.)
| | - Gregory Webster
- Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, IL (G.W.)
| | | | - Christopher Ratnasamy
- Congenital Heart Center, Spectrum Health, Helen DeVos Children's Hospital, Grand Rapids, MI (C.R.)
| | | | - Shaun Mohan
- University of Kentucky HealthCare, Lexington (S.M.)
| | - Nicholas H Von Bergen
- American Family Children's Hospital, University of Wisconsin School of Medicine & Public Health, Madison (N.H.V.B.)
| | | | | | - David S Spar
- The Heart Institute (J.A.R., D.S.S., R.J.C.), Cincinnati Children's Hospital Medical Center, OH
- Division of Biostatistics & Epidemiology (D.S.S., R.J.C.), Cincinnati Children's Hospital Medical Center, OH
| | - Richard J Czosek
- The Heart Institute (J.A.R., D.S.S., R.J.C.), Cincinnati Children's Hospital Medical Center, OH
- Division of Biostatistics & Epidemiology (D.S.S., R.J.C.), Cincinnati Children's Hospital Medical Center, OH
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11
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Hunfeld M, Nadkarni VM, Topjian A, Harpman J, Tibboel D, van Rosmalen J, de Hoog M, Catsman-Berrevoets CE, Buysse CMP. Timing and Cause of Death in Children Following Return of Circulation After Out-of-Hospital Cardiac Arrest: A Single-Center Retrospective Cohort Study. Pediatr Crit Care Med 2021; 22:101-113. [PMID: 33027241 DOI: 10.1097/pcc.0000000000002577] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine timing and cause of death in children admitted to the PICU following return of circulation after out-of-hospital cardiac arrest. DESIGN Retrospective observational study. SETTING Single-center observational cohort study at the PICU of a tertiary-care hospital (Erasmus MC-Sophia, Rotterdam, The Netherlands) between 2012 and 2017. PATIENTS Children younger than 18 years old with out-of-hospital cardiac arrest and return of circulation admitted to the PICU. MEASUREMENTS AND RESULTS Data included general, cardiopulmonary resuscitation and postreturn of circulation characteristics. The primary outcome was defined as survival to hospital discharge. Modes of death were classified as brain death, withdrawal of life-sustaining therapies due to poor neurologic prognosis, withdrawal of life-sustaining therapies due to refractory circulatory and/or respiratory failure, and recurrent cardiac arrest without return of circulation. One hundred thirteen children with out-of-hospital cardiac arrest were admitted to the PICU following return of circulation (median age 53 months, 64% male, most common cause of out-of-hospital cardiac arrest drowning [21%]). In these 113 children, there was 44% survival to hospital discharge and 56% nonsurvival to hospital discharge (brain death 29%, withdrawal of life-sustaining therapies due to poor neurologic prognosis 67%, withdrawal of life-sustaining therapies due to refractory circulatory and/or respiratory failure 2%, and recurrent cardiac arrest 2%). Compared with nonsurvivors, more survivors had witnessed arrest (p = 0.007), initial shockable rhythm (p < 0.001), shorter cardiopulmonary resuscitation duration (p < 0.001), and more favorable clinical neurologic examination within 24 hours after admission. Basic cardiopulmonary resuscitation event and postreturn of circulation (except for the number of extracorporeal membrane oxygenation) characteristics did not significantly differ between the withdrawal of life-sustaining therapies due to poor neurologic prognosis and brain death patients. Timing of decision-making to withdrawal of life-sustaining therapies due to poor neurologic prognosis ranged from 0 to 18 days (median: 0 d; interquartile range, 0-3) after cardiopulmonary resuscitation. The decision to withdrawal of life-sustaining therapies was based on neurologic examination (100%), electroencephalography (44%), and/or brain imaging (35%). CONCLUSIONS More than half of children who achieve return of circulation after out-of-hospital cardiac arrest died after PICU admission. Of these deaths, two thirds (67%) underwent withdrawal of life-sustaining therapies based on an expected poor neurologic prognosis and did so early after return of circulation. There is a need for international guidelines for accurate neuroprognostication in children after cardiac arrest.
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Affiliation(s)
- Maayke Hunfeld
- Department of Pediatric Neurology, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
- Department of Pediatric Surgery and Intensive Care, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Alexis Topjian
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Jasmijn Harpman
- Department of Pediatric Surgery and Intensive Care, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Dick Tibboel
- Department of Pediatric Surgery and Intensive Care, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Matthijs de Hoog
- Department of Pediatric Surgery and Intensive Care, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
| | | | - Corinne M P Buysse
- Department of Pediatric Surgery and Intensive Care, Erasmus MC, Sophia Children's Hospital, Rotterdam, The Netherlands
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A Systematic Review of Neuromonitoring Modalities in Children Beyond Neonatal Period After Cardiac Arrest. Pediatr Crit Care Med 2020; 21:e927-e933. [PMID: 32541373 DOI: 10.1097/pcc.0000000000002415] [Citation(s) in RCA: 5] [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 Postresuscitation care in children focuses on preventing secondary neurologic injury and attempts to provide (precise) prognostication for both caregivers and the medical team. This systematic review provides an overview of neuromonitoring modalities and their potential role in neuroprognostication in postcardiac arrest children. DATA RESOURCES Databases EMBASE, Web of Science, Cochrane, MEDLINE Ovid, Google Scholar, and PsycINFO Ovid were searched in February 2019. STUDY SELECTION Enrollment of children after in- and out-of-hospital cardiac arrest between 1 month and 18 years and presence of a neuromonitoring method obtained within the first 2 weeks post cardiac arrest. Two reviewers independently selected appropriate studies based on the citations. DATA EXTRACTION Data collected included study characteristics and methodologic quality, populations enrolled, neuromonitoring modalities, outcome, and limitations. Evidence tables per neuromonitoring method were constructed using a standardized data extraction form. Each included study was graded according to the Oxford Evidence-Based Medicine scoring system. DATA SYNTHESIS Of 1,195 citations, 27 studies met the inclusion criteria. There were 16 retrospective studies, nine observational prospective studies, one observational exploratory study, and one pilot randomized controlled trial. Neuromonitoring methods included neurologic examination, routine electroencephalography and continuous electroencephalography, transcranial Doppler, MRI, head CT, plasma biomarkers, somatosensory evoked potentials, and brainstem auditory evoked potential. All evidence was graded 2B-2C. CONCLUSIONS The appropriate application and precise interpretation of available modalities still need to be determined in relation to the individual patient. International collaboration in standardized data collection during the (acute) clinical course together with detailed long-term outcome measurements (including functional outcome, neuropsychologic assessment, and health-related quality of life) are the first steps toward more precise, patient-specific neuroprognostication after pediatric cardiac arrest.
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13
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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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14
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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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15
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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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16
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Chest-compression-only versus conventional cardiopulmonary resuscitation by bystanders for children with out-of-hospital cardiac arrest: A systematic review and meta-analysis. Resuscitation 2019; 134:81-90. [DOI: 10.1016/j.resuscitation.2018.10.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/05/2018] [Accepted: 10/30/2018] [Indexed: 01/11/2023]
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Mokhateb-Rafii T, Bialer M, Rodgers S, Moore C, Sweberg T. A Cryptic Cause of Cardiac Arrest. J Emerg Med 2018; 56:e1-e4. [PMID: 30420309 DOI: 10.1016/j.jemermed.2018.09.044] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 09/20/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND RIPPLY2-associated spondylocostal dysostosis is a rare disorder that leads to segmentation defects of the vertebrae. These vertebral defects can result in severe instability of the cervical spine, leading to cardiac arrest after only minor whiplash injury. CASE REPORT We present the case of a healthy 7-year-old child who experienced an out-of-hospital cardiac arrest. He was reported to have profound respiratory distress and collapsed after going down a slide, without trauma. He was resuscitated in the field, and presented to the emergency department, where return of spontaneous circulation was achieved. Imaging of his cervical spine revealed multiple abnormalities. It was determined that a whiplash injury led to hypoxia and bradycardia due to the anatomic abnormalities of his cervical spine, resulting in cardiovascular collapse. He recovered fully and was later diagnosed with SCDO6, an autosomal recessive inherited disorder caused by a mutation in the RIPPLY2 gene. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Unfamiliarity of providers with this mechanism of cardiac arrest, and the rarity of the syndrome itself, make early recognition very difficult. Late diagnosis and lack of preventative measures, including immediate cervical spine stabilization, can lead to catastrophic outcomes. In patients with cardiac arrest of unclear etiology, early consideration of cervical spine immobilization and evaluation can be lifesaving.
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Affiliation(s)
- Tanya Mokhateb-Rafii
- Department of Pediatric Critical Care, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York
| | - Martin Bialer
- Department of Medical Genetics, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York
| | - Shaun Rodgers
- Department of Neurosurgery, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York
| | - Christine Moore
- Department of Medical Genetics, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York
| | - Todd Sweberg
- Department of Pediatric Critical Care, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York
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18
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McCrory MC, Wang SS, Shetty AK, McLean TW, Lantz PE, Cannon ML. Sudden Cardiac Arrest Due to Hemophagocytic Lymphohistiocytosis in a Child. J Emerg Med 2018; 55:e119-e123. [DOI: 10.1016/j.jemermed.2018.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/29/2018] [Accepted: 08/03/2018] [Indexed: 12/22/2022]
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Impact of a CPR feedback device on healthcare provider workload during simulated cardiac arrest. Resuscitation 2018; 130:111-117. [PMID: 30049656 DOI: 10.1016/j.resuscitation.2018.06.035] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/12/2018] [Accepted: 06/27/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We aimed to describe the differences in workload between team leaders and CPR providers during a simulated pediatric cardiac arrest, to evaluate the impact of a CPR feedback device on provider workload, and to describe the association between provider workload and the quality of CPR. METHODS We conducted secondary analysis of data from a randomized trial comparing CPR quality in teams with and without use of a real-time visual CPR feedback device [1]. Healthcare providers (team leaders and CPR providers) completed the NASA Task Load Index survey after participating in a simulated cardiac arrest scenario. The effect of provider roles and real-time feedback on workload were compared with independent t-tests. RESULTS Team leaders reported higher levels of mental demand, temporal demand, performance-related workload and frustration, while CPR providers reported comparatively higher physical workload. CPR providers reported significantly higher average workload (control 58.5 vs. feedback 62.3; p = 0.035) with real-time feedback provided compared to the group without feedback. Providers with high workloads (average score >60) had an increased percentage of time with guideline-compliant CPR depth versus those with low workloads (average score <60) (p = 0.034). CONCLUSIONS Healthcare providers reported high workloads during a simulated pediatric cardiac arrest. Physical and mental workloads differed based on provider role. CPR providers using a CPR feedback device reported increased average workloads. The quality of CPR improved with higher reported physical workloads.
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Tham LP, Wah W, Phillips R, Shahidah N, Ng YY, Shin SD, Nishiuchi T, Wong KD, Ko PCI, Khunklai N, Naroo GY, Ong MEH. Epidemiology and outcome of paediatric out-of-hospital cardiac arrests: A paediatric sub-study of the Pan-Asian resuscitation outcomes study (PAROS). Resuscitation 2018; 125:111-117. [PMID: 29421664 DOI: 10.1016/j.resuscitation.2018.01.040] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 12/27/2017] [Accepted: 01/26/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The Pan Asian Resuscitation Outcomes Study (PAROS) is a retrospective study of out- of-hospital cardiac arrest(OHCA), collaborating with EMS agencies and academic centers in Japan, South Korea, Malaysia, Singapore, Taiwan, Thailand and UAE-Dubai. The objectives of this study is to describe the characteristics and outcomes, and to find factors associated with survival after paediatric OHCA. METHODS We studied all children less than 17 years of age with OHCA conveyed by EMS and non-EMS transports from January 2009 to December 2012. We did univariate and multivariate logistic regression analyses to assess the factors associated with survival-to-discharge outcomes. RESULTS A total of 974 children with OHCA were included. Bystander cardiopulmonary resuscitation rates ranged from 53.5% (Korea), 35.6% (Singapore) to 11.8% (UAE). Overall, 8.6% (range 0%-9.7%) of the children survived to discharge from hospital. Adolescents (13-17 years) had the highest survival rate of 13.8%. 3.7% of the children survived with good neurological outcomes of CPC 1 or 2. The independent pre-hospital factors associated with survival to discharge were witnessed arrest and initial shockable rhythm. In the sub-group analysis, pre-hospital advanced airway [odds ratio (OR) = 3.35, 95% confidence interval (CI) = 1.23-9.13] was positively associated with survival-to-discharge outcomes in children less than 13 years-old. Among adolescents, bystander CPR (OR = 2.74, 95%CI = 1.03-7.3) and initial shockable rhythm (OR = 20.51, 95%CI = 2.15-195.7) were positive factors. CONCLUSION The wide variation in the survival outcomes amongst the seven countries in our study may be due to the differences in the delivery of pre-hospital interventions and bystander CPR rates.
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Affiliation(s)
- Lai Peng Tham
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore, Singapore.
| | - Win Wah
- Department of Emergency Medicine, Singapore General Hospital, Singapore
| | - Rachel Phillips
- Department of Primary Care and Public Health Sciences, King's College London, London, United Kingdom
| | - Nur Shahidah
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore
| | - Yih Yng Ng
- Medical Department, Singapore Civil Defence Force, Singapore, Singapore
| | - Sang Do Shin
- Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Tatsuya Nishiuchi
- Department of Acute Medicine, Kindai University Faculty of Medicine, Osaka, Japan
| | | | - Patrick Chow-In Ko
- Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Nalinas Khunklai
- Department of Emergency Medicine, Rajavithi Hospital, Bangkok, Thailand
| | - Ghulam Yasin Naroo
- Department of Health and Medical Services, ED-Trauma Center, Rashid Hospital, Dubai, United Arab Emirates
| | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Singapore, Singapore; Health Services and Systems Research, Duke-NUS Graduate Medical School, Singapore
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McCarrison R, Ren D, Woomer GR, Cassidy B. Evaluation of a Self-Instructional CPR Program for Parents With Children Enrolled in Community Swim Lessons. J Pediatr Health Care 2017; 31:314-319. [PMID: 27771045 DOI: 10.1016/j.pedhc.2016.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/19/2016] [Accepted: 09/22/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION This project evaluated an evidence-based self-instructional program aimed at improving cardiopulmonary resuscitation (CPR) knowledge and confidence in parents with children in swim lessons. METHOD A prospective, repeated-measures design evaluated the CPR Anytime Child program. Twenty-nine parents completed questionnaires before, immediately after, and 1 month after the program. RESULTS Knowledge and confidence scores improved significantly over time. Compared with a baseline knowledge mean score of 47.3%, mean score immediately after the program was 93.5% (t = -12.176, p < .01) and at 1 month was 80.9% (t = -8.459, p < .01). Confidence in determining CPR need increased from a baseline of 2.52 to 3.18 points immediately after the program (t = -2.88, p = .013) and 3.20 at 1 month (t = 4.759, p < .01). Confidence in performing CPR increased from a baseline of 2.14 to 3.18 immediately after the program (t = 4.759, p < .01) and 2.73 at 1 month (t = -2.88, p = .013). DISCUSSION The CPR Anytime Child program had a significant sustained effect on improving knowledge and confidence in parents of children in swim lessons. The simplicity of this program makes it replicable and sustainable in this setting.
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Bielski K, Szarpak L, Smereka J, Ladny JR, Leung S, Ruetzler K. Comparison of four different intraosseous access devices during simulated pediatric resuscitation. A randomized crossover manikin trial. Eur J Pediatr 2017; 176:865-871. [PMID: 28500463 PMCID: PMC5486567 DOI: 10.1007/s00431-017-2922-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/24/2017] [Accepted: 04/28/2017] [Indexed: 02/06/2023]
Abstract
UNLABELLED The aim of the study was to compare the success rate, procedure time, and user satisfaction of pediatric NIO™ compared to Pediatric BIG®, EZ-IO®, and Jamshidi intraosseous access devices. This was a randomized, crossover manikin trial with 87 paramedics. The correct location of intraosseous access when using NIO, BIG, EZ-IO, and Jamshidi was varied and was respectively 100, 90, 90, and 90%. The time required to obtain intravascular access (time T1) in the case of NIO, BIG, EZ-IO, and Jamshidi was varied and amounted to 9 s [IQR, 8-12] for NIO, 12 s [IQR, 9-16] for BIG, 13.5 s [IQR, 11-17] for the EZ-IO, and 15 s [IQR, 13-19] for Jamshidi. The paramedics evaluated each device on the subjective ease with which they performed the procedures. The intraosseous device, which proved the easiest to use was NIO, which in the case of CPR received a median rating of 1.5 (IQR, 0.5-1.5) points. CONCLUSION Our study found that NIO® is superior to BIG®, EZ-IO®, and Jamshidi. NIO® achieved the highest first attempt success rate. NIO® also required the least time to insert and easiest to operate even by novice users. Further study is needed to test our findings in cadavers or human subjects. Based on our findings, NIO® is a promising intraosseous device for use in pediatric resuscitation. What is Known: • Venous access in acutely ill pediatric patients, such as those undergoing cardiopulmonary resuscitation, is needed for prompt administration of drugs and fluids. • Intraosseous access is recommended by American Heart Association and European Resuscitation council if vascular access is not readily obtainable to prevent delay in treatment. What is New: • This simulated pediatric resuscitation compared performance of four commercially available pediatric intraosseous devices in a manikin model. • NIO® outperformed BIG®, EZ-IO®, and Jamshidi in first attempt success rates and time of procedure among novice users.
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Affiliation(s)
- Karol Bielski
- MEDITRANS The Voivodship Emergency Medical Service and Sanitary Transport, Warsaw, Poland
| | - Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Lindleya 4 Street, 02-005, Warsaw, Poland.
| | - Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy R. Ladny
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, Poland
| | - Steve Leung
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH USA
| | - Kurt Ruetzler
- Department of Outcomes Research, Cleveland Clinic, Cleveland, OH USA ,Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH USA
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Smereka J, Szarpak L, Smereka A, Leung S, Ruetzler K. Evaluation of new two-thumb chest compression technique for infant CPR performed by novice physicians. A randomized, crossover, manikin trial. Am J Emerg Med 2016; 35:604-609. [PMID: 28040386 DOI: 10.1016/j.ajem.2016.12.045] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 12/16/2016] [Accepted: 12/16/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The impact of high-quality chest compressions during CPR for the patients' outcome is undisputed, as it is essential for maintaining vital organ perfusion. The aim of our study is to compare the quality of chest compression (CC) and ventilation among the two current standard techniques with our novel "nTTT" technique in infant CPR. METHODS In this randomized crossover, manikin trial, participants performed CCs using three techniques in a randomized sequence: standard two finger technique (TFT); standard two thumb technique (TTHT), and the 'new two-thumb technique' (nTTT). The novel method of CCs in an infant consists in using two thumbs directed at the angle of 90° to the chest while closing the fingers of both hands in a fist. RESULTS Median depth compression using the distinct chest compression techniques varied and amounted to 26 [IQR, 25-28] mm for TFT, and 39 [IQR, 39-39] mm for TTHT as well as for nTTT. Best percentage of fully released compressions were received using TFT (100[100-100] %), then in the case of nTTT (99[98-100] %), and the worst in situation where TTHT (18[14-19] %). was used. The fastest chest compression rate was achieved with TFT (134[IQR, 129-135]/min) and the slowest when using nTTT (109 [IQR, 105-111]/min). CONCLUSIONS We found that our new nTTT technique's performance, in terms of compression depth, hands-off time, and ventilation quality, is comparable to the current standards. Based on our findings of this initial manikin study, the nTTT technique is superior to TFT in many of parameters that are vital to a quality chest compression during pediatric CPR.
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Affiliation(s)
- Jacek Smereka
- Department of Emergency Medical Service, Wroclaw Medical University, Wroclaw, Poland
| | - Lukasz Szarpak
- Department of Emergency Medicine, Medical University of Warsaw, Warsaw, Poland.
| | - Adam Smereka
- Department of Clinic of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland
| | - Steve Leung
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA
| | - Kurt Ruetzler
- Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA; Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA
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Födinger A, Wöss C, Semsroth S, Stadlbauer KH, Wenzel V. [Drowning versus cardiac ischemia: Cardiac arrest of an 11-year-old boy at a swimming lake]. Anaesthesist 2015; 64:839-42. [PMID: 26423258 DOI: 10.1007/s00101-015-0088-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/18/2015] [Accepted: 08/20/2015] [Indexed: 11/27/2022]
Abstract
This report describes a case of sudden cardiac arrest and subsequent attempted cardiopulmonary resuscitation of an 11-year-old child on the shores of a swimming lake. Reports of eyewitnesses excluded the obviously suspected diagnosis of a drowning accident. The result of the autopsy was sudden cardiac death due to a congenital coronary anomaly (abnormal left coronary artery, ALCA). Favored by vigorous physical activity, this anomaly can lead to malignant arrhythmias because the ectopic coronary artery with its intramural course through the aortic wall is compressed during every systole. This pathology was not known to the boy or his family; in fact he liked sports but had suffered of a syncope once which was not followed up. Without a strong suspicion it is difficult to diagnose a coronary artery anomaly and it is often missed even in college athletes. Tragically, sudden cardiac arrest may be the first symptom of an undiagnosed abnormal coronary artery. Following syncope or chest pain during exercise with a normal electrocardiogram (ECG) cardiac imaging, such as computed tomography (CT) or angiography should be initiated in order to enable surgical repair of an abnormal coronary artery.
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Affiliation(s)
- A Födinger
- Univ.-Klinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - C Wöss
- Institut für Rechtsmedizin, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - S Semsroth
- Univ.-Klinik für Herzchirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - K H Stadlbauer
- Univ.-Klinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich
| | - V Wenzel
- Univ.-Klinik für Anästhesie und Intensivmedizin, Medizinische Universität Innsbruck, Anichstr. 35, 6020, Innsbruck, Österreich.
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Zhu Y, Jiang X, Li H, Li F, Chen J. Mortality among drowning rescuers in China, 2013: a review of 225 rescue incidents from the press. BMC Public Health 2015; 15:631. [PMID: 26156246 PMCID: PMC4496822 DOI: 10.1186/s12889-015-2010-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 07/01/2015] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Drowning is common worldwide. Rescue efforts attempted by untrained bystanders often lead to the death of the primary drowning victim (PDV), the rescuer or both. Our study aimed to inform prevention by identifying risk factors in rescuer drowning. METHODS Data on drowning rescue incidents reported online in mainland China, 2013, were reviewed. Information on the drowning incidents, PDVs and rescuers were retrieved for analysis. RESULTS A total of 225 rescue incidents were identified, of which 14 were victim-rescuer drowning incidents (VRDIs) (6.2%). A person-to-person rescue by swimming to PDVs was the most commonly used method (58.9%). Resuscitation was given immediately to 35.5% of PDVs after rescue. The mortality rate of the rescuers (13.3%) was similar to that of the PDVs (11.5%) (χ(2) = 0.5, p =0.49). Being an adult (OR = 0.2, 95% CI: 0.1-0.5) and other than the first rescuer (OR = 0.4, 95% CI: 0.2-0.9) decreased the risk of rescuers drowning. CONCLUSIONS Most of the currently employed life-saving methods are dangerous and even potentially life threatening. The idea of "rescuers' safety first" should be embraced, especially with teenage and child rescuers, who should never be encouraged to rescue others without first guaranteeing their own safety. Promotion of basic rescue skills should be implemented in the general public.
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Affiliation(s)
- Yinchao Zhu
- Institute of Non-Communicable Disease Control and Prevention, Ningbo Municipal Center for Disease Control and Prevention, No. 237, Yongfeng Road, Haishu District, Ningbo, Zhejiang Province, 315010, People's Republic of China.
| | - Xia Jiang
- Cardiovascular Epidemiology Unit, Institute of Environmental Medicine, Karolinska Institutet, Solna, 17172, Stockholm, Sweden.
| | - Hui Li
- Institute of Non-Communicable Disease Control and Prevention, Ningbo Municipal Center for Disease Control and Prevention, No. 237, Yongfeng Road, Haishu District, Ningbo, Zhejiang Province, 315010, People's Republic of China.
| | - Fudong Li
- Department of Public Health Surveillance & Advisory Division, Zhejiang Province Center for Disease Control and Prevention, No.630, Xincheng Road, Binjiang District, Hangzhou, Zhejiang Province, 310051, People's Republic of China.
| | - Jieping Chen
- Institute of Non-Communicable Disease Control and Prevention, Ningbo Municipal Center for Disease Control and Prevention, No. 237, Yongfeng Road, Haishu District, Ningbo, Zhejiang Province, 315010, People's Republic of China.
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Labenne M, Paut O. Arrêt cardiaque chez l’enfant : définition, épidémiologie, prise en charge et pronostic. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.jeurea.2014.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Demographics, bystander CPR, and AED use in out-of-hospital pediatric arrests. Resuscitation 2014; 85:920-6. [PMID: 24681302 DOI: 10.1016/j.resuscitation.2014.03.044] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 02/03/2014] [Accepted: 03/19/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND In 2005 the American Heart Association released guidelines calling for routine use of automated external defibrillators during pediatric out-of-hospital arrest. The goal of this study was to determine if these guidelines are used during resuscitations. METHODS We conducted a secondary analysis of prospectively collected data from 29 U.S. cities that participate in the Cardiac Arrest Registry to Enhance Survival (CARES). Patients were included if they were older than 1 year of age and had a documented resuscitation attempt from October 1, 2005 through December 31, 2009 from an arrest presumed to be cardiac in nature. Hierarchical multivariable logistic regression analysis was used to estimate the associations between age, demographic factors, and AED use. RESULTS 129 patients were 1-8 years of age (younger children), 88 patients were 9-17 years of age (older children), and 19,338 patients were ≥18 years of age (adults). When compared to adults, younger children were less likely to be found in a shockable rhythm (young children 11.6%, adults 23.7%) and were less likely to have an AED used (young children 16.3%, adults 28.3%). Older children had a similar prevalence of shockable rhythms as adults (31.8%) and AED use (20.5%). A multivariable analysis demonstrated that, when compared to adults, younger children had decreased odds of having an AED used (OR 0.42, 95% CI 0.26-0.69), but there was no difference in AED use among older children and adults. CONCLUSIONS Young children suffering from presumed out-of-hospital cardiac arrests are less likely to have a shockable rhythm when compared to adults, and are less likely to have an AED used during resuscitation.
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Lewis M, Stubbs BA, Eisenberg MS. Dispatcher-assisted cardiopulmonary resuscitation: time to identify cardiac arrest and deliver chest compression instructions. Circulation 2013; 128:1522-30. [PMID: 23983252 DOI: 10.1161/circulationaha.113.002627] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR), in which 9-1-1 dispatchers provide CPR instructions over the telephone, has been shown to nearly double the rate of bystander CPR. We sought to identify factors that hampered the identification of cardiac arrest by 9-1-1 dispatchers and prevented or delayed the provision of dispatcher-assisted CPR chest compressions. METHODS AND RESULTS We reviewed dispatch recordings for 476 out-of-hospital cardiac arrests occurring between January 1, 2011, and December 31, 2011. We found that the dispatcher correctly identified cardiac arrest in 80% of reviewed cases and 92% of cases in which they were able to assess patient consciousness and breathing. The median time to recognition of the arrest was 75 seconds. Chest compressions following dispatcher-assisted CPR instructions occurred in 62% of cases when the dispatcher had the opportunity to asses for consciousness and breathing and bystander CPR was not already started. The median time to first dispatcher-assisted CPR chest compression was 176 seconds. CONCLUSIONS Dispatchers are able to accurately diagnose cardiac arrest over the telephone, but recognition is likely not possible in all circumstances. In some cases, recognition of cardiac arrest may be improved through training in the detection of agonal respirations. Delays in the delivery of dispatcher-assisted CPR chest compressions are common and are attributable to a mixture of dispatcher behavior and factors beyond the control of the dispatcher. Performance standards for the successful and quick recognition of cardiac arrest and delivery of first chest compressions should be adopted as metrics against which emergency medical services systems can measure their performance.
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Affiliation(s)
- Miranda Lewis
- School of Medicine (M.L.) and Department of Medicine (M.S.E.), University of Washington, Seattle; and Public Health Seattle & King County, Emergency Medical Services Division, Seattle, WA (B.A.S., M.S.E.)
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Choi EJ. Effects of Case-based Small Group Learning on Daycare Center Teachers' Coping Ability in Emergency Situations: Focus on Daily Life and Cardiopulmonary Resuscitation. CHILD HEALTH NURSING RESEARCH 2013. [DOI: 10.4094/chnr.2013.19.3.168] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Eun-Ju Choi
- Department of Nusring, Cheongam College, Suncheon, Korea
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