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Mand N, Hoffmann M, Schwalb A, Leonhardt A, Sassen M, Stibane T, Maier RF, Donath C. Management of Paediatric Cardiac Arrest due to Shockable Rhythm-A Simulation-Based Study at Children's Hospitals in a German Federal State. CHILDREN (BASEL, SWITZERLAND) 2024; 11:776. [PMID: 39062225 PMCID: PMC11274526 DOI: 10.3390/children11070776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/21/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024]
Abstract
(1) Background: To improve the quality of emergency care for children, the Hessian Ministry for Social Affairs and Integration offered paediatric simulation-based training (SBT) for all children's hospitals in Hesse. We investigated the quality of paediatric life support (PLS) in simulated paediatric resuscitations before and after SBT. (2) Methods: In 2017, a standardised, high-fidelity, two-day in-house SBT was conducted in 11 children's hospitals. Before and after SBT, interprofessional teams participated in two study scenarios (PRE and POST) that followed the same clinical course of apnoea and cardiac arrest with a shockable rhythm. The quality of PLS was assessed using a performance evaluation checklist. (3) Results: 179 nurses and physicians participated, forming 47 PRE and 46 POST interprofessional teams. Ventilation was always initiated. Before SBT, chest compressions (CC) were initiated by 87%, and defibrillation by 60% of teams. After SBT, all teams initiated CC (p = 0.012), and 80% defibrillated the patient (p = 0.028). The time to initiate CC decreased significantly (PRE 123 ± 11 s, POST 76 ± 85 s, p = 0.030). (4) Conclusions: The quality of PLS in simulated paediatric cardiac arrests with shockable rhythm was poor in Hessian children's hospitals and improved significantly after SBT. To improve children's outcomes, SBT should be mandatory for paediatric staff and concentrate on the management of shockable rhythms.
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Affiliation(s)
- Nadine Mand
- Neonatology and Paediatric Intensive Care, Department of Paediatrics, Philipps-University Marburg, 35043 Marburg, Germany
| | - Marieke Hoffmann
- Department of Paediatric Surgery, Philipps-University Marburg, 35037 Marburg, Germany
| | - Anja Schwalb
- Department of Child and Adolescent Psychiatry, Vitos Klinik, 34745 Herborn, Germany
| | - Andreas Leonhardt
- Neonatology and Paediatric Intensive Care, Department of Paediatrics, Philipps-University Marburg, 35043 Marburg, Germany
| | - Martin Sassen
- Department of Acute and Emergency Medicine, Diakonie-Hospital Wehrda, Philipps-University Marburg, 35041 Marburg, Germany
| | - Tina Stibane
- Reinfried-Pohl-Zentrum for Medical Learning, Philipps-University Marburg, 35043 Marburg, Germany
| | - Rolf Felix Maier
- Neonatology and Paediatric Intensive Care, Department of Paediatrics, Philipps-University Marburg, 35043 Marburg, Germany
| | - Carolin Donath
- Neonatology and Paediatric Intensive Care, Department of Paediatrics, Philipps-University Marburg, 35043 Marburg, Germany
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Raymond TT, Esangbedo ID, Rajapreyar P, Je S, Zhang X, Griffis HM, Wakeham MK, Petersen TL, Kirschen MP, Topjian AA, Lasa JJ, Francoeur CI, Nadkarni VM. Cerebral Oximetry During Pediatric In-Hospital Cardiac Arrest: A Multicenter Study of Survival and Neurologic Outcome. Crit Care Med 2024; 52:775-785. [PMID: 38180092 PMCID: PMC11024591 DOI: 10.1097/ccm.0000000000006186] [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] [Indexed: 01/06/2024]
Abstract
OBJECTIVES To determine if near-infrared spectroscopy measuring cerebral regional oxygen saturation (crS o2 ) during cardiopulmonary resuscitation is associated with return of spontaneous circulation (ROSC) and survival to hospital discharge (SHD) in children. DESIGN Multicenter, observational study. SETTING Three hospitals in the pediatric Resuscitation Quality (pediRES-Q) collaborative from 2015 to 2022. PATIENTS Children younger than 18 years, gestational age 37 weeks old or older with in-hospital cardiac arrest (IHCA) receiving cardiopulmonary resuscitation greater than or equal to 1 minute and intra-arrest crS o2 monitoring. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Primary outcome was ROSC greater than or equal to 20 minutes without extracorporeal membrane oxygenation. Secondary outcomes included SHD and favorable neurologic outcome (FNO) (Pediatric Cerebral Performance Category 1-2 or no change from prearrest). Among 3212 IHCA events (index and nonindex), 123 met inclusion criteria in 93 patients. Median age was 0.3 years (0.1-1.4 yr) and 31% (38/123) of the cardiopulmonary resuscitation events occurred in patients with cyanotic heart disease. Median cardiopulmonary resuscitation duration was 8 minutes (3-28 min) and ROSC was achieved in 65% (80/123). For index events, SHD was achieved in 59% (54/91) and FNO in 41% (37/91). We determined the association of median intra-arrest crS o2 and percent of crS o2 values above a priori thresholds during the: 1) entire cardiopulmonary resuscitation event, 2) first 5 minutes, and 3) last 5 minutes with ROSC, SHD, and FNO. Higher crS o2 for the entire cardiopulmonary resuscitation event, first 5 minutes, and last 5 minutes were associated with higher likelihood of ROSC, SHD, and FNO. In multivariable analysis of the infant group (age < 1 yr), higher crS o2 was associated with ROSC (odds ratio [OR], 1.06; 95% CI, 1.03-1.10), SHD (OR, 1.04; 95% CI, 1.01-1.07), and FNO (OR, 1.05; 95% CI, 1.02-1.08) after adjusting for presence of cyanotic heart disease. CONCLUSIONS Higher crS o2 during pediatric IHCA was associated with increased rate of ROSC, SHD, and FNO. Intra-arrest crS o2 may have a role as a real-time, noninvasive predictor of ROSC.
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Affiliation(s)
- Tia T Raymond
- Department of Pediatrics, Cardiac Intensive Care, Medical City Children's Hospital, Dallas, TX
| | - Ivie D Esangbedo
- Department of Pediatrics, Division of Cardiac Critical Care Medicine, University of Washington, Seattle, WA
| | - Prakadeshwari Rajapreyar
- Department of Pediatrics, Division of Critical Care, Children's Healthcare of Atlanta, Atlanta, GA
| | - Sangmo Je
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Xuemei Zhang
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Heather M Griffis
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Martin K Wakeham
- Division of Pediatric Critical Care, Department of Pediatrics, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI
| | - Tara L Petersen
- Division of Pediatric Critical Care, Department of Pediatrics, Medical College of Wisconsin, Children's Wisconsin, Milwaukee, WI
| | - Matthew P Kirschen
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Alexis A Topjian
- Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Javier J Lasa
- Divisions of Cardiology and Critical Care, Children's Medical Center, UT Southwestern Medical Center, Dallas, TX
| | - Conall I Francoeur
- Division of Pediatric Critical Care, Montreal Children's Hospital, McGill University Health Center, Montreal, QC, Canada
| | - Vinay M Nadkarni
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, Philadelphia, PA
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Kadden M, Zhang A, Shoykhet M. Association of temperature management strategy with fever in critically ill children after out-of-hospital cardiac arrest. Front Pediatr 2024; 12:1355385. [PMID: 38659696 PMCID: PMC11039828 DOI: 10.3389/fped.2024.1355385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/21/2024] [Indexed: 04/26/2024] Open
Abstract
Objective To determine whether ICU temperature management strategy is associated with fever in children with return of spontaneous circulation (ROSC) after out-of-hospital cardiac arrest (OHCA). Methods We conducted a single-center retrospective cohort study at a quaternary Children's hospital between 1/1/2016-31/12/2020. Mechanically ventilated children (<18 y/o) admitted to Pediatric or Cardiac ICU (PICU/CICU) with ROSC after OHCA who survived at least 72 h were included. Primary exposure was initial PICU/CICU temperature management strategy of: (1) passive management; or (2) warming with an air-warming blanket; or (3) targeted temperature management with a heating/cooling (homeothermic) blanket. Primary outcome was fever (≥38°C) within 72 h of admission. Results Over the study period, 111 children with ROSC after OHCA were admitted to PICU/CICU, received mechanical ventilation and survived at least 72 h. Median age was 31 (IQR 6-135) months, 64% (71/111) were male, and 49% (54/111) were previously healthy. Fever within 72 h of admission occurred in 51% (57/111) of patients. The choice of initial temperature management strategy was associated with occurrence of fever (χ2 = 9.36, df = 2, p = 0.009). Fever occurred in 60% (43/72) of patients managed passively, 45% (13/29) of patients managed with the air-warming blanket and 10% (1/10) of patients managed with the homeothermic blanket. Compared to passive management, use of homeothermic, but not of air-warming, blanket reduced fever risk [homeothermic: Risk Ratio (RR) = 0.17, 95%CI 0.03-0.69; air-warming: RR = 0.75, 95%CI 0.46-1.12]. To prevent fever in one child using a homeothermic blanket, number needed to treat (NNT) = 2. Conclusion In critically ill children with ROSC after OHCA, ICU temperature management strategy is associated with fever. Use of a heating/cooling blanket with homeothermic feedback reduces fever incidence during post-arrest care.
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Affiliation(s)
- Micah Kadden
- Pediatric Critical Care Medicine, Children’s National Hospital, Washington, DC,United States
- Pediatric Critical Care Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, United States
| | - Anqing Zhang
- Division of Biostatistics and Study Methodology, Children’s National Hospital, Silver Spring, MD, United States
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC,United States
| | - Michael Shoykhet
- Pediatric Critical Care Medicine, Children’s National Hospital, Washington, DC,United States
- Department of Pediatrics, School of Medicine and Health Sciences, The George Washington University, Washington, DC,United States
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Schinasi DA, Colgan J, Nadel FM, Hales RL, Lorenz D, Donoghue AJ. A Brief, Just-in-Time Sedation Training in the Pediatric Emergency Department Improves Performance During Adverse Events Encountered in Simulated Procedural Sedations. Pediatr Emerg Care 2022; 38:e1030-e1035. [PMID: 35226626 DOI: 10.1097/pec.0000000000002657] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Procedural sedation (PS) is commonly performed in emergency departments (EDs) by nonanesthesiologists. Although adverse events (AEs) are rare, providers must possess the clinical skills to react in a timely manner. We previously described residents' experience and confidence in PS as part of a needs assessment. We found that their ability to perform important clinical tasks as a result of the usual training experience demonstrates educational needs. We developed an educational intervention to address the deficiencies uncovered during our needs assessment. OBJECTIVE To evaluate the effectiveness of an educational intervention on pediatric residents' clinical performance and confidence when faced with an AE during a simulated PS. METHODS This was a prospective observational cohort study of residents at a tertiary care children's hospital. All ED attending physicians and fellows were trained in uniform delivery of the educational intervention, which was delivered extemporaneously at the bedside ("Just-in-Time" [JIT]) to all residents performing PS on actual patients in the pediatric ED, over the course of 1 year. Subjects completed the following both before and after the educational intervention: a survey pertaining to confidence in PS, followed by a standardized, video-recorded simulated PS complicated by apnea and desaturation. Clinical performance was evaluated and assessed both in real time and by a video-rater blinded to participants' year of training. We summarized baseline resident characteristics, confidence questionnaire item rankings and success in both the preparation and AE tasks. We compared successful task completion and time to task completion before and after intervention. RESULTS Forty residents completed both the PRE and POST phases of the study. There was significant improvement in the proportion of residents who completed both preparation and AE tasks after the JIT training. Specifically, there was a significant improvement in the proportion of residents who performed positive-pressure ventilation to treat an apneic event associated with desaturation during the PS (P = 0.007). Residents' confidence scores also significantly improved after the training. CONCLUSION A brief JIT training in the pediatric ED improves resident clinical performance and confidence when faced with an AE during a simulated PS. Future direction includes correlating this improved performance with patient outcomes in PS.
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Affiliation(s)
- Dana Aronson Schinasi
- From the Northwestern University Feinberg School of Medicine, Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Jennifer Colgan
- From the Northwestern University Feinberg School of Medicine, Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL
| | - Frances M Nadel
- Perelman School of Medicine at the University of Pennsylvania, Division of Emergency Medicine
| | - Roberta L Hales
- Center for Simulation, Advanced Education, and Innovation, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Douglas Lorenz
- Department of Bioinformatics and Biostatistics, University of Louisville, KY
| | - Aaron J Donoghue
- Perelman School of Medicine at the University of Pennsylvania, Divisions of Critical Care and Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
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Francoeur C, Landis WP, Winters M, Naim MY, Donoghue A, Dominick CL, Huh JW, MacDonald JM, Lang SS, Yuan I, Berg RA, Nadkarni VM, Kilbaugh TJ, Sutton RM, Kirschen MP, Morgan RW, Topjian AA. Near-infrared spectroscopy during cardiopulmonary resuscitation for pediatric cardiac arrest: a prospective, observational study. Resuscitation 2022; 174:35-41. [PMID: 35314211 PMCID: PMC9724995 DOI: 10.1016/j.resuscitation.2022.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/09/2022] [Accepted: 03/13/2022] [Indexed: 02/04/2023]
Abstract
AIM Cerebral oxygenation (rSO2) is not routinely measured during pediatric cardiopulmonary resuscitation (CPR). We aimed to determine whether higher intra-arrest rSO2 was associated with return of spontaneous circulation (ROSC) and survival to hospital discharge. METHODS Prospective, single-center observational study of cerebral oximetry using near-infrared spectroscopy (NIRS) during pediatric cardiac arrest from 2016 to 2020. Eligible patients had ≥30 s of rSO2 data recorded during CPR. We compared median rSO2 and percentage of rSO2 measurements above a priori thresholds for the entire event and the final five minutes of the CPR event between patients with and without ROSC and survival to discharge. RESULTS Twenty-one patients with 23 CPR events were analyzed. ROSC was achieved in 17/23 (73.9%) events and five/21 (23.8%) patients survived to discharge. The median rSO2 was higher for events with ROSC vs. no ROSC for the overall event (62% [56%, 70%] vs. 45% [35%, 51%], p = 0.025) and for the final 5 minutes of the event (66% [55%, 72%] vs. 43% [35%, 44%], p = 0.01). Patients with ROSC had a higher percentage of measurements above 50% during the final five minutes of CPR (100% [100%, 100%] vs. 0% [0%, 29%], p = 0.01). There was no association between rSO2 and survival to discharge. CONCLUSIONS Higher cerebral rSO2 during CPR for pediatric cardiac arrest was associated with higher rates of ROSC but not with survival to discharge.
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Affiliation(s)
- C Francoeur
- Department of Pediatrics, CHU de Québec - Université Laval Research Center, Quebec, Canada.
| | - W P Landis
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - M Winters
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - M Y Naim
- The Cardiac Center, Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - A Donoghue
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - C L Dominick
- Department of Respiratory Therapy, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - J W Huh
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - J M MacDonald
- Division of Pediatric Critical Care Medicine, Nationwide Children's Hospital, The Ohio State University College of Medicine, OH, USA
| | - S S Lang
- Division of Neurosurgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurosurgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - I Yuan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - R A Berg
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - V M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - T J Kilbaugh
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - R M Sutton
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - M P Kirschen
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - R W Morgan
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - A A Topjian
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Ulmer F, Pallivathukal S, Bartenstein A, Bieri R, Studer D, Lava SAG. Preparedness for Life-Threatening Situations in a Pediatric Tertiary-Care University Children’s Hospital: A Survey. CHILDREN 2022; 9:children9020271. [PMID: 35204991 PMCID: PMC8870381 DOI: 10.3390/children9020271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 01/28/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022]
Abstract
Pediatric nurses and physicians are rarely exposed to life-threatening events. Understanding the needs of clinicians is key for designing continuing training programs. A survey exploring preparedness to manage life-threatening events as well as training needs was mailed to all clinically active nurses and physicians at a tertiary-level referral children’s hospital. Overall, 469 participants out of 871 answered the questionnaire (54% response rate). Respondents felt well or very well (nurses 93%, physicians 74%) prepared to recognize a deteriorating child and rated their theoretical understanding (70% well or very well prepared) of how to manage life-threatening situations significantly higher (p < 0.0001) than their cardiopulmonary resuscitation (CPR) preparedness (52% well or very well prepared). Both perceived theoretical understanding (p < 0.0001) and CPR preparedness (p < 0.002) were rated higher among nurses than physicians. Arrhythmias, shock, cardiac arrest and airway management constitute main areas of perceived training need. In conclusion, although a majority of pediatric nurses and physicians felt sufficiently trained to recognize a deteriorating child, their perceived ability to actively manage life-threatening events was inferior to their theoretical understanding of how to resuscitate a child. A high degree of institutional confidence and identification of areas of training need provide a good foundation for customizing future continuing education programs.
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Affiliation(s)
- Francis Ulmer
- Paediatric Intensive Care Unit, Department of Paediatrics, University Children Hospital of Berne, Inselspital, and University of Bern, 3010 Bern, Switzerland; (F.U.); (R.B.); (D.S.)
| | - Sabine Pallivathukal
- Paediatric Cardiology Unit, Center for Congenital Heart Disease, Department of Cardiology, Inselspital, Bern University Hospital, and University of Bern, 3010 Bern, Switzerland;
| | - Andreas Bartenstein
- Department of Paediatric Surgery, University Children Hospital of Bern, Inselspital, and University of Bern, 3010 Bern, Switzerland;
| | - Ruth Bieri
- Paediatric Intensive Care Unit, Department of Paediatrics, University Children Hospital of Berne, Inselspital, and University of Bern, 3010 Bern, Switzerland; (F.U.); (R.B.); (D.S.)
| | - Daniela Studer
- Paediatric Intensive Care Unit, Department of Paediatrics, University Children Hospital of Berne, Inselspital, and University of Bern, 3010 Bern, Switzerland; (F.U.); (R.B.); (D.S.)
| | - Sebastiano A. G. Lava
- Paediatric Cardiology Unit, Department of Paediatrics, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland
- Division of Clinical Pharmacology and Toxicology, Institute of Pharmacological Sciences of Southern Switzerland, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland
- Heart Failure and Transplantation, Department of Paediatric Cardiology, Great Ormond Street Hospital, London WC1N 3JH, UK
- Correspondence:
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Binkhorst M, Hogeveen M, Benthem Y, van de Pol EM, van Heijst AFJ, Draaisma JMT. Validation of an Assessment Instrument for Pediatric Basic Life Support. Pediatr Emerg Care 2021; 37:e1057-e1064. [PMID: 31318831 DOI: 10.1097/pec.0000000000001899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To develop a valid and reliable instrument for the assessment of pediatric basic life support (PBLS). METHODS An assessment instrument for PBLS was developed, based on 3 existing scoring systems and the European Resuscitation Council PBLS guideline. We tested if experienced PBLS instructors performed better than medical students on a standard PBLS examination on a low-fidelity pediatric manikin (construct validity). To pass the examination, 15 penalty points or less were required. The examinations were videotaped. One researcher assessed all videos once, and approximately half of them twice (intrarater reliability). A second researcher independently assessed part of the videos (interrater reliability). The time needed to assess 1 examination was determined. RESULTS Face and content validity were established, because PBLS experts reached consensus on the instrument and because the instrument incorporated all items of the European Resuscitation Council algorithm. Of the 157 medical students that were scored, 98 (62.4%) passed the examination. Fourteen PBLS instructors were scored; all passed (100%). Pass rate (62.4% vs 100%) and median penalty points (15 [interquartile range, 10-22.5] vs 7.5 [interquartile range, 1.25-10]) were significantly different between students and instructors (P = 0.005 and <0.001, respectively). Reassessment demonstrated a κ for intrarater reliability of 0.62 (95% confidence interval, 0.45-0.81) (substantial agreement); κ for interrater reliability was 0.51 (95% confidence interval, 0.09-0.93) (moderate agreement). It took approximately 3 minutes to assess 1 videotaped examination. CONCLUSIONS Our instrument for the (video-based) assessment of PBLS is valid and sufficiently reliable. It is also designed to be practical, time-efficient, and applicable in various settings, including resource limited.
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Affiliation(s)
| | | | - Yvet Benthem
- Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Eva M van de Pol
- Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, the Netherlands
| | | | - Jos M Th Draaisma
- Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, the Netherlands
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Shah P, Havalad V. A Novel Code Team Leader Card to Improve Leader Identification. J Patient Cent Res Rev 2021; 8:354-359. [PMID: 34722805 DOI: 10.17294/2330-0698.1847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Prompt and clear code team leader identification is vital in effective cardiopulmonary resuscitation (CPR), and pediatric trainees often have limited experience in these scenarios. This project sought to develop a tangible object that provided clear leader identification and assisted in code team management and simulated team training. A Code Team Leader Card (CTLC) was designed to provide clear leader identification while simultaneously providing a cognitive aid via integration of pediatric advanced life support (PALS) algorithms. Additionally, CTLC served to occupy the leader's hands to limit their ability to intervene on procedural tasks. The CTLC was incorporated into pediatric resident simulation training, and pre- and postintervention survey data were analyzed. Analysis particularly focused on whether "a leader was clearly identified by all team members." The relationship between CTLC implementation and consistent leader recognition was evaluated using chi-squared test, and secondary qualitative data were obtained via debriefing sessions. Pediatric residents completed 131 surveys prior to CTLC implementation and 41 surveys after implementation. Consistent code team leader recognition increased significantly from 61.8% (81 of 131) pre-CTLC to 80.5% (33 of 41) after introduction of CTLC (P=0.027). Participants commented on the benefits of CTLC during debriefing sessions. Use of a CTLC significantly improved leader recognition during simulated CPR. Inclusion of PALS algorithms led to normalization and increased utilization of these adjunct materials. The CTLC provided a secondary benefit of occupying the leader's hands, thereby allowing that person to focus on overseeing the team rather than assisting with procedural tasks.
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Affiliation(s)
- Palak Shah
- Pediatric Critical Care Medicine, Presbyterian Hospital - The Children's Center at Presbyterian, Albuquerque, NM
| | - Vinod Havalad
- Pediatric Simulation Program, Pediatric Critical Care Medicine, Advocate Children's Hospital, Advocate Aurora Health, Park Ridge, IL
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Impact of Infant Positioning on Cardiopulmonary Resuscitation Performance During Simulated Pediatric Cardiac Arrest: A Randomized Crossover Study. Pediatr Crit Care Med 2020; 21:e1076-e1083. [PMID: 32826836 DOI: 10.1097/pcc.0000000000002521] [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] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The primary objective was to determine the impact of infant positioning on cardiopulmonary resuscitation performance during simulated pediatric cardiac arrest. DESIGN A single-center, prospective, randomized, unblinded manikin study. SETTING Medical university-affiliated simulation facility. SUBJECTS Fifty-two first-line professional rescuers (n = 52). INTERVENTIONS Performance of cardiopulmonary resuscitation was determined using an infant manikin model in three different positions (on a table [T], on the provider's forearm with the manikin's head close to the provider's elbow [P], and on the provider's forearm with the manikin's head close to the provider's palm [D]). For the measurement of important cardiopulmonary resuscitation performance variables, a commercially available infant simulator was modified. In a randomized sequence, healthcare professionals performed single-rescuer cardiopulmonary resuscitation for 3 minutes in each position. Performances of chest compression (primary outcome), ventilation, and hands-off time were analyzed using a multilevel regression model. MEASUREMENTS AND MAIN RESULTS Mean (± SD) compression depth significantly differed between table and the other two manikin positions (31 ± 2 [T], 29 ± 3 [P], and 29 ± 3 mm [D]; overall p < 0.001; repeated measures design adjusted difference: T vs P, -2 mm [95% CI, -2 to -1 mm]; T vs D, -1 mm [95% CI, -2 to -1 mm]). Secondary outcome variables showed no significant differences. CONCLUSIONS Compressions were significantly deeper in the table group compared to positions on the forearm during cardiopulmonary resuscitation, yet the differences were small and perhaps not clinically important.
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10
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Postcardiac Arrest Care: Streamlining and Personalizing Our Approach. Pediatr Crit Care Med 2020; 21:907-908. [PMID: 33009304 DOI: 10.1097/pcc.0000000000002423] [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: 11/26/2022]
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Abstract
OBJECTIVES Postcardiac arrest care bundles following adult cardiac arrest are associated with improved survival to discharge. We aimed to evaluate whether a clinical pathway and computerized order entry were associated with improved pediatric postcardiac arrest care and discharge outcomes. DESIGN Single-center retrospective before-after study. SETTING Academic PICU. PATIENTS Patients who suffered an in- or out-of-hospital cardiac arrest from January 2008 to December 2015 cared for in the PICU within 12 hours of sustained return of circulation. INTERVENTION Deployment of a postcardiac arrest clinical pathway and computerized order entry system. MEASUREMENTS AND MAIN RESULTS There were 380 patients included-163 in the pre-pathway period and 217 in the post-pathway period. Primary outcome was percent adherence to pathway clinical goals at 0-6 and 6-24 hours post-return of circulation and to diagnostics (continuous electroencephalogram monitoring, head CT for out-of-hospital cardiac arrests, echocardiogram). Secondary outcomes included survival to hospital discharge and survival with favorable neurologic outcome (Pediatric Cerebral Performance Category of 1-3 or no change from baseline). The pre-pathway and post-pathway groups differed in their baseline Pediatric Cerebral Performance Category scores and the following causes of arrest: airway obstruction, arrhythmias, and electrolyte abnormalities. Pathway adherence was not significantly different between the pre-pathway and post-pathway groups, with the exception of higher rates of continuous electroencephalogram monitoring (45% vs 64%; p < 0.001). There was no difference in survival to hospital discharge between the two groups (56% vs 67%; adjusted odds ratio, 1.68; 95% CI, 0.95-2.84; p = 0.05). Survival to discharge was higher in the post-pathway group for the in-hospital cardiac arrest cohort (55% vs 76%; adjusted odds ratio, 3.06; 95% CI, 1.44-6.51; p < 0.01). There was no difference in favorable neurologic outcome between all patients (adjusted odds ratio, 1.21; 95% CI, 0.72-2.04) or among survivors (adjusted odds ratio, 0.72; 95% CI, 0.27-1.43). CONCLUSIONS After controlling for known potential confounders, the creation and deployment of a postcardiac arrest care pathway and computerized order entry set were not associated with improvement in pathway adherence or overall outcomes, but was associated with increased survival to hospital discharge for children with in-hospital cardiac arrests.
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12
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Bibl K, Gröpel P, Berger A, Schmölzer GM, Olischar M, Wagner M. Randomised simulation trial found an association between rescuers' height and weight and chest compression quality during paediatric resuscitation. Acta Paediatr 2020; 109:1831-1837. [PMID: 32053243 PMCID: PMC7496260 DOI: 10.1111/apa.15229] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/22/2019] [Accepted: 02/11/2020] [Indexed: 12/27/2022]
Abstract
AIM Our aim was to examine the relationship between rescuers' anthropometric data and chest compression quality during paediatric resuscitation training. METHODS This study focused on 224 medical students (53% women) who performed 2 minutes of paediatric resuscitation at the Medical University of Vienna, Austria: 116 on a baby manikin and 108 on an adolescent manikin. Skill Reporter software measured chest compression quality by recording compression depth, frequency, hand position and complete recoil. The participants' height, weight and body mass index (BMI) were recorded. RESULTS Participants with a lower BMI achieved higher total chest compression scores on both the baby and adolescent manikins than participants with a higher BMI. The latter were more likely to exceed the correct compression depth and not achieve complete chest recoil in the adolescent manikin. When it came to the baby manikin, the female participants achieved better chest recoil and the males achieved a higher number of compressions at the correct rate. Males also achieved better chest recoil with the adolescent manikins. Being tall only correlated with incomplete recoil in the adolescent manikin. CONCLUSION The results indicate that anthropometric variables were associated with chest compression quality in paediatric patients and should be considered by future education programmes.
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Affiliation(s)
- Katharina Bibl
- Division of Neonatology, Paediatric Intensive Care and Neuropaediatrics Department of Paediatrics Comprehensive Center for Paediatrics Medical University of Vienna Vienna Austria
| | - Peter Gröpel
- Department of Applied Psychology: Work, Education and Economy University of Vienna Vienna Austria
| | - Angelika Berger
- Division of Neonatology, Paediatric Intensive Care and Neuropaediatrics Department of Paediatrics Comprehensive Center for Paediatrics Medical University of Vienna Vienna Austria
| | - Georg M. Schmölzer
- Neonatal Research Unit Centre for the Studies of Asphyxia and Resuscitation Royal Alexandra Hospital Alberta Health Services Edmonton AB Canada
- Division of Neonatology Department of Paediatrics University of Alberta Edmonton AB Canada
| | - Monika Olischar
- Division of Neonatology, Paediatric Intensive Care and Neuropaediatrics Department of Paediatrics Comprehensive Center for Paediatrics Medical University of Vienna Vienna Austria
| | - Michael Wagner
- Division of Neonatology, Paediatric Intensive Care and Neuropaediatrics Department of Paediatrics Comprehensive Center for Paediatrics Medical University of Vienna Vienna Austria
- Neonatal Research Unit Centre for the Studies of Asphyxia and Resuscitation Royal Alexandra Hospital Alberta Health Services Edmonton AB Canada
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13
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Hazwani TR, Alosaimi A, Almutairi M, Shaheen N, Al Hassan Z, Antar M. The Impact of Mock Code Simulation on the Resuscitation Practice and Patient Outcome for Children With Cardiopulmonary Arrest. Cureus 2020; 12:e9197. [PMID: 32789097 PMCID: PMC7417123 DOI: 10.7759/cureus.9197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background Cardiopulmonary arrest is an uncommon event in pediatric patients. Additionally, physicians-in-training see far fewer cardiopulmonary arrest events. Therefore, they have limited confidence in their resuscitation skills. Mock code training with active participation and debriefing may be an effective tool to fill this gap in experience. The aims of the study were to assess the impact of a mock code simulation program on patient outcome for children with cardiopulmonary arrest in a tertiary pediatric academic center and provide evidence that code simulations can improve the quality of cardiopulmonary resuscitation (CPR). Methods This was a retrospective cohort study conducted in a tertiary academic center. This study had two phases: Phase 1 before the mock code simulation program began (pre-intervention) and Phase 2 after the mock code program began (post-intervention). The data were collected from pediatric patients with cardiopulmonary arrest during the study period who met the inclusion criteria, and variables included the survival rate at hospital discharge, CPR initiation time, time to the first dose of epinephrine, and the adherence rate to American Heart Association (AHA) guidelines. Results A total of 13 patients in the pre-intervention period and 19 patients in the post-intervention period were included. The results showed a significant improvement in team performance represented by a decrease in CPR initiation time post-intervention and improvement in AHA adherence; however, the results did not show a significant difference in the survival rate or mortality within 28 days of the cardiopulmonary arrest event between the pre- and post-intervention groups. Conclusions Mock code simulation was a helpful tool to enhance team performance and improve the quality of cardiac resuscitation and cardiac arrest recognition, while its impact on the survival rate was not significant in our study.
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Affiliation(s)
- Tarek R Hazwani
- Pediatric Intensive Care, King Abdulaziz Medical City, Ministry of National Guard - Health Affairs, Riyadh, SAU.,Pediatric Critical Care, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Arwa Alosaimi
- Pediatrics, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Manal Almutairi
- Family Medicine, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Naila Shaheen
- Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, SAU
| | - Zahra Al Hassan
- Nursing, Ministry of National Guard - Health Affairs, Riyadh, SAU
| | - Mohannad Antar
- Pediatrics, Ministry of National Guard - Health Affairs, Riyadh, SAU
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14
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Hazwani TR, Harder N, Shaheen NA, Al Hassan Z, Antar M, Alshehri A, Alali H, Kazzaz YM. Effect of a Pediatric Mock Code Simulation Program on Resuscitation Skills and Team Performance. Clin Simul Nurs 2020. [DOI: 10.1016/j.ecns.2020.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Wise KM, Zinkan JL, Rutledge C, Gaither S, Norwood C, Tofil NM. Development of a "First Five Minutes" Program to Improve Staff Response to Pediatric Codes. Am J Crit Care 2020; 29:233-236. [PMID: 32355972 DOI: 10.4037/ajcc2020407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Delayed or inadequate cardiopulmonary resuscitation during cardiopulmonary arrest is associated with adverse resuscitation outcomes in pediatric patients. Therefore, a "First Five Minutes" program was developed to train all inpatient acute care nurses in resuscitation skills. The program focused on steps to take during the first 5 minutes. OBJECTIVE To improve response of bedside personnel in the first few minutes of a cardiopulmonary emergency. METHODS A simulation-based in situ educational program was developed that focused on the components of the American Heart Association's "Get With the Guidelines" recommendations. The program was implemented in several phases to improve instruction and focus on necessary skills. RESULTS The program garnered positive feedback from participants and was deemed helpful in preparing nurses and other staff members to respond to a patient in cardiopulmonary arrest. Time to chest compressions improved after training, and postintervention responses to questions regarding future code performance indicated participant recognition of the priority of the interventions addressed, such as backboard use, timely initiation of chest compressions, and timely administration of medications. Preliminary data show staff improvements in mock code performance. CONCLUSIONS The First Five Minutes program has proved to be a successful educational initiative and is expected to be continued indefinitely, with additional phases incorporated as needed. A rigorous study on best teaching methods for the program is planned.
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Affiliation(s)
- Kandi M. Wise
- Kandi M. Wise, J. Lynn Zinkan, and Carrie Norwood are educators and Stacy Gaither is director of research and simulation education for the Pediatric Simulation Center at Children’s of Alabama (Department of Pediatrics, University of Alabama at Birmingham), Birmingham, Alabama
| | - J. Lynn Zinkan
- Kandi M. Wise, J. Lynn Zinkan, and Carrie Norwood are educators and Stacy Gaither is director of research and simulation education for the Pediatric Simulation Center at Children’s of Alabama (Department of Pediatrics, University of Alabama at Birmingham), Birmingham, Alabama
| | - Chrystal Rutledge
- Chrystal Rutledge is co-medical director of the Pediatric Simulation Center at Children’s of Alabama and an assistant professor of pediatrics at the University of Alabama at Birmingham
| | - Stacy Gaither
- Stacy Gaither is director of research and simulation education for the Pediatric Simulation Center at Children’s of Alabama (Department of Pediatrics, University of Alabama at Birmingham), Birmingham, Alabama
| | - Carrie Norwood
- Kandi M. Wise, J. Lynn Zinkan, and Carrie Norwood are educators and Stacy Gaither is director of research and simulation education for the Pediatric Simulation Center at Children’s of Alabama (Department of Pediatrics, University of Alabama at Birmingham), Birmingham, Alabama
| | - Nancy M. Tofil
- Nancy M. Tofil is medical director of the Pediatric Simulation Center at Children’s of Alabama and professor of pediatrics, University of Alabama at Birmingham
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16
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Edwards-Jackson N, North K, Chiume M, Nakanga W, Schubert C, Hathcock A, Phiri A, Eckerle M. Outcomes of in-hospital paediatric cardiac arrest from a tertiary hospital in a low-income African country. Paediatr Int Child Health 2020; 40:11-15. [PMID: 30714507 DOI: 10.1080/20469047.2019.1570443] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: There are scarce data on outcomes of in-hospital paediatric cardiac arrest (CA) in resource-poor settings and none for World Bank-defined low-income countries.Aim: To report the outcomes of in-hospital paediatric CA from a university-affiliated referral hospital in Malawi.Methods: Data were collected prospectively on patients aged 30 days to 13 years who experienced CA and underwent cardiopulmonary resuscitation (CPR) at Kamuzu Central Hospital in Lilongwe, Malawi from January through June 2017. Utstein-style reporting guidelines for CAs were used to define outcomes; the primary outcome was survival to hospital discharge. A data collection form was used to record patient, arrest and resuscitation characteristics.Results: A total of 135 patients fulfilled the criteria for inclusion in the study. Resuscitation outcomes are presented in Figure 1 using a modified Utstein template. In-hospital CA was associated with 100% mortality. Return of spontaneous circulation (ROSC) was obtained in 6% of patients and sustained ROSC in 4%; 24-h survival was zero. The most common admission diagnosis was malaria (51%). Most arrests occurred on the paediatric ward (90%) rather than critical care units. Most resuscitations were led by trainees and mid-level providers (58%) rather than paediatricians (23%).Conclusion: Survival following in-hospital paediatric CA was zero, suggesting that CPR may have no benefit in this tertiary hospital. Future efforts to improve outcomes should focus on advocating better pre-arrest care and research interventions aimed to identify and treat children at risk of CA within the resource constraints of this setting.
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Affiliation(s)
- Nneka Edwards-Jackson
- Department of Paediatrics, Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Krysten North
- Department of Paediatrics, Division of Neonatology, University of North Carolina, Chapel Hill, NC, USA
| | - Msandeni Chiume
- Department of Paediatrics, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Wisdom Nakanga
- Malawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi
| | - Charles Schubert
- Department of Paediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amber Hathcock
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Ajib Phiri
- College of Medicine, University of Malawi, Blantyre, Malawi
| | - Michelle Eckerle
- Department of Paediatrics, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Paediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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17
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Laverriere EK, Polansky M, French B, Nadkarni VM, Berg RA, Topjian AA. Association of Duration of Hypotension With Survival After Pediatric Cardiac Arrest. Pediatr Crit Care Med 2020; 21:143-149. [PMID: 31568263 DOI: 10.1097/pcc.0000000000002119] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To evaluate the association of a single episode of hypotension and burden of hypotension with survival to hospital discharge following resuscitation from pediatric cardiac arrest. DESIGN Retrospective cohort study. SETTING Single-center PICU. PATIENTS Patients between 1 day and 18 years old who had a cardiac arrest, received chest compressions for more than 2 minutes, had return of spontaneous circulation for more than 20 minutes, and survived to receive postresuscitation care in the ICU. INTERVENTIONS None. MEASUREMENT AND MAIN RESULTS One-hundred sixteen patients were evaluable. Hypotension, defined as systolic blood pressure less than the fifth percentile for age and sex, occurred in 37 patients (32%) within the first 6 hours and 64 (55%) within 72 hours of postresuscitation ICU care. There was no significant difference in survival to discharge for patients who had a single episode of hypotension within 6 hours (51% vs 69%; p = 0.06) or within 72 hours (56% vs 73%; p = 0.06). Burden of hypotension was defined as the percentage of hypotension measurements that were below the fifth percentile. After controlling for patient and cardiac arrest event characteristics, a higher burden of hypotension within the first 72 hours of ICU postresuscitation care was associated with decreased discharge survival (adjusted odds ratio = 0.67 per 10% increase in hypotension burden; 95% CI, 0.48-0.86; p = 0.006). CONCLUSIONS After successful resuscitation from pediatric cardiac arrest, systolic hypotension was common (55%). A higher burden of postresuscitation hypotension within the first 72 hours of ICU postresuscitation care was associated with significantly decreased discharge survival, after accounting for potential confounders including number of doses of epinephrine, arrest location, and arrest etiology due to airway obstruction or trauma.
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Affiliation(s)
- Elizabeth K Laverriere
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Marcia Polansky
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA.,Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Benjamin French
- Department of Biostatistics and Epidemiology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Vinay M Nadkarni
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Robert A Berg
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
| | - Alexis A Topjian
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Medicine, Children's Hospital of Philadelphia, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA
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18
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Abstract
Paediatric medical emergencies can be distressing for the child, parent and clinician alike. This paper aims to remind those in primary dental care how to manage these emergencies safely and effectively. Topics covered include paediatric airway management, basic life support, defibrillation, choking, asthma, paediatric emergency drug doses and epilepsy.
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19
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Lee JE, Lee J, Oh J, Park CH, Kang H, Lim TH, Yoo KH. Comparison of two-thumb encircling and two-finger technique during infant cardiopulmonary resuscitation with single rescuer in simulation studies: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e17853. [PMID: 31702646 PMCID: PMC6855637 DOI: 10.1097/md.0000000000017853] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The recommended chest compression technique for a single rescuer performing infant cardiopulmonary resuscitation is the two-finger technique. For 2 rescuers, a two-thumb-encircling hands technique is recommended. Several recent studies have reported that the two-thumb-encircling hands technique is more effective for high-quality chest compression than the two-finger technique for a single rescuer performing infant cardiopulmonary resuscitation. We undertook a systematic review and meta-analysis of infant manikin studies to compare two-thumb-encircling hands technique with two-finger technique for a single rescuer. METHODS We searched MEDLINE, EMBASE, and the Cochrane Library for eligible randomized controlled trials published prior to December 2017, including cross-over design studies. The primary outcome was the mean difference in chest compression depth (mm). The secondary outcome was the mean difference in chest compression rate (counts/min). A meta-analysis was performed using Review Manager (version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2014). RESULTS Six studies that had reported data concerning both chest compression depth and chest compression rate were included. The two-thumb-encircling hands technique was associated with deeper chest compressions compared with two-finger technique for mean chest compression depth (mean difference, 5.50 mm; 95% confidence interval, 0.32-10.69 mm; P = .04), but no significant difference in the mean chest compression rate (mean difference, 7.89 counts/min; 95% confidence interval, to 0.99, 16.77 counts/min; P = .08) was noted. CONCLUSION This study indicates that the two-thumb-encircling hands technique is a more appropriate technique for a single rescuer to perform high-quality chest compression in consideration of chest compression depth than the two-finger technique in infant manikin studies.
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Affiliation(s)
- Ji Eun Lee
- Department of Emergency Medicine, College of Medicine
| | - Juncheol Lee
- Department of Emergency Medicine, Armed Forces Capital Hospital, Seongnam
- Graduate School, College of Medicine, Hanyang University, Seoul
| | - Jaehoon Oh
- Department of Emergency Medicine, College of Medicine
| | - Chan Hyuk Park
- Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Republic of Korea
| | - Hyunggoo Kang
- Department of Emergency Medicine, College of Medicine
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine
| | - Kyung Hun Yoo
- Department of Emergency Medicine, College of Medicine
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20
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Stewart SA. Parents' Experience During a Child's Resuscitation: Getting Through It. J Pediatr Nurs 2019; 47:58-67. [PMID: 31048114 DOI: 10.1016/j.pedn.2019.04.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 04/18/2019] [Accepted: 04/18/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to elucidate the experiences of parents during their child's resuscitation in the hospital setting. DESIGN AND METHODS This qualitative descriptive study took place in a 280 bed children's hospital with parents whose children experienced resuscitation while they were present in the room or nearby. Semi-structured interviews were conducted between one and twelve months following a child's resuscitation. A rigorous thematic analysis was performed. RESULTS This study elucidates parent experience during a child's resuscitation using four overarching themes; "Overwhelming chaos", "Getting through it", "Cognitive presence" and "Joy mixed with heartache". Parents described their experience to be stressful, yet identified things that helped them get through it and make sense of the experience. CONCLUSIONS During a child's resuscitation parents perceived a sense of overwhelming chaos, yet still had an innate need to be present and know what was going on. While emotional support was appreciated, most important was to receive real time clinical information from healthcare staff and to see and feel that the team was personally invested in their child. PRACTICE IMPLICATIONS During a child's resuscitation, parents should be allowed to choose their level of presence to meet their individual needs. A clinical staff member should answer questions and share clinical information with parents. In addition, clinicians should allow themselves to connect with parents on a personal level. This research provides a foundation for further study, including parents' experience after experiencing a child's resuscitation.
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Affiliation(s)
- Stephanie A Stewart
- University of Iowa College of Nursing, Iowa City, Iowa United States of America; University of Iowa Stead Family Children's Hospital, Iowa City, Iowa United States of America.
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21
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Topjian AA, Sutton RM, Reeder RW, Telford R, Meert KL, Yates AR, Morgan RW, Berger JT, Newth CJ, Carcillo JA, McQuillen PS, Harrison RE, Moler FW, Pollack MM, Carpenter TC, Notterman DA, Holubkov R, Dean JM, Nadkarni VM, Berg RA, Zuppa AF, Graham K, Twelves C, Diliberto MA, Landis WP, Tomanio E, Kwok J, Bell MJ, Abraham A, Sapru A, Alkhouli MF, Heidemann S, Pawluszka A, Hall MW, Steele L, Shanley TP, Weber M, Dalton HJ, Bell AL, Mourani PM, Malone K, Locandro C, Coleman W, Peterson A, Thelen J, Doctor A. The association of immediate post cardiac arrest diastolic hypertension and survival following pediatric cardiac arrest. Resuscitation 2019; 141:88-95. [PMID: 31176666 DOI: 10.1016/j.resuscitation.2019.05.033] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 05/20/2019] [Accepted: 05/29/2019] [Indexed: 10/26/2022]
Abstract
AIM In-hospital cardiac arrest occurs in >5000 children each year in the US and almost half will not survive to discharge. Animal data demonstrate that an immediate post-resuscitation burst of hypertension is associated with improved survival. We aimed to determine if systolic and diastolic invasive arterial blood pressures immediately (0-20 min) after return of spontaneous circulation (ROSC) are associated with survival and neurologic outcomes at hospital discharge. METHODS This is a secondary analysis of the Pediatric Intensive Care Quality of CPR (PICqCPR) study of invasively measured blood pressures during intensive care unit CPR. Patients were eligible if they achieved ROSC and had at least one invasively measured blood pressure within the first 20 min following ROSC. Post-ROSC blood pressures were normalized for age, sex and height. "Immediate hypertension" was defined as at least one systolic or diastolic blood pressure >90th percentile. The primary outcome was survival to hospital discharge. RESULTS Of 102 children, 70 (68.6%) had at least one episode of immediate post-CPR diastolic hypertension. After controlling for pre-existing hypotension, duration of CPR, calcium administration, and first documented rhythm, patients with immediate post-CPR diastolic hypertension were more likely to survive to hospital discharge (79.3% vs. 54.5%; adjusted OR = 2.93; 95%CI, 1.16-7.69). CONCLUSIONS In this post hoc secondary analysis of the PICqCPR study, 68.6% of subjects had diastolic hypertension within 20 min of ROSC. Immediate post-ROSC hypertension was associated with increased odds of survival to discharge, even after adjusting for covariates of interest.
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Affiliation(s)
- Alexis A Topjian
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States.
| | - Robert M Sutton
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Ron W Reeder
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States
| | - Russell Telford
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States
| | - Kathleen L Meert
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, United States
| | - Andrew R Yates
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States
| | - Ryan W Morgan
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - John T Berger
- Department of Pediatrics, Children's National Medical Center, Washington D.C., United States
| | - Christopher J Newth
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Joseph A Carcillo
- Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, United States
| | - Patrick S McQuillen
- Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, United States
| | - Rick E Harrison
- Department of Pediatrics, Mattel Children's Hospital, University of California Los Angeles, Los Angeles, CA, United States
| | - Frank W Moler
- Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, MI, United States
| | - Murray M Pollack
- Department of Pediatrics, Children's National Medical Center, Washington D.C., United States; Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Todd C Carpenter
- Department of Pediatrics, Denver Children's Hospital, University of Colorado, Denver, CO, United States
| | - Daniel A Notterman
- Department of Molecular Biology, Princeton University, Princeton, New Jersey, United States
| | - Richard Holubkov
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States
| | - J Michael Dean
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | | | - Athena F Zuppa
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Katherine Graham
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Carolann Twelves
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Mary Ann Diliberto
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - William P Landis
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Elyse Tomanio
- Department of Pediatrics, Children's National Medical Center, Washington D.C., United States
| | - Jeni Kwok
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Michael J Bell
- Department of Pediatrics, Children's National Medical Center, Washington D.C., United States; Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, United States
| | - Alan Abraham
- Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA, United States
| | - Anil Sapru
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, United States; Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, United States
| | - Mustafa F Alkhouli
- Department of Pediatrics, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, United States
| | - Sabrina Heidemann
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, United States
| | - Ann Pawluszka
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit, MI, United States
| | - Mark W Hall
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States
| | - Lisa Steele
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus, OH, United States
| | - Thomas P Shanley
- Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, MI, United States; Department of Pediatrics, Lurie Children's Hospital, Northwestern University, Chicago, IL, United States
| | - Monica Weber
- Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, MI, United States
| | - Heidi J Dalton
- Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Aimee La Bell
- Department of Pediatrics, Phoenix Children's Hospital, Phoenix, AZ, United States
| | - Peter M Mourani
- Department of Pediatrics, Denver Children's Hospital, University of Colorado, Denver, CO, United States
| | - Kathryn Malone
- Department of Pediatrics, Denver Children's Hospital, University of Colorado, Denver, CO, United States
| | - Christopher Locandro
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States
| | - Whitney Coleman
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States
| | - Alecia Peterson
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States
| | - Julie Thelen
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, United States
| | - Allan Doctor
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
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22
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The Association of Hospital Rate of Delayed Epinephrine Administration With Survival to Discharge for Pediatric Nonshockable In-Hospital Cardiac Arrest. Pediatr Crit Care Med 2019; 20:405-416. [PMID: 30672841 DOI: 10.1097/pcc.0000000000001863] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the variation of hospital rates of delayed epinephrine administration in pediatric patients with nonshockable in-hospital cardiac arrest, and the association of those rates with event, 24-hour, and overall survival to hospital discharge. DESIGN A retrospective evaluation was performed. Delayed epinephrine was defined as greater than 5 minutes between the time the need for chest compressions was identified and epinephrine was administered. The main outcome was the association of hospital rate of delayed epinephrine administration with survival to hospital discharge. Secondary outcomes were event and 24-hour survival. Evaluation used hierarchical logistic regression and included 13 patient/event-level and seven hospital-level factors. SETTING Hospitals with greater than 6 months data in the American Heart Association's Get With the Guidelines-Resuscitation registry (2000-2016) and greater than or equal to five total pediatric cardiac arrests with nonshockable rhythm. PATIENTS Children less than 18 years old with index nonshockable in-hospital cardiac arrest treated with greater than or equal to one epinephrine dose. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS One-thousand four-hundred sixty-two patients at 69 hospitals were included: 218 patients (14.9%) had epinephrine delay rates ranging from 0% to 80% of events (median, 15.6%; interquartile range, 7-25%). The median and interquartile range of hospital level delay was 16% (7-25%). Patient/event-level predictors of delayed epinephrine were asystole (odds ratio, 1.54 [95% CI, 1.10-2.16]) and insertion of an endotracheal tube (odds ratio, 1.86 [95% CI, 1.27-2.73]). Hospital size less than 200 compared with greater than or equal to 500 beds (odds ratio, 3.07 [95% CI, 1.22-7.73]) and ICU location (odds ratio, 0.51 [95% CI, 0.36-0.74]) were associated with epinephrine delay rates. After adjustment, increasing quartiles of epinephrine delay were associated with lower patient and hospital-level return of spontaneous circulation (p = 0.019, p = 0.006) and 24-hour survival (p = 0.018, p = 0.002) respectively, but not survival to discharge (p = 0.20, p = 0.24). CONCLUSIONS Delayed epinephrine administration following pediatric nonshockable in-hospital cardiac arrest varies significantly between hospitals. Hospitals with higher rates of delayed epinephrine administration had worse patient- and hospital-level outcomes after adjusting for multiple patient- and hospital-level factors. Delayed epinephrine administration may directly contribute to increased mortality risk and/or may be a marker of unmeasured elements of hospital resuscitation performance.
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Khera R, Tang Y, Girotra S, Nadkarni VM, Link MS, Raymond TT, Guerguerian AM, Berg RA, Chan PS. Pulselessness After Initiation of Cardiopulmonary Resuscitation for Bradycardia in Hospitalized Children. Circulation 2019; 140:370-378. [PMID: 31006260 DOI: 10.1161/circulationaha.118.039048] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) is initiated in hospitalized children with bradycardia and poor perfusion. However, their rate of progression to pulseless cardiac arrest despite CPR and the differences in survival compared with initially pulseless arrest are unknown. We examined the prevalence and predictors of survival of children who progress from bradycardia to pulseless in-hospital cardiac arrest despite CPR. METHODS Pediatric patients >30 days and <18 years of age who received CPR at hospitals participating in Get With The Guidelines-Resuscitation during 2000 to 2016 were included. Each CPR event was classified as bradycardia with pulse, bradycardia with subsequent pulselessness, and initial pulseless cardiac arrest. We assessed risk-adjusted rates of survival to hospital discharge using multilevel Poisson regression models. RESULTS Overall, 5592 pediatric patients were treated with CPR, of whom 2799 (50.1%) received CPR for bradycardia with poor perfusion and 2793 (49.9%) for initial pulseless cardiac arrest. Among those with bradycardia, 869 (31.0%, or 15.5% of cohort) became pulseless after a median of 3 minutes of CPR (interquartile range, 1-9 minutes). Rates of survival to discharge were 70.0% (1351 of 1930) for bradycardia with pulse, 30.1% (262 of 869) for bradycardia progressing to pulselessness, and 37.5% (1046 of 2793) for initial pulseless cardiac arrest (P for difference across groups <0.001). Children who became pulseless despite CPR for bradycardia had a 19% lower likelihood (risk ratio, 0.81 [95% CI, 0.70, 0.93]; P=0.004) of surviving to hospital discharge than those who were initially pulseless. Among children who progressed to pulselessness despite CPR for bradycardia, a longer interval between CPR and pulselessness was a predictor of lower survival (reference, <2 minutes; for 2-5 minutes, risk ratio, 0.54 [95% CI, 0.41-0.70]; for >5 minutes, risk ratio, 0.41 [95% CI, 0.32-0.53]). CONCLUSIONS Among hospitalized children in whom CPR is initiated, half have bradycardia with poor perfusion at the initiation of chest compressions, and nearly one-third of these progress to pulseless in-hospital cardiac arrest despite CPR. Survival was significantly lower for children who progress to pulselessness despite CPR compared with those who were initially pulseless. These findings suggest that pediatric patients who lose their pulse despite resuscitation attempts are at particularly high risk and require a renewed focus on postresuscitation care.
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Affiliation(s)
- Rohan Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (R.K., M.S.L.)
| | - Yuanyuan Tang
- Mid-America Heart Institute, Kansas City, MO (Y.T., P.S.C.)
| | - Saket Girotra
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City (S.G.)
| | - Vinay M Nadkarni
- Children's Hospital of Philadelphia, PA (V.M.N., R.A.B.).,Department of Anesthesiology and Critical Care Medicine and Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia (V.M.N., R.A.B.)
| | - Mark S Link
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas (R.K., M.S.L.)
| | - Tia T Raymond
- Division of Pediatric Cardiac Critical Care, Department of Pediatrics, Medical City Children's Hospital, Dallas, TX (T.T.R.)
| | | | - Robert A Berg
- Children's Hospital of Philadelphia, PA (V.M.N., R.A.B.).,Department of Anesthesiology and Critical Care Medicine and Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia (V.M.N., R.A.B.)
| | - Paul S Chan
- Mid-America Heart Institute, Kansas City, MO (Y.T., P.S.C.).,Division of Cardiology, Department of Internal Medicine, University of Missouri-Kansas City (P.S.C.)
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24
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Vancomycin Prescribing and Therapeutic Drug Monitoring in Children With and Without Acute Kidney Injury After Cardiac Arrest. Paediatr Drugs 2019; 21:107-112. [PMID: 30864056 PMCID: PMC6526504 DOI: 10.1007/s40272-019-00328-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) commonly occurs after cardiac arrest. Those subsequently treated with vancomycin are at additional risk for drug-induced kidney injury. OBJECTIVE We aimed to determine whether opportunities exist for improved drug monitoring after cardiac arrest. METHODS This was a retrospective cohort study of children aged 30 days-17 years treated after cardiac arrest in an intensive care unit from January 2010 to September 2014 who received vancomycin within 24 h of arrest. Vancomycin dosing and monitoring were compared between those with and without AKI, with AKI defined as pRIFLE (pediatric risk, injury, failure, loss, end-stage renal disease) stage 2-3 AKI at day 5 using Schwartz formula-calculated estimated glomerular filtration rate (eGFR). RESULTS Of 43 children, 16 (37%) had AKI at day 5. Age, arrest duration, median time to first vancomycin dose, and the number of doses before and time to first vancomycin concentration measurement were similar between groups. Children with AKI had higher initial vancomycin concentrations than those without AKI (median 16 vs. 7 mg/L; p = 0.003). A concentration was not measured before the second dose in 44% of children with AKI. Initial eGFR predicted day 5 AKI. In children with AKI, the initial eGFR was lower in those with than those without a concentration measurement before the second dose (29 mL/min/1.73 m2 [interquartile range (IQR) 23-47] vs. 52 [IQR 50-57]; p = 0.03) but well below normal in both. CONCLUSIONS In children with AKI after cardiac arrest, decreased vancomycin clearance was evident early, and early monitoring was not performed universally in those with low initial eGFR. Earlier vancomycin therapeutic drug monitoring is indicated in this high-risk population.
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26
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Pollack MM, Holubkov R, Berg RA, Newth CJL, Meert KL, Harrison RE, Carcillo J, Dalton H, Wessel DL, Dean JM. Predicting cardiac arrests in pediatric intensive care units. Resuscitation 2018; 133:25-32. [PMID: 30261219 PMCID: PMC6258339 DOI: 10.1016/j.resuscitation.2018.09.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/22/2018] [Accepted: 09/19/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Early identification of children at risk for cardiac arrest would allow for skill training associated with improved outcomes and provides a prevention opportunity. OBJECTIVE Develop and assess a predictive model for cardiopulmonary arrest using data available in the first 4 h. METHODS Data from PICU patients from 8 institutions included descriptive, severity of illness, cardiac arrest, and outcomes. RESULTS Of the 10074 patients, 120 satisfying inclusion criteria sustained a cardiac arrest and 67 (55.9%) died. In univariate analysis, patients with cardiac arrest prior to admission were over 6 times and those with cardiac arrests during the first 4 h were over 50 times more likely to have a subsequent arrest. The multivariate logistic regression model performance was excellent (area under the ROC curve = 0.85 and Hosmer-Lemeshow statistic, p = 0.35). The variables with the highest odds ratio's for sustaining a cardiac arrest in the multivariable model were admission from an inpatient unit (8.23 (CI: 4.35-15.54)), and cardiac arrest in the first 4 h (6.48 (CI: 2.07-20.36). The average risk predicted by the model was highest (11.6%) among children sustaining an arrest during hours >4-12 and continued to be high even for days after the risk assessment period; the average predicted risk was 9.5% for arrests that occurred after 8 PICU days. CONCLUSIONS Patients at high risk of cardiac arrest can be identified with routinely available data after 4 h. The cardiac arrest may occur relatively close to the risk assessment period or days later.
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Affiliation(s)
- Murray M Pollack
- Department of Pediatrics, Children's National Health System and the George Washington University School of Medicine and Health Sciences, Washington DC, United States.
| | - Richard Holubkov
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States
| | - Robert A Berg
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Christopher J L Newth
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, University of Southern California Keck School of Medicine, Los Angeles, CA, United States
| | - Kathleen L Meert
- Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, United States
| | - Rick E Harrison
- Department of Pediatrics, University of California at Los Angeles, Los Angeles, CA, United States
| | - Joseph Carcillo
- Department of Critical Care Medicine, Children's Hospital of Pittsburgh, Pittsburgh, PA, United States
| | - Heidi Dalton
- Department of Child Health, Phoenix Children's Hospital and University of Arizona College of Medicine-Phoenix, Phoenix, AZ, United States(1)
| | - David L Wessel
- Department of Pediatrics, Children's National Medical Center, Washington DC, United States
| | - J Michael Dean
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, United States
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27
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Couto TB, Barreto JKS, Marcon FC, Mafra ACCN, Accorsi TAD. Detecting latent safety threats in an interprofessional training that combines in situ simulation with task training in an emergency department. Adv Simul (Lond) 2018; 3:23. [PMID: 30505467 PMCID: PMC6260660 DOI: 10.1186/s41077-018-0083-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 11/06/2018] [Indexed: 11/10/2022] Open
Abstract
Background During in situ simulation, interprofessional care teams practice in an area where clinical care occurs. This study aimed to detect latent safety threats (LST) in a training program, which combined in situ simulation scenarios with just-in-time and just-in-place self-directed task training in an emergency department. We hypothesized this simulation-based training in actual care areas allows the detection of at least one LST per simulation scenario. Methods This prospective observational study (April 2015–March 2016) involved 135 physicians, nurses, and nurse technicians. Training themes selected were arrhythmia, respiratory insufficiency, shock, and cardiopulmonary resuscitation. Simulation weeks occurred every 3 months, with three 10-min scheduled in situ simulation scenarios alternating for each theme daily. The scenarios were followed by co-debriefing by two facilitators (a physician and a nurse). LST were identified by facilitators using a debriefing checklist. Additionally, a room was set up with task-trainers related to each theme. Results The number participants in scenarios was 114 (84% of the population) and in task-training, 101. The number of scenario cancelations was nine, making the final total number to 49 of 58 proposed. Fifty-six LST were observed, with an average of 1.1 per scenario. LST were divided into four categories: equipment (n = 23, 41.1%), teamwork (n = 12, 21.4%), medication (n = 11, 19.6%), and others (n = 10, 17.9%). There was a higher proportion in equipment-related LST (p < 0.01). Conclusions The training allowed a high rate of detecting LST regardless of theme. Equipment-related LST were more frequently found. Electronic supplementary material The online version of this article (10.1186/s41077-018-0083-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomaz Bittencourt Couto
- 1Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, Bloco A-1 subsolo, Sao Paulo, SP CEP 05651-901 Brazil.,Centro de Simulação Realística Albert Einstein, Sao Paulo, Brazil
| | | | | | | | - Tarso Augusto Duenhas Accorsi
- 1Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, Bloco A-1 subsolo, Sao Paulo, SP CEP 05651-901 Brazil.,Centro de Simulação Realística Albert Einstein, Sao Paulo, Brazil
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28
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Chen GL, Qiao YR, Ma JH, Wang JX, Hei FL, Yu J. Extracorporeal Cardiopulmonary Resuscitation in Children of Asia Pacific: A Retrospective Analysis of Extracorporeal Life Support Organization Registry. Chin Med J (Engl) 2018; 131:1436-1443. [PMID: 29893360 PMCID: PMC6006813 DOI: 10.4103/0366-6999.233946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Recent advances in extracorporeal membrane oxygenation (ECMO) have led to increasing interest in its use during cardiopulmonary resuscitation (CPR). However, decisions regarding extracorporeal CPR (ECPR) in children are difficult as a result of limited studies, especially in Asia Pacific. The objective of this study was to investigate trends in survival and demographic details for children with ECPR in Asia Pacific recorded in the Extracorporeal Life Support Organization (ELSO) registry from 1999 to 2016 and identify the risk factors associated with in-hospital mortality. Methods The data of children younger than 18 years of age who received ECPR over the past 18 years in Asia Pacific were retrospectively analyzed. The data were extracted from the ELSO registry and divided into two 9-year groups (Group 1: 1999-2007 and Group 2: 2008-2016) to assess temporal changes using univariate analysis. Then, univariate and multiple logistic regression analyses were performed between survivors and nonsurvivors to identify factors independently associated with in-hospital mortality. Results A total of 321 children were included in final analysis, with an overall survival rate of 50.8%. Although survival rates were similar between Group 1 and Group 2 (43.1% vs. 52.5%, χ2 = 1.67, P = 0.196), the median age (1.7 [0.3, 19.2] months for Group 1 vs. 5.6 [0.8, 64.9] months for Group 2, t = -2.93, P = 0.003) and weight (3.7 [3.0, 11.5] kg for Group 1 vs. 6.0 [3.4, 20.3] kg for Group 2, t = -3.14, P = 0.002) of children increased over time, while the proportion of congenital heart disease (75.9% for Group 1 vs. 57.8% for Group 2, χ2 = 6.52, P = 0.011) and cardiogenic shock (36.2% for Group 1 vs. 7.2% for Group 2, χ2 = 36.59, P < 0.001) decreased. Patient conditions before ECMO were worse, while ECMO complications decreased across time periods, especially renal complications. Multiple logistic regression analysis of ECMO complications showed that disseminated intravascular coagulation (DIC), myocardial stunning, and neurological complications were independently associated with increased odds of hospital mortality. Conclusions The broader indications and decreased complication rates make EPCR to be applicated more and more extensive in children in Asia Pacific region. ECMO complications such as myocardial stunning are independently associated with decreased survival.
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Affiliation(s)
- Gai-Ling Chen
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Ye-Ru Qiao
- Department of Extracorporeal Circulation, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jin-Hui Ma
- Department of Extracorporeal Circulation, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jian-Xin Wang
- Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - Fei-Long Hei
- Department of Extracorporeal Circulation, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Jie Yu
- Department of Extracorporeal Circulation, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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29
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AlSohime F, NurHussen A, Temsah MH, Alabdulhafez M, Al-Eyadhy A, Hasan GM, Al-Huzaimi A, AlKanhal A, Almanie D. Factors that influence the self-reported confidence of pediatric residents as team leaders during cardiopulmonary resuscitation: A national survey. Int J Pediatr Adolesc Med 2018; 5:116-121. [PMID: 30805545 PMCID: PMC6363252 DOI: 10.1016/j.ijpam.2018.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 07/09/2018] [Accepted: 07/15/2018] [Indexed: 11/26/2022]
Abstract
Objective The leadership skills of pediatric residents during cardiopulmonary resuscitation (CPR) may have major impacts on their performance. These skills should be addressed during the pediatric residency training program. Therefore, we aimed to identify the perceptions of residents regarding their level of confidence in providing or leading a real pediatric CPR code, and to identify different factors that might influence their self-confidence when assuming the role of a team leader during a real CPR. Design & setting Cross-sectional paper-based and online electronic surveys were conducted in February 2017, which included all Saudi pediatric residency program trainees. Interventions A survey questionnaire was distributed to Saudi pediatric residency trainees throughout the Kingdom. The main aim was to assess their perceived level of confidence when running a real pediatric CPR code either as a team leader or as a team member. Results The survey was distributed and sent by email to 1052 residents, where it was received by 640 and 231 responded (response rate = 36%). Almost one-fifth of the respondents (19.5%) did not have a valid pediatric advanced life support (PALS) certificate. The most frequently reported obstacles to life support training were lack of time (45.8%) and its financial cost (22.7%). The mean self-reported confidence as a CPR team member was reported significantly more frequently than being a CPR team leader (mean standard deviation, SD) = 7.8 (2.1) and 6.7 (2.4) respectively, P < .001). The self-reported confidence as a CPR team leader was reported significantly more frequently in males compared with female respondents (mean ± SD = 6.7 ± 2.4 and 5.9 ± 2.4, respectively; P < .013). There was a significant positive effect of recent attendance at a real CPR event on the perceived self-rated confidence of residents as a CPR team leader (P < .001). Residents who reported that they had often assumed a real CPR leadership role had significantly greater perceived self-confidence compared with those who assumed a member role (P < .05). Furthermore, residents without a valid PALS certificate had significantly less confidence in leading CPR teams than their peers who were recently certified (P < .05). Conclusions The self-reported confidence as team leader during CPR was higher among residents who were certified in life support courses, exposed to CPR during their training, and those who assumed the role of a team leader during CPR. Our findings suggests the need to incorporate life support training courses and simulation-based mock code programs with an emphasis on the leadership in the curriculum of the pediatric residency training program.
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Affiliation(s)
- Fahad AlSohime
- College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Akram NurHussen
- Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia.,College of Medicine, Sulaiman Al Rajhi Colleges, Al Bukairyah, Saudi Arabia
| | - Mohamad-Hani Temsah
- College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia.,Prince Abdullah Bin Khaled Coeliac Disease Research Chair, Department of Pediatrics, Faculty of Medicine, King Saud University, Saudi Arabia
| | - Majed Alabdulhafez
- College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ayman Al-Eyadhy
- College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Gamal M Hasan
- Pediatric Department, King Saud University Medical City, Riyadh, Saudi Arabia.,Pediatric Department, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Abdullah Al-Huzaimi
- College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Cardiac Science Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Abdulrahman AlKanhal
- College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Cardiac Science Department, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Deemah Almanie
- College of Medicine, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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30
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Du Pont-Thibodeau G, Fry M, Kirschen M, Abend NS, Ichord R, Nadkarni VM, Berg R, Topjian A. Timing and modes of death after pediatric out-of-hospital cardiac arrest resuscitation. Resuscitation 2018; 133:160-166. [PMID: 30118814 DOI: 10.1016/j.resuscitation.2018.08.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 08/08/2018] [Accepted: 08/13/2018] [Indexed: 12/18/2022]
Abstract
AIM To determine the timing and modes of death of children admitted to a pediatric critical care unit (PICU) of a tertiary care center after an out-of-hospital cardiac arrest (OHCA). METHODS This is a retrospective descriptive study at a tertiary care PICU of all consecutive patients <18 years old who received ≥1 min of chest compressions, had return of spontaneous circulation (ROSC) for ≥20 min, and were admitted to the PICU after an OHCA. Modes of death were classified as brain death (BD), withdrawal due to neurologic prognosis (W/D-neuro), withdrawal for refractory circulatory failure (W/D-RCF), and re-arrest without ROSC (RA). RESULTS 191 consecutive patients were admitted to the PICU from February 2005 to May 2013 after an OHCA. Eighty-six(45%) patients died prior to discharge: BD in 47%(40/86), W/D-neuro in 34%(29/86), W/D-RCF in 10%(9/86), and RA in 9%(8/86). Time to death was longer for patients with W/D-neuro: 4 days [1, 5] and BD 4 days [1, 5](p < 0.01) as opposed to those with W/D-RCF (1 day[1, 2]) and RA(1 day[0.5, 1]). Of patients who underwent W/D-neuro, 9/29(31%) died within 3 days of PICU admission and 20/29(69%) ≥3 days. Of patients who died after W/D-neuro, 12/29(41%) received therapeutic hypothermia, 27/29(93%) underwent EEG monitoring, 21/29(72%) had a brain CT, and 13/29(45%) had a brain MRI. All MRIs showed signs of hypoxic-ischemic injury. CONCLUSION Neurologic injury was the most common mode of death post-resuscitation care OHCA after in a tertiary care center PICU. Neurologic prognostication impacts the outcome of a large proportion of patients after OHCA, and further studies are warranted to improve its reliability.
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Affiliation(s)
- Geneviève Du Pont-Thibodeau
- Department of Pediatrics, Sainte-Justine University Hospital, University of Montreal, Montreal, Quebec, Canada.
| | - Michael Fry
- The Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, United States; Department of Anesthesiology and Critical Care Medicine, United States
| | - Matthew Kirschen
- The Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, United States; Department of Anesthesiology and Critical Care Medicine, United States; Department of Neurology, United States
| | - Nicholas S Abend
- The Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, United States; Department of Neurology, United States
| | - Rebecca Ichord
- The Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, United States; Department of Neurology, United States
| | - Vinay M Nadkarni
- The Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, United States; Department of Anesthesiology and Critical Care Medicine, United States
| | - Robert Berg
- The Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, United States; Department of Anesthesiology and Critical Care Medicine, United States
| | - Alexis Topjian
- The Children's Hospital of Philadelphia, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, United States; Department of Anesthesiology and Critical Care Medicine, United States
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31
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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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Berg RA, Sutton RM, Reeder RW, Berger JT, Newth CJ, Carcillo JA, McQuillen PS, Meert KL, Yates AR, Harrison RE, Moler FW, Pollack MM, Carpenter TC, Wessel DL, Jenkins TL, Notterman DA, Holubkov R, Tamburro RF, Dean JM, Nadkarni VM. Association Between Diastolic Blood Pressure During Pediatric In-Hospital Cardiopulmonary Resuscitation and Survival. Circulation 2018; 137:1784-1795. [PMID: 29279413 PMCID: PMC5916041 DOI: 10.1161/circulationaha.117.032270] [Citation(s) in RCA: 112] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/07/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND On the basis of laboratory cardiopulmonary resuscitation (CPR) investigations and limited adult data demonstrating that survival depends on attaining adequate arterial diastolic blood pressure (DBP) during CPR, the American Heart Association recommends using blood pressure to guide pediatric CPR. However, evidence-based blood pressure targets during pediatric CPR remain an important knowledge gap for CPR guidelines. METHODS All children ≥37 weeks' gestation and <19 years old in Collaborative Pediatric Critical Care Research Network intensive care units with chest compressions for ≥1 minute and invasive arterial blood pressure monitoring before and during CPR between July 1, 2013, and June 31, 2016, were included. Mean DBP during CPR and Utstein-style standardized cardiac arrest data were collected. The hypothesis was that DBP ≥25 mm Hg during CPR in infants and ≥30 mm Hg in children ≥1 year old would be associated with survival. Primary outcome was survival to hospital discharge. Secondary outcome was survival to hospital discharge with favorable neurological outcome, defined as Pediatric Cerebral Performance Categories 1 to 3 or no worse than prearrest baseline. Multivariable Poisson regression models with robust error estimates were used to estimate the relative risk of outcomes. RESULTS Blinded investigators analyzed blood pressure waveforms during CPR from 164 children, including 60% <1 year old, 60% with congenital heart disease, and 54% after cardiac surgery. The immediate cause of arrest was hypotension in 67%, respiratory decompensation in 44%, and arrhythmia in 19%. Median duration of CPR was 8 minutes (quartiles, 3 and 27 minutes). Ninety percent survived the event, 68% with return of spontaneous circulation and 22% by extracorporeal life support. Forty-seven percent survived to hospital discharge, and 43% survived to discharge with favorable neurological outcome. Maintaining mean DBP ≥25 mm Hg in infants and ≥30 mm Hg in children ≥1 year old occurred in 101 of 164 children (62%) and was associated with survival (adjusted relative risk, 1.7; 95% confidence interval, 1.2-2.6; P=0.007) and survival with favorable neurological outcome (adjusted relative risk, 1.6; 95% confidence interval, 1.1-2.5; P=0.02). CONCLUSIONS These data demonstrate that mean DBP ≥25 mm Hg during CPR in infants and ≥30 mm Hg in children ≥1 year old was associated with greater likelihood of survival to hospital discharge and survival with favorable neurological outcome.
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Affiliation(s)
- Robert A Berg
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania (R.A.B., R.M.S., V.M.N).
| | - Robert M Sutton
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania (R.A.B., R.M.S., V.M.N)
| | - Ron W Reeder
- Department of Pediatrics, University of Utah, Salt Lake City (R.W.R., R.H., J.M.D.)
| | - John T Berger
- Department of Pediatrics, Children's National Medical Center, Washington, DC (J.T.B., M.M.P., D.L.W.)
| | - Christopher J Newth
- Department of Anesthesiology, Children's Hospital of Los Angeles, University of Southern California Keck College of Medicine (C.J.N.)
| | - Joseph A Carcillo
- Department of Critical Care Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh, PA (J.A.C.)
| | - Patrick S McQuillen
- Department of Pediatrics, Benioff Children's Hospital, University of California, San Francisco (P.S.M.)
| | - Kathleen L Meert
- Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit (K.L.M.)
| | - Andrew R Yates
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University, Columbus (A.R.Y.)
| | - Rick E Harrison
- Department of Pediatrics, Mattel Children's Hospital, University of California, Los Angeles (R.E.H.)
| | - Frank W Moler
- Department of Pediatrics, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor (F.W.M.)
| | - Murray M Pollack
- Department of Pediatrics, Children's National Medical Center, Washington, DC (J.T.B., M.M.P., D.L.W.)
- Department of Pediatrics, Phoenix Children's Hospital, AZ (M.M.P.)
| | - Todd C Carpenter
- Department of Pediatrics, Denver Children's Hospital, University of Colorado, Aurora (T.C.C.)
| | - David L Wessel
- Department of Pediatrics, Children's National Medical Center, Washington, DC (J.T.B., M.M.P., D.L.W.)
| | - Tammara L Jenkins
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (T.L.J., R.F.T.)
| | | | - Richard Holubkov
- Department of Pediatrics, University of Utah, Salt Lake City (R.W.R., R.H., J.M.D.)
| | - Robert F Tamburro
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD (T.L.J., R.F.T.)
| | - J Michael Dean
- Department of Pediatrics, University of Utah, Salt Lake City (R.W.R., R.H., J.M.D.)
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania (R.A.B., R.M.S., V.M.N)
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Marino BS, Tabbutt S, MacLaren G, Hazinski MF, Adatia I, Atkins DL, Checchia PA, DeCaen A, Fink EL, Hoffman GM, Jefferies JL, Kleinman M, Krawczeski CD, Licht DJ, Macrae D, Ravishankar C, Samson RA, Thiagarajan RR, Toms R, Tweddell J, Laussen PC. Cardiopulmonary Resuscitation in Infants and Children With Cardiac Disease: A Scientific Statement From the American Heart Association. Circulation 2018; 137:e691-e782. [PMID: 29685887 DOI: 10.1161/cir.0000000000000524] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cardiac arrest occurs at a higher rate in children with heart disease than in healthy children. Pediatric basic life support and advanced life support guidelines focus on delivering high-quality resuscitation in children with normal hearts. The complexity and variability in pediatric heart disease pose unique challenges during resuscitation. A writing group appointed by the American Heart Association reviewed the literature addressing resuscitation in children with heart disease. MEDLINE and Google Scholar databases were searched from 1966 to 2015, cross-referencing pediatric heart disease with pertinent resuscitation search terms. The American College of Cardiology/American Heart Association classification of recommendations and levels of evidence for practice guidelines were used. The recommendations in this statement concur with the critical components of the 2015 American Heart Association pediatric basic life support and pediatric advanced life support guidelines and are meant to serve as a resuscitation supplement. This statement is meant for caregivers of children with heart disease in the prehospital and in-hospital settings. Understanding the anatomy and physiology of the high-risk pediatric cardiac population will promote early recognition and treatment of decompensation to prevent cardiac arrest, increase survival from cardiac arrest by providing high-quality resuscitations, and improve outcomes with postresuscitation care.
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Derivation and Internal Validation of a Mortality Prediction Tool for Initial Survivors of Pediatric In-Hospital Cardiac Arrest. Pediatr Crit Care Med 2018; 19:186-195. [PMID: 29239980 PMCID: PMC5834369 DOI: 10.1097/pcc.0000000000001416] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To develop a clinical prediction score for predicting mortality in children following return of spontaneous circulation after in-hospital cardiac arrest. DESIGN Observational study using prospectively collected data. SETTING This was an analysis using data from the Get With The Guidelines-Resuscitation registry between January 2000 and December 2015. PATIENTS Pediatric patients (< 18 yr old) who achieved return of spontaneous circulation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The primary outcome was in-hospital mortality. Patients were divided into a derivation (3/4) and validation (1/4) cohort. A prediction score was developed using a multivariable logistic regression model with backward selection. Patient and event characteristics for the derivation cohort (n = 3,893) and validation cohort (n = 1,297) were similar. Seventeen variables associated with the outcome remained in the final reduced model after backward elimination. Predictors of in-hospital mortality included age, illness category, pre-event characteristics, arrest location, day of the week, nonshockable pulseless rhythm, duration of chest compressions, and interventions in place at time of arrest. The C-statistic for the final score was 0.77 (95% CI, 0.75-0.78) in the derivation cohort and 0.77 (95% CI, 0.74-0.79) in the validation cohort. The expected versus observed mortality plot indicated good calibration in both the derivation and validation cohorts. The score showed a stepwise increase in mortality with an observed mortality of less than 15% for scores 0-9 and greater than 80% for scores greater than or equal to 25. The model also performed well for neurologic outcome and in sensitivity analyses for events within the past 5 years and for patients with or without a pulse at the onset of chest compressions. CONCLUSIONS We developed and internally validated a prediction score for initial survivors of pediatric in-hospital cardiac arrest. This prediction score may be useful for prognostication following cardiac arrest, stratifying patients for research, and guiding quality improvement initiatives.
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Kung SW, Yung TC, Chiu WK. Successful Resuscitation of Out-Of-Hospital Ventricular Fibrillation Cardiac Arrest in an Adolescent. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791001700509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cardiac arrest in the paediatric age group is uncommon. Successful resuscitation of out-of-hospital cardiac arrest in children with subsequent hospital discharge and normal neurological outcome is even rarer. A 14-year-old girl who presented with recurrent convulsive syncope was misdiagnosed to be suffering from epilepsy. Subsequently she was witnessed to have cardiac arrest and was successfully resuscitated. Catecholaminergic polymorphic ventricular tachycardia was suspected to be the underlying cause of her symptoms. This case illustrated the important concept of the paediatric chain of survival in the prevention of death and improvement of survival in paediatric cardiac arrest.
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Affiliation(s)
| | - TC Yung
- Queen Mary Hospital, Department of Paediatric Cardiology, 102 Pokfulam Road, Pokfulam, Hong Kong
| | - WK Chiu
- United Christian Hospital, Department of Paediatrics and Adolescent Medicine, 130 Hip Woo Street, Kwun Tong, Kowloon, Hong Kong
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Cardiac Arrest in Children. CURRENT ANESTHESIOLOGY REPORTS 2017. [DOI: 10.1007/s40140-017-0215-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Siebert JN, Ehrler F, Gervaix A, Haddad K, Lacroix L, Schrurs P, Sahin A, Lovis C, Manzano S. Adherence to AHA Guidelines When Adapted for Augmented Reality Glasses for Assisted Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial. J Med Internet Res 2017; 19:e183. [PMID: 28554878 PMCID: PMC5468544 DOI: 10.2196/jmir.7379] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 04/03/2017] [Accepted: 04/28/2017] [Indexed: 12/18/2022] Open
Abstract
Background The American Heart Association (AHA) guidelines for cardiopulmonary resuscitation (CPR) are nowadays recognized as the world’s most authoritative resuscitation guidelines. Adherence to these guidelines optimizes the management of critically ill patients and increases their chances of survival after cardiac arrest. Despite their availability, suboptimal quality of CPR is still common. Currently, the median hospital survival rate after pediatric in-hospital cardiac arrest is 36%, whereas it falls below 10% for out-of-hospital cardiac arrest. Among emerging information technologies and devices able to support caregivers during resuscitation and increase adherence to AHA guidelines, augmented reality (AR) glasses have not yet been assessed. In order to assess their potential, we adapted AHA Pediatric Advanced Life Support (PALS) guidelines for AR glasses. Objective The study aimed to determine whether adapting AHA guidelines for AR glasses increased adherence by reducing deviation and time to initiation of critical life-saving maneuvers during pediatric CPR when compared with the use of PALS pocket reference cards. Methods We conducted a randomized controlled trial with two parallel groups of voluntary pediatric residents, comparing AR glasses to PALS pocket reference cards during a simulation-based pediatric cardiac arrest scenario—pulseless ventricular tachycardia (pVT). The primary outcome was the elapsed time in seconds in each allocation group, from onset of pVT to the first defibrillation attempt. Secondary outcomes were time elapsed to (1) initiation of chest compression, (2) subsequent defibrillation attempts, and (3) administration of drugs, as well as the time intervals between defibrillation attempts and drug doses, shock doses, and number of shocks. All these outcomes were assessed for deviation from AHA guidelines. Results Twenty residents were randomized into 2 groups. Time to first defibrillation attempt (mean: 146 s) and adherence to AHA guidelines in terms of time to other critical resuscitation endpoints and drug dose delivery were not improved using AR glasses. However, errors and deviations were significantly reduced in terms of defibrillation doses when compared with the use of the PALS pocket reference cards. In a total of 40 defibrillation attempts, residents not wearing AR glasses used wrong doses in 65% (26/40) of cases, including 21 shock overdoses >100 J, for a cumulative defibrillation dose of 18.7 Joules per kg. These errors were reduced by 53% (21/40, P<.001) and cumulative defibrillation dose by 37% (5.14/14, P=.001) with AR glasses. Conclusions AR glasses did not decrease time to first defibrillation attempt and other critical resuscitation endpoints when compared with PALS pocket cards. However, they improved adherence and performance among residents in terms of administering the defibrillation doses set by AHA.
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Affiliation(s)
- Johan N Siebert
- Geneva Children's Hospital, Department of Pediatric Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Frederic Ehrler
- Division of Medical Information Sciences, Department of Radiology and Medical Informatics, University Hospitals of Geneva, Geneva, Switzerland
| | - Alain Gervaix
- Geneva Children's Hospital, Department of Pediatric Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Kevin Haddad
- Geneva Children's Hospital, Department of Pediatric Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Laurence Lacroix
- Geneva Children's Hospital, Department of Pediatric Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
| | - Philippe Schrurs
- Geneva Medical Center, University Hospitals of Geneva, Geneva, Switzerland
| | - Ayhan Sahin
- Geneva Medical Center, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Lovis
- Division of Medical Information Sciences, Department of Radiology and Medical Informatics, University Hospitals of Geneva, Geneva, Switzerland
| | - Sergio Manzano
- Geneva Children's Hospital, Department of Pediatric Emergency Medicine, University Hospitals of Geneva, Geneva, Switzerland
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Pediatric out-of-hospital cardiac arrest caused by left coronary-artery agenesis with primary shockable rhythm. Am J Emerg Med 2017; 35:1718-1723. [PMID: 28549578 DOI: 10.1016/j.ajem.2017.05.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/09/2017] [Accepted: 05/10/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To illustrate a rare cause of out-of-hospital cardiac arrest in children, its differential diagnoses, emergency and subsequent treatment at various steps in the rescue chain, and potential outcomes. CASE PRESENTATION A 4-year-old boy with unknown agenesis of the left coronary ostium sustained out-of-hospital cardiac arrest. Bystander cardio-pulmonary resuscitation was initiated and defibrillation was performed via an automated external defibrillator (AED) shortly after paramedics arrived at the scene, restoring sinus rhythm and spontaneous circulation. After admission to the intensive care unit the child was intubated for airway and seizure control. Further diagnostic work-up by angiography revealed agenesis of the left coronary artery. After initial seizures, the boy's neurological recovery was complete. He subsequently underwent successful internal mammary artery in-situ bypass surgery to the trunk of the left coronary artery. One year after cardiac arrest, the patient had completely recovered with no physical or intellectual sequelae. A catheter examination proved excellent growth of the bypass and good cardiac function. CONCLUSIONS This case illustrates the long term outcome after agenesis of the LCA while reiterating that prompt access to pediatric defibrillation may be lifesaving-albeit in a minority of pediatric OHCA.
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Smereka J, Szarpak L, Rodríguez-Núñez A, Ladny JR, Leung S, Ruetzler K. A randomized comparison of three chest compression techniques and associated hemodynamic effect during infant CPR: A randomized manikin study. Am J Emerg Med 2017; 35:1420-1425. [PMID: 28433454 DOI: 10.1016/j.ajem.2017.04.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 04/08/2017] [Accepted: 04/13/2017] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Pediatric cardiac arrest is an uncommon but critical life-threatening event requiring effective cardiopulmonary resuscitation. High-quality cardio-pulmonary resuscitation (CPR) is essential, but is poorly performed, even by highly skilled healthcare providers. The recently described two-thumb chest compression technique (nTTT) consists of the two thumbs directed at the angle of 90° to the chest while having the fingers fist-clenched. This technique might facilitate adequate chest-compression depth, chest-compression rate and rate of full chest-pressure relief. METHODS 42 paramedics from the national Emergency Medical Service of Poland performed three single-rescuer CPR sessions for 10 minutes each. Each session was randomly assigned to the conventional two-thumb (TTHT), the conventional two-finger (TFT) or the nTTT. The manikin used for this study was connected with an arterial blood pressure measurement device and blood measurements were documented on a 10-seconds cycle. RESULTS The nTTT provided significant higher systolic (82 vs. 30 vs. 41 mmHg). A statistically significant difference was noticed between nTTT and TFT (p<.001), nTTT and TTHT (p<0.001), TFT and TTHT (p=0.003). The median diastolic preassure using nTTT was 16 mmHg compared with 9 mmHg for TFT (p<0.001), and 9.5 mmHg for TTHT (p<0.001). Mean arterial pressure using distinct methods varied and amounted to 40 vs. 22. vs. 26 mmHg (nTTT vs. TFT vs. TTHT, respectively). A statistically significant difference was noticed between nTTT and TFT (p<0.001), nTTT and TTEHT (p<0.001), and TFT and TTHT (p<0.001). The highest median pulse pressure was obtained by the nTTT 67.5 mmHg. Pulse pressure was 31.5 mmHg in the TTHT and 24 mmHg in the TFT. The difference between TFT and TTHT (p=0.025), TFT and nTTT (p<0.001), as well as between TTHT and nTTT (p<0.001) were statistically significant. CONCLUSIONS The new nTTT technique generated higher arterial blood pressures compared to established chest compression techniques using an infant manikin model, suggesting a more effective chest compression. Our results have important clinical implications as nTTT was simple to perform and could be widely taught to both healthcare professionals and bystanders. Whether this technique translates to improved outcomes over existing techniques needs further animal studies and subsequent human trials.
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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.
| | - Antonio Rodríguez-Núñez
- Paediatric Emergency and Critical Care Division, Clinical University Hospital, University of Santiago de Compostela, Santiago de Compostela, Institute of Research of Santiago [IDIS] and SAMID Network, Spain
| | - Jerzy R Ladny
- Department of Emergency Medicine and Disaster, Medical University Bialystok, Bialystok, 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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Siebert JN, Ehrler F, Combescure C, Lacroix L, Haddad K, Sanchez O, Gervaix A, Lovis C, Manzano S. A Mobile Device App to Reduce Time to Drug Delivery and Medication Errors During Simulated Pediatric Cardiopulmonary Resuscitation: A Randomized Controlled Trial. J Med Internet Res 2017; 19:e31. [PMID: 28148473 PMCID: PMC5311423 DOI: 10.2196/jmir.7005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/11/2017] [Indexed: 11/18/2022] Open
Abstract
Background During pediatric cardiopulmonary resuscitation (CPR), vasoactive drug preparation for continuous infusion is both complex and time-consuming, placing children at higher risk than adults for medication errors. Following an evidence-based ergonomic-driven approach, we developed a mobile device app called Pediatric Accurate Medication in Emergency Situations (PedAMINES), intended to guide caregivers step-by-step from preparation to delivery of drugs requiring continuous infusion. Objective The aim of our study was to determine whether the use of PedAMINES reduces drug preparation time (TDP) and time to delivery (TDD; primary outcome), as well as medication errors (secondary outcomes) when compared with conventional preparation methods. Methods The study was a randomized controlled crossover trial with 2 parallel groups comparing PedAMINES with a conventional and internationally used drugs infusion rate table in the preparation of continuous drug infusion. We used a simulation-based pediatric CPR cardiac arrest scenario with a high-fidelity manikin in the shock room of a tertiary care pediatric emergency department. After epinephrine-induced return of spontaneous circulation, pediatric emergency nurses were first asked to prepare a continuous infusion of dopamine, using either PedAMINES (intervention group) or the infusion table (control group), and second, a continuous infusion of norepinephrine by crossing the procedure. The primary outcome was the elapsed time in seconds, in each allocation group, from the oral prescription by the physician to TDD by the nurse. TDD included TDP. The secondary outcome was the medication dosage error rate during the sequence from drug preparation to drug injection. Results A total of 20 nurses were randomized into 2 groups. During the first study period, mean TDP while using PedAMINES and conventional preparation methods was 128.1 s (95% CI 102-154) and 308.1 s (95% CI 216-400), respectively (180 s reduction, P=.002). Mean TDD was 214 s (95% CI 171-256) and 391 s (95% CI 298-483), respectively (177.3 s reduction, P=.002). Medication errors were reduced from 70% to 0% (P<.001) by using PedAMINES when compared with conventional methods. Conclusions In this simulation-based study, PedAMINES dramatically reduced TDP, to delivery and the rate of medication errors.
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Affiliation(s)
- Johan N Siebert
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Frederic Ehrler
- Department of Radiology and Medical Informatics, Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Christophe Combescure
- Department of Health and Community Medicine, Division of Clinical Epidemiology, University of Geneva and University Hospitals of Geneva, Geneva, Switzerland
| | - Laurence Lacroix
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Kevin Haddad
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Oliver Sanchez
- Department of Pediatric Surgery, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Alain Gervaix
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
| | - Christian Lovis
- Department of Radiology and Medical Informatics, Division of Medical Information Sciences, University Hospitals of Geneva, Geneva, Switzerland
| | - Sergio Manzano
- Department of Pediatric Emergency Medicine, Geneva Children's Hospital, University Hospitals of Geneva, Geneva, Switzerland
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Calhoun AW, Sutton ERH, Barbee AP, McClure B, Bohnert C, Forest R, Taillac P, Fallat ME. Compassionate Options for Pediatric EMS (COPE): Addressing Communication Skills. PREHOSP EMERG CARE 2017; 21:334-343. [PMID: 28103120 DOI: 10.1080/10903127.2016.1263370] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Each year, 16,000 children suffer cardiopulmonary arrest, and in one urban study, 2% of pediatric EMS calls were attributed to pediatric arrests. This indicates a need for enhanced educational options for prehospital providers that address how to communicate to families in these difficult situations. In response, our team developed a cellular phone digital application (app) designed to assist EMS providers in self-debriefing these events, thereby improving their communication skills. The goal of this study was to pilot the app using a simulation-based investigative methodology. METHODS Video and didactic app content was generated using themes developed from a series of EMS focus groups and evaluated using volunteer EMS providers assessed during two identical nonaccidental trauma simulations. Intervention groups interacted with the app as a team between assessments, and control groups debriefed during that period as they normally would. Communication performance and gap analyses were measured using the Gap-Kalamazoo Consensus Statement Assessment Form. RESULTS A total of 148 subjects divided into 38 subject groups (18 intervention groups and 20 control groups) were assessed. Comparison of initial intervention group and control group scores showed no statistically significant difference in performance (2.9/5 vs. 3.0/5; p = 0.33). Comparisons made during the second assessment revealed a statistically significant improvement in the intervention group scores, with a moderate to large effect size (3.1/5 control vs. 4.0/5 intervention; p < 0.001, r = 0.69, absolute value). Gap analysis data showed a similar pattern, with gaps of -0.6 and -0.5 (values suggesting team self-over-appraisal of communication abilities) present in both control and intervention groups (p = 0.515) at the initial assessment. This gap persisted in the control group at the time of the second assessment (-0.8), but was significantly reduced (0.04) in the intervention group (p = 0.013, r = 0.41, absolute value). CONCLUSION These results suggest that an EMS-centric app containing guiding information regarding compassionate communication skills can be effectively used by EMS providers to self-debrief after difficult events in the absence of a live facilitator, significantly altering their near-term communication patterns. Gap analysis data further imply that engaging with the app in a group context positively impacts the accuracy of each team's self-perception.
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Gebreegziabher Gebremedhn E, Berhe Gebregergs G, Anderson BB, Nagaratnam V. Attitude and skill levels of graduate health professionals in performing cardiopulmonary resuscitation. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2017; 8:43-50. [PMID: 28123315 PMCID: PMC5234554 DOI: 10.2147/amep.s114726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Cardiopulmonary resuscitation (CPR) is an emergency procedure used to treat victims following cardiopulmonary arrest. Graduate health professionals at the University of Gondar Teaching Hospital manage many trauma and critically ill patients. The chance of survival after cardiopulmonary arrest may be increased with sufficient attitude and skill levels. The study aimed to assess the attitude and skill levels of graduate health professionals in performing CPR. METHODS A hospital-based cross-sectional study was conducted from May 1 to 30, 2013, at the University of Gondar Teaching Hospital. The mean attitude and skill scores were compared for sex, original residence, and department of the participants using Student's t-test and analysis of variance (Scheffe's test). P-values <0.05 were considered to be statistically significant. RESULTS Of the 506 graduates, 461 were included in this study with a response rate of 91.1%. The mean attitude scores of nurse, interns, health officer, midwifery, anesthesia, and psychiatric nursing graduates were 1.15 (standard deviation [SD] =1.67), 8.21 (SD =1.24), 7.2 (SD =1.49), 6.69 (SD =1.83), 8.19 (SD =1.77), and 7.29 (SD =2.01), respectively, and the mean skill scores were 2.34 (SD =1.95), 3.77 (SD =1.58), 1.18 (SD =1.52), 2.16 (SD =1.93), 3.88 (SD =1.36), and 1.21 (SD =1.77), respectively. CONCLUSION AND RECOMMENDATIONS Attitude and skill level of graduate health professionals with regard to CPR were insufficient. Training on CPR for graduate health professionals needs to be given emphasis.
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Affiliation(s)
| | - Gebremedhn Berhe Gebregergs
- Department of Public Health, Bahir Dar College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar
| | - Bernard Bradley Anderson
- Department of Surgery, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Vidhya Nagaratnam
- Department of Anaesthesia, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar
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Peer SM, Ramakrishnan K, Wade JR, Endicott KM, Jonas RA, Nath DS. Rapid Response Extracorporeal Membrane Oxygenation Deployment-Surgical Technique. World J Pediatr Congenit Heart Surg 2016; 7:753-757. [PMID: 27834771 DOI: 10.1177/2150135116662632] [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: 04/17/2016] [Accepted: 07/12/2016] [Indexed: 11/17/2022]
Abstract
The availability of extracorporeal membrane oxygenation (ECMO) is the standard of care at most high-acuity congenital heart surgery programs. Extracorporeal membrane oxygenation is also an integral part of managing children with in-hospital cardiac arrest refractory to conventional cardiopulmonary resuscitation (extracorporeal cardiopulmonary resuscitation). In this article, we aim to provide a practical guide to initiate rapid ECMO in a nonoperating room setting.
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Affiliation(s)
- Syed M Peer
- Division of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Karthik Ramakrishnan
- Department of Cardiothoracic Surgery, Children's National Medical Center, Washington DC, USA
| | - James R Wade
- Division of Cardiothoracic Surgery, Virginia Commonwealth University, Richmond, VA, USA
| | - Kendal M Endicott
- Department of Cardiothoracic Surgery, Children's National Medical Center, Washington DC, USA
| | - Richard A Jonas
- Department of Cardiothoracic Surgery, Children's National Medical Center, Washington DC, USA
| | - Dilip S Nath
- Department of Cardiothoracic Surgery, Children's National Medical Center, Washington DC, USA
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Abstract
Extracorporeal membrane oxygenation (ECMO) is a highly technical and complex method of life support. Patient and circuit emergencies on ECMO are rare, but in these cases, prompt and correct actions to address the crisis are needed to prevent morbidity and mortality. ECMO simulation programs have gained popularity in recent years, as they provide a standardized educational experience for all members of the inter-professional care team. In addition to providing a context in which to solidify knowledge of ECMO support, participants are also able to focus on vital technical and behavioral skills that are not highlighted in other training methodologies. ECMO simulation can also be used for quality improvement, clinical and educational research, and assessment/credentialing. Multi-organizational international collaboratives have formed, and are working to standardize ECMO education training across institutions; simulation will play an essential role in this process.
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Affiliation(s)
- Lindsay Johnston
- Division of Neonatology, Yale University School of Medicine, PO Box 208064, New Haven, CT 06520-8064.
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Andersen LW, Raymond TT, Berg RA, Nadkarni VM, Grossestreuer AV, Kurth T, Donnino MW. Association Between Tracheal Intubation During Pediatric In-Hospital Cardiac Arrest and Survival. JAMA 2016; 316:1786-1797. [PMID: 27701623 PMCID: PMC6080953 DOI: 10.1001/jama.2016.14486] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Tracheal intubation is common during pediatric in-hospital cardiac arrest, although the relationship between intubation during cardiac arrest and outcomes is unknown. OBJECTIVE To determine if intubation during pediatric in-hospital cardiac arrest is associated with improved outcomes. DESIGN, SETTING, AND PARTICIPANTS Observational study of data from United States hospitals in the Get With The Guidelines-Resuscitation registry. Pediatric patients (<18 years) with index in-hospital cardiac arrest between January 2000 and December 2014 were included. Patients who were receiving assisted ventilation, had an invasive airway in place, or both at the time chest compressions were initiated were excluded. EXPOSURES Tracheal intubation during cardiac arrest . MAIN OUTCOMES AND MEASURES The primary outcome was survival to hospital discharge. Secondary outcomes included return of spontaneous circulation and neurologic outcome. A favorable neurologic outcome was defined as a score of 1 to 2 on the pediatric cerebral performance category score. Patients being intubated at any given minute were matched with patients at risk of being intubated within the same minute (ie, still receiving resuscitation) based on a time-dependent propensity score calculated from multiple patient, event, and hospital characteristics. RESULTS The study included 2294 patients; 1308 (57%) were male, and all age groups were represented (median age, 7 months [25th-75th percentiles, 21 days, 4 years]). Of the 2294 included patients, 1555 (68%) were intubated during the cardiac arrest. In the propensity score-matched cohort (n = 2270), survival was lower in those intubated compared with those not intubated (411/1135 [36%] vs 460/1135 [41%]; risk ratio [RR], 0.89 [95% CI, 0.81-0.99]; P = .03). There was no significant difference in return of spontaneous circulation (770/1135 [68%] vs 771/1135 [68%]; RR, 1.00 [95% CI, 0.95-1.06]; P = .96) or favorable neurologic outcome (185/987 [19%] vs 211/983 [21%]; RR, 0.87 [95% CI, 0.75-1.02]; P = .08) between those intubated and not intubated. The association between intubation and decreased survival was observed in the majority of the sensitivity and subgroup analyses, including when accounting for missing data and in a subgroup of patients with a pulse at the beginning of the event. CONCLUSIONS AND RELEVANCE Among pediatric patients with in-hospital cardiac arrest, tracheal intubation during cardiac arrest compared with no intubation was associated with decreased survival to hospital discharge. Although the study design does not eliminate the potential for confounding, these findings do not support the current emphasis on early tracheal intubation for pediatric in-hospital cardiac arrest.
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Affiliation(s)
- Lars W Andersen
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts2Department of Anesthesiology, Aarhus University Hospital, Aarhus, Denmark3Research Center for Emergency Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Tia T Raymond
- Division of Cardiac Critical Care, Department of Pediatrics, Medical City Children's Hospital, Dallas, Texas
| | - Robert A Berg
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania6Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia7Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Vinay M Nadkarni
- Department of Anesthesiology and Critical Care, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania6Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia7Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Anne V Grossestreuer
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia9Now with the Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Tobias Kurth
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael W Donnino
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts11Department of Medicine, Division of Pulmonary and Critical Care Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Abstract
OBJECTIVES To determine the incidence of cardiopulmonary resuscitation in PICUs and subsequent outcomes. DESIGN, SETTING, AND PATIENTS Multicenter prospective observational study of children younger than 18 years old randomly selected and intensively followed from PICU admission to hospital discharge in the Collaborative Pediatric Critical Care Research Network December 2011 to April 2013. RESULTS Among 10,078 children enrolled, 139 (1.4%) received cardiopulmonary resuscitation for more than or equal to 1 minute and/or defibrillation. Of these children, 78% attained return of circulation, 45% survived to hospital discharge, and 89% of survivors had favorable neurologic outcomes. The relative incidence of cardiopulmonary resuscitation events was higher for cardiac patients compared with non-cardiac patients (3.4% vs 0.8%, p <0.001), but survival rate to hospital discharge with favorable neurologic outcome was not statistically different (41% vs 39%, respectively). Shorter duration of cardiopulmonary resuscitation was associated with higher survival rates: 66% (29/44) survived to hospital discharge after 1-3 minutes of cardiopulmonary resuscitation versus 28% (9/32) after more than 30 minutes (p < 0.001). Among survivors, 90% (26/29) had a favorable neurologic outcome after 1-3 minutes versus 89% (8/9) after more than 30 minutes of cardiopulmonary resuscitation. CONCLUSIONS These data establish that contemporary PICU cardiopulmonary resuscitation, including long durations of cardiopulmonary resuscitation, results in high rates of survival-to-hospital discharge (45%) and favorable neurologic outcomes among survivors (89%). Rates of survival with favorable neurologic outcomes were similar among cardiac and noncardiac patients. The rigorous prospective, observational study design avoided the limitations of missing data and potential selection biases inherent in registry and administrative data.
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Neurologic outcome after cardiac arrest: What you see at hospital discharge may or may not be what you get. Resuscitation 2016; 102:A1-2. [PMID: 26956839 DOI: 10.1016/j.resuscitation.2016.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 02/29/2016] [Indexed: 11/21/2022]
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Basismaßnahmen der kardiopulmonalen Reanimation bei Kindern und Jugendlichen. Monatsschr Kinderheilkd 2016. [DOI: 10.1007/s00112-016-0043-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Manchester LC, Lee V, Schmithorst V, Kochanek PM, Panigrahy A, Fink EL. Global and Regional Derangements of Cerebral Blood Flow and Diffusion Magnetic Resonance Imaging after Pediatric Cardiac Arrest. J Pediatr 2016; 169:28-35.e1. [PMID: 26561380 PMCID: PMC4729616 DOI: 10.1016/j.jpeds.2015.10.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 08/19/2015] [Accepted: 10/01/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To quantify and examine the relationship between global and regional cerebral blood flow (CBF) and water diffusion on brain magnetic resonance imaging (MRI) in children after cardiac arrest. STUDY DESIGN Children admitted to a tertiary care children's hospital from July 2011 to April 2013 who received a brain MRI within 2 weeks after cardiac arrest that included arterial spin labeling and apparent diffusion coefficient (ADC) sequences were studied. CBF and ADC values were calculated globally and in 19 regions of interest. Outcome variables included survival and favorable neurologic outcome, which was defined as Pediatric Cerebral Performance Category ≤3 at 6 months. We examined global and regional relationships between CBF and ADC and their association with outcome. RESULTS This sample included 14 pediatric patients (mean time to MRI 6 ± 4 days), 9 of whom survived and 6 who survived with favorable outcome. Global ADC was significantly decreased in patients with unfavorable outcome (P = .02). Increased CBF and decreased ADC often were colocalized in the same region, especially in children who had unfavorable outcomes. CONCLUSIONS In this exploratory study, global restricted water diffusion on ADC after pediatric cardiac arrest was associated with unfavorable outcome. MRI assessments of perfusion and diffusion may have prognostic value after pediatric cardiac arrest.
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Affiliation(s)
| | - Vince Lee
- Department of Radiology, Children’s Hospital of Pittsburgh
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Zimmerman E, Cohen N, Maniaci V, Pena B, Lozano JM, Linares M. Use of a Metronome in Cardiopulmonary Resuscitation: A Simulation Study. Pediatrics 2015; 136:905-11. [PMID: 26459645 DOI: 10.1542/peds.2015-1858] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Determine whether the use of a metronome improves chest compression rate and depth during cardiopulmonary resuscitation (CPR) on a pediatric manikin. METHODS A prospective, simulation-based, crossover, randomized controlled trial was conducted. Participants included pediatric residents, fellows, nurses, and medical students who were randomly assigned to perform chest compressions on a pediatric manikin with and without an audible metronome. Each participant performed 2 rounds of 2 minutes of chest compressions separated by a 15-minute break. RESULTS A total of 155 participants performed 2 rounds of chest compressions (74 with the metronome on during the first round and 81 with the metronome on during the second round of CPR). There was a significant improvement in the mean percentage of compressions delivered within an adequate rate (90-100 compressions per minute) with the metronome on compared with off (72% vs 50%; mean difference [MD] 22%; 95% confidence interval [CI], 15% to 29%). No significant difference was noted in the mean percentage of compressions within acceptable depth (38-51 mm) (72% vs 70%; MD 2%; 95% CI, -2% to 6%). The metronome had a larger effect among medical students (73% vs 55%; MD 18%; 95% CI, 8% to 28%) and pediatric residents and fellows (84% vs 48%; MD 37%; 95% CI, 27% to 46%) but not among pediatric nurses (46% vs 48%; MD -3%; 95% CI, -19% to 14%). CONCLUSIONS The rate of chest compressions during CPR can be optimized by the use of a metronome. These findings will help medical professionals comply with the American Heart Association guidelines.
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Affiliation(s)
- Elise Zimmerman
- Department of Emergency Medicine, Nicklaus Children's Hospital, Miami, Florida; and
| | - Naiomi Cohen
- Department of Emergency Medicine, Nicklaus Children's Hospital, Miami, Florida; and
| | - Vincenzo Maniaci
- Department of Emergency Medicine, Nicklaus Children's Hospital, Miami, Florida; and
| | - Barbara Pena
- Department of Emergency Medicine, Nicklaus Children's Hospital, Miami, Florida; and
| | - Juan Manuel Lozano
- Department of Medical and Health Sciences Research, Florida International University Herbert Wertheim College of Medicine, Miami, Florida
| | - Marc Linares
- Department of Emergency Medicine, Nicklaus Children's Hospital, Miami, Florida; and
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