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Al-Eyadhy A, Almazyad M, Hasan G, AlKhudhayri N, AlSaeed AF, Habib M, Alhaboob AAN, AlAyed M, AlSehibani Y, Alsohime F, Alabdulhafid M, Temsah MH. Outcomes of Cardiopulmonary Resuscitation in the Pediatric Intensive Care of a Tertiary Center. J Pediatr Intensive Care 2023; 12:303-311. [PMID: 37970137 PMCID: PMC10631842 DOI: 10.1055/s-0041-1733855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 07/04/2021] [Indexed: 10/20/2022] Open
Abstract
Understanding the factors affecting survival and modifying the preventable factors may improve patient outcomes following cardiopulmonary resuscitation (CPR). The aim of this study was to assess the prevalence and outcomes of cardiac arrest and CPR events in a tertiary pediatric intensive care unit (PICU). Outcomes of interest were the return of spontaneous circulation (ROSC) lasting more than 20 minutes, survival for 24 hours post-CPR, and survival to hospital discharge. We analyzed data from the PICU CPR registry from January 1, 2011 to January 1, 2018. All patients who underwent at least 2 minutes of CPR in the PICU were included. CPR was administered in 65 PICU instances, with a prevalence of 1.85%. The mean patient age was 32.7 months. ROSC occurred in 38 (58.5%) patients, 30 (46.2%) achieved 24-hour survival, and 21 (32.3%) survived to hospital discharge. Younger age ( p < 0.018), respiratory cause ( p < 0.001), bradycardia ( p < 0.018), and short duration of CPR ( p < 0.001) were associated with better outcomes, while sodium bicarbonate, norepinephrine, and vasopressin were associated with worse outcome ( p < 0.009). The off-hour CPR had no impact on the outcome. The patients' cumulative predicted survival declined by an average of 8.7% for an additional 1 minute duration of CPR ( p = 0.001). The study concludes that the duration of CPR, therefore, remains one of the crucial factors determining CPR outcomes and needs to be considered in parallel with the guideline emphasis on CPR quality. The lower survival rate post-ROSC needs careful consideration during parental counseling. Better anticipation and prevention of CPR remain ongoing challenges.
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Affiliation(s)
- Ayman Al-Eyadhy
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pediatrics, Pediatric Intensive Care Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed Almazyad
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pediatrics, Pediatric Intensive Care Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Gamal Hasan
- Department of Pediatrics, Pediatric Intensive Care Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Department of Pediatrics, Assiut Faculty of Medicine, Assiut University, Assiut, Egypt
- Department of Pediatrics, Pediatric Critical Care Unit, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | | | - Mohammed Habib
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ali A. N. Alhaboob
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pediatrics, Pediatric Intensive Care Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed AlAyed
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Fahad Alsohime
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pediatrics, Pediatric Intensive Care Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Majed Alabdulhafid
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pediatrics, Pediatric Intensive Care Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mohamad-Hani Temsah
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Department of Pediatrics, Pediatric Intensive Care Unit, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Al-Eyadhy A, Almazyad M, Hasan G, Almuhaideb Q, AbuDujain N, Alhaboob AAN, Alfawaz F, Alshenaifi S, Alfayez F, Aljebrin Y, Alsohime F, Alabdulhafid M, Temsah MH. The burden of viral infections in pediatric intensive care unit between endemic and pandemic coronavirus infections: A tertiary care center experience. J Infect Chemother 2022; 29:20-25. [PMID: 36103948 PMCID: PMC9464359 DOI: 10.1016/j.jiac.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022]
Abstract
Objectives To measure the prevalence of viral infections, length of stay (LOS), and outcome in children admitted to the pediatric intensive care unit (PICU) during the period preceding the COVID-19 pandemic in a MERS-CoV endemic country. Methods A retrospective chart review of children 0–14 years old admitted to PICU with a viral infection. Results Of 1736 patients, 164 patients (9.45%) had a positive viral infection. The annual prevalence trended downward over a three-year period, from 11.7% to 7.3%. The median PICU LOS was 11.6 days. Viral infections were responsible for 1904.4 (21.94%) PICU patient-days. Mechanical ventilation was used in 91.5% of patients, including noninvasive and invasive modes. Comorbidities were significantly associated with intubation (P-value = 0.025). Patients infected with multiple viruses had median pediatric index of mortality 2 (PIM 2) scores of 4, as compared to 1 for patients with single virus infections (p < 0.001), and a median PICU LOS of 12 days, compared to 4 in the single-virus group (p < 0.001). Overall, mortality associated with viral infections in PICU was 7 (4.3%). Patients with viral infections having multiple organ failure were significantly more likely to die in the PICU (p = 0.001). Conclusion Viral infections are responsible for one-fifth of PICU patient-days, with a high demand for mechanical ventilation. Patients with multiple viral infections had longer LOS, and higher PIM 2 scores. The downward trend in the yearly rate of PICU admissions for viral infections between the end of the MERS-CoV outbreak and the start of the COVID-19 pandemic may suggest viral interference that warrants further investigations.
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Affiliation(s)
- Ayman Al-Eyadhy
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
| | - Mohammed Almazyad
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Gamal Hasan
- Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia; Assiut Faculty of Medicine, Assiut University, Egypt; Pediatric Critical Care Unit, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | | | - Ali A N Alhaboob
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | | | | | - Fahad Alfayez
- College of Medicine, King Saud University, Saudi Arabia
| | | | - Fahad Alsohime
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Majed Alabdulhafid
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mohamad-Hani Temsah
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Pediatric Intensive Care Unit, Department of Pediatrics, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
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Al-Eyadhy AA, Temsah MH, Alhaboob AAN, Aldubayan AK, Almousa NA, Alsharidah AM, Alangari MI, Alshaya AM. Asthma changes at a pediatric intensive care unit after 10 years: Observational study. Ann Thorac Med 2015; 10:243-8. [PMID: 26664561 PMCID: PMC4652289 DOI: 10.4103/1817-1737.165302] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES: To describe the change in the management, and outcome of children with acute severe asthma (ASA) admitted to Pediatric Intensive Care Unit (PICU) at tertiary institute, as compared to previously published report in 2003. METHODS: This is a retrospective observational study. All consecutive pediatric ASA patients who were admitted to PICU during the study period were included. The data were extracted from PICU database and medical records. The Cohort in this study (2013 Cohort) was compared with the Cohort of ASA, which was published in 2003 from the same institution (2003 Cohort). RESULTS: In comparison to previous 2003 Cohort, current Cohort (2013) revealed higher mean age (5.5 vs. 3.6 years; P ≤ 0.001), higher rate of PICU admission (20.3% vs. 3.6%; P ≤ 0.007), less patients who received maintenance inhaled steroids (43.3% vs. 62.4%; P ≤ 0.03), less patients with pH <7.3 (17.9% vs. 42.9%; P ≤ 0.001). There were more patients in 2013 Cohort who received: Inhaled Ipratropium bromide (97% vs. 68%; P ≤ 0.001), intravenous magnesium sulfate (68.2% vs. none), intravenous salbutamol (13.6% vs. 3.6%; P ≤ 0.015), and noninvasive ventilation (NIV) (35.8% vs. none) while no patients were treated with theophylline (none vs. 62.5%). The median length of stay (LOS) was 2 days while mean LOS was half a day longer in the 2013 Cohort. None of our patients required intubation, and there was no mortality. CONCLUSION: We observed slight shift toward older age, considerably increased the rate of PICU admission, increased utilization of Ipratropium bromide, magnesium sulfate, and NIV as important modalities of treatment.
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Affiliation(s)
- Ayman A Al-Eyadhy
- Pediatric Intensive Care Unit, Department of Pediatrics, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Mohamad-Hani Temsah
- Pediatric Intensive Care Unit, Department of Pediatrics, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Ali A N Alhaboob
- Pediatric Intensive Care Unit, Department of Pediatrics, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abdulmalik K Aldubayan
- Pediatric Intensive Care Unit, Department of Pediatrics, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Nasser A Almousa
- Pediatric Intensive Care Unit, Department of Pediatrics, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman M Alsharidah
- Pediatric Intensive Care Unit, Department of Pediatrics, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed I Alangari
- Pediatric Intensive Care Unit, Department of Pediatrics, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
| | - Abdulrahman M Alshaya
- Pediatric Intensive Care Unit, Department of Pediatrics, College of Medicine, King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia
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