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We report on in-hospital cardiac arrest outcomes in the USA. The data were obtained from the National (Nationwide) Inpatient Sample datasets for the years 2000–2017, which includes data from participating hospitals in 47 US states and the District of Columbia. We included pediatric patients (< 18 years of age) with cardiac arrest, and we excluded p...
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The sign of contrast agent pooling (C.A.P.) in dependent part of the venous system were reported in some case reports, which happened in the patients before sudden cardiac arrest. Until now, there is no solid evidence enough to address the importance of the sign. This study aimed to assess the accuracy of the C.A.P. sign in predicting im...
Background:
The use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) for hemodynamic support is on the rise. Not much is known about the impact of extracorporeal membrane oxygenation (ECMO) and its complications on long-term survival and quality of life.
Methods:
In this single-center, cross-sectional study, we evaluated the surviv...
Background
Extracorporeal membrane oxygenation (ECMO) patients have a high incidence of acute kidney injury (AKI). Extracorporeal cardiopulmonary resuscitation (ECPR) patients are more likely to develop AKI than ECMO patients because of serious injury during cardiac arrest (CA).
Objectives
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Objectives:
Veno-arterial extracorporeal membrane oxygenation (ECMO) is increasingly used to treat high-risk pulmonary embolism (PE). However, its efficacy and safety remain uncertain. This retrospective cohort study aimed to determine whether ECMO could improve the clinical outcomes of patients with high-risk PE.
Methods:
Forty patients with hi...
Background: The aim of this study was to analyze the effect of extracorporeal cardiopulmonary resuscitation on survival and neurological outcomes in in-hospital cardiac arrest patients.
Methods: Between January 2018 and December 2020, a total of 22 patients (17 males, 5 females; mean age: 52.8±9.0 years; range, 32 to 70 years) treated with extracor...
Citations
... A meta-analysis that included 141 studies conducted in North America, Europe, Asia, and Oceania on CPA in adults in the outof-hospital setting found spontaneous circulation return rates of 29.7%, with a survival rate of less than 10%. [22][23][24][25][26][27] The literature still lacks similar data related to the pediatric age group. ...
... A study conducted in the USA with the pediatric age group showed a mortality rate of more than 60% due to CPA in hospitals. 22 In addition, as shown in a Brazilian observational study including CPR care delivered both on individual and team levels in a pediatric hospital, there is low adherence to the Pediatric Advanced Life Support protocol among health care professionals; this information is aligned with the mortality results found in the present study, since the quality of resuscitation directly impacts the survival of these individuals. 18 The comparative analysis between primary causes of death and CPA as a notified event in a population sample is pioneering in the scientific literature and allows the understanding of comorbidities and etiologies most associated with this event, tracing a profile of individuals at greater risk of presenting CPA and progressing to death, so that these deaths can be prevented. ...
Background:
In pediatrics, cardiopulmonary arrest (CPA) is associated with high mortality and severe neurologic sequelae. Information on the causes and mechanisms of death below the age of 20 years could provide theoretical support for health improvement among children and adolescents.
Objectives:
To conduct a population analysis of mortality rates due to primary and multiple causes of death below the age of 20 years in both sexes from 1996 to 2019 in Brazil, and identify the frequency in which CPA was recorded in the death certificates (DCs) of these individuals and the locations where the deaths occurred, in order to promote strategies to improve the prevention of deaths.
Method:
Ecological time-series study of deaths below the age of 20 years from 1996 to 2019, evaluating the mortality rates (MRs) and proportional mortality (PM) by primary cause of death. We analyzed the percentages of CPA recorded in any line of the DC and the location where the deaths occurred. We calculated the MRs per 100,000 inhabitants and the PM by primary cause of death under the age of 20 years according to sex and age group, the percentages of death from primary causes by age group when CPA was described in any line of Parts I and II of the DC, and the percentage of deaths from primary causes according to their location of occurrence. We retrieved the data from DATASUS, IBGE, and SINASC.
Results:
From 1996 to 2019, there were 2,151,716 deaths below the age of 20 years in Brazil, yielding a mortality rate of 134.38 per 100,000 inhabitants. The death rate was highest among male neonates. Of all deaths, 249,334 (11.6%) had CPA recorded in any line of the DC. Specifically, CPA was recorded in 49,178 DCs between the ages of 1 and 4 years and in 88,116 of those between the ages of 29 and 365 days, corresponding, respectively, to 26% and 22% of the deaths in these age groups. These two age groups had the highest rates of CPA recorded in any line of the DC. The main primary causes of death when CPA was recorded in the sequence of death were respiratory, hematologic, and neoplastic diseases.
Conclusion:
Perinatal and external causes were the primary causes of death, with highest MRs under the age of 20 years in Brazil from 1996 to 2019. When multiple causes of death were considered, the main primary causes associated with CPA were respiratory, hematologic, and neoplastic diseases. Most deaths occurred in the hospital environment. Better understanding of the sequence of events in these deaths and improvements in teaching strategies in pediatric cardiopulmonary resuscitation are needed.
... This improvement in survival over the past 18 years is in part due to the improved quality of resuscitation practices, such as high-quality chest compressions with minimal interruptions, use of extracorporeal membrane oxygenation during resuscitation, and post-resuscitation care [1]. A detailed analysis of peri-arrest management is necessary, as it is associated with high mortality and morbidity and places a heavy burden on hospitals [3]. IHCA occurs more frequently in intensive care units despite being highly monitored because of the severity of illness. ...
Aim: The incidence of pediatric in-hospital cardiac arrest (IHCA) is between 2-6%. There is significant morbidity and mortality associated with these events which leads to tremendous burden on the hospital resources. It is necessary to fully analyze these events. This study aimed at evaluating the survival predictors after in-hospital pediatric cardiac arrest.
Methods: Patients aged <18 years who received cardiopulmonary resuscitation (CPR) for > 1 min during their hospital stay between June 1, 2015, and May 31, 2020, were included. We examined the pre arrest, intra arrest, and post arrest factors. Analysis of risk factors between survivors and non-survivors to discharge was performed on a complete-case basis and all tests were two-tailed and performed at a significance level of 0.05.
Results: Of the 144 cardiac arrest events included in the study, the survival to hospital discharge was 58%. Pre-arrest factors associated with survival in the univariate model were median age < 1-year, female sex, and factors associated with lower survival were hematological/oncological disease, cyanotic congenital heart disease, and presence of central and arterial lines. In a multivariable regression model, the following factors were associated with mortality: CPR duration > 14 minutes (aOR 12.3, 95% CI-4.8-31.5, p<0.001), serum lactate > 8 mg/dl (aOR 10, 95% CI, 2.7-38.7; p<0.001), number of epinephrine doses (aOR 1.24, 95% CI-1.13-1.37, p<0.001), number of sodium bicarbonate doses (aOR 1.81, 95% CI-0.6-2.7, p<0.001), and fluid administration (aOR 1.06, 95% CI-1.03-1.09, p<0.001), all with p-values <0.001.
Conclusion: We identified modifiable factors in in-hospital cardiac arrest associated with survival: fewer doses of epinephrine, CPR duration <14 minutes, fluid boluses < 10 ml/kg, inciting event of arrest due to bradycardia or hypoxia from respiratory failure, post arrest serum lactate level <8 mg/dl, and fewer doses of sodium bicarbonate. Considering these factors during resuscitation could aid healthcare practitioners in predicting children at risk of poor prognosis, allowing appropriate treatment decisions, improving resuscitation methods, and counseling families.
... There were 4 observational studies in children. [41][42][43][44] All studies included patients with IHCA. Years of inclusion ranged from 2000 to 2017. ...
Objectives
To provide an updated systematic review on the use of extracorporeal cardiopulmonary resuscitation (ECPR) compared with manual or mechanical cardiopulmonary resuscitation during cardiac arrest.
Methods
This was an update of a systematic review published in 2018. OVID Medline, Embase, and the Cochrane Central Register of Controlled Trials were searched for randomized trials and observational studies between January 1, 2018, and June 21, 2022. The population included adults and children with out-of-hospital or in-hospital cardiac arrest. Two investigators reviewed studies for relevance, extracted data, and assessed bias. The certainty of evidence was evaluated using GRADE.
Results
The search identified 3 trials, 27 observational studies, and 6 cost-effectiveness studies. All trials included adults with out-of-hospital cardiac arrest and were terminated before enrolling the intended number of subjects. One trial found a benefit of ECPR in survival and favorable neurological status, whereas two trials found no statistically significant differences in outcomes. There were 23 observational studies in adults with out-of-hospital cardiac arrest or in combination with in-hospital cardiac arrest, and 4 observational studies in children with in-hospital cardiac arrest. Results of individual studies were inconsistent, although many studies favored ECPR. The risk of bias was intermediate for trials and critical for observational studies. The certainty of evidence was very low to low. Study heterogeneity precluded meta-analyses. The cost-effectiveness varied depending on the setting and the analysis assumptions.
Conclusions
Recent randomized trials suggest potential benefit of ECPR, but the certainty of evidence remains low. It is unclear which patients might benefit from ECPR.
... There are over 15,000 pediatric in-hospital cardiac arrests requiring CPR per year in the United States, with several studies documenting an increase in survival over time (10, 11, 124, 125). Pediatric IHCA occurs in 2-6% of intensive care admissions, and the majority of arrests occur in intensively monitored patients (90%) with a secured airway (80%) (11,(126)(127)(128). Survival rates for pediatric IHCA are 40-49% with 34-90% of survivors achieving favorable neurological outcome depending on the study (11,15,128,129). ...
... Pediatric IHCA occurs in 2-6% of intensive care admissions, and the majority of arrests occur in intensively monitored patients (90%) with a secured airway (80%) (11,(126)(127)(128). Survival rates for pediatric IHCA are 40-49% with 34-90% of survivors achieving favorable neurological outcome depending on the study (11,15,128,129). Additionally, over 5,000 children experience non-traumatic OHCA annually (130). ...
... In fact, ECPR was used in 27% of arrests between 2014 and 2016 according to the Pediatric Cardiac Critical Care Consortium registry (154). Use of ECPR for refractory IHCA has increased threefold in the last two decades according to the National Inpatient Sample dataset (128). Overall, registry analyses show ECPR survival is 27-44% for IHCA with neurologically favorable outcomes in 56-73% of survivors (150)(151)(152)155). ...
Extracorporeal cardiopulmonary resuscitation (ECPR) is an adjunct supportive therapy to conventional cardiopulmonary resuscitation (CCPR) employing veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in the setting of refractory cardiac arrest. Its use has seen a significant increase in the past decade, providing hope for good functional recovery to patients with cardiac arrest refractory to conventional resuscitation maneuvers. This review paper aims to summarize key findings from the ECPR literature available to date as well as the recommendations for ECPR set forth by leading national and international resuscitation societies. Additionally, we describe the successful pediatric ECPR program at Texas Children's Hospital, highlighting the logistical, technical and educational features of the program.
BACKGROUND
cardiorespiratory arrest (CRA) is a severe public health concern, and clinical simulation has proven to be a beneficial educational strategy for training on this topic.
OBJECTIVE
To describe the implementation of a program for pediatric cardiac arrest care using rapid-cycle deliberate practice (RCDP), the quality of the technique employed, and participants' opinions on the methodology.
DESIGN AND SETTING
This descriptive cross-sectional study of pre- and post-performance training in cardiopul monary resuscitation (CPR) techniques and reaction evaluation was conducted in a hospital in São Paulo.
METHODS
Multidisciplinary groups performed pediatric resuscitation in a simulated scenario with RCDP mediated by a facilitator. The study sample included professionals working in patient care. During the simulation, the participants were evaluated for their compliance with the CRA care algorithm. Further, their execution of chest compressions was assessed pre- and post-intervention.
RESULTS
In total, 302 professionals were trained in this study. The overall quality of CPR measured pre-intervention was inadequate, and only 26% had adequate technique proficiency, whereas it was 91% (P < 0.01) post-intervention. Of the participants, 95.7% responded to the final evaluation and provided positive comments on the method and their satisfaction with the novel simulation. Of these, 88% considered that repetition of the technique used was more effective than traditional simulation.
CONCLUSIONS
The RCDP is effective for training multidisciplinary teams in pediatric CPR, with an emphasis on the quality of chest compressions. However, further studies are necessary to explore whether this trend translates to differential performances in practical settings.
KEYWORDS (MeSH terms):
Simulation training; Interprofessional education; Cardiopulmonary resuscitation; Continuing education
AUTHOR KEYWORDS:
Rapid-cycle deliberate practice; Simulation; Pediatric resuscitation; Learner perception; Heart Attack
Extracorporeal Cardiopulmonary Resuscitation (ECPR) has potential benefits compared to conventional Cardiopulmonary Resuscitation (CCPR) in children. Although no randomised trials for paediatric ECPR have been conducted, there is extensive literature on survival, neurological outcome and risk factors for survival. Based on current literature and guidelines, we suggest recommendations for deployment of paediatric ECPR emphasising the requirement for protocols, training, and timely intervention to enhance patient outcomes. Factors related to outcomes of paediatric ECPR include initial underlying rhythm, CCPR duration, quality of CCPR, medications during CCPR, cannulation site, acidosis and renal dysfunction. Based on current evidence and experience, we provide an approach to patient selection, ECMO initiation and management in ECPR regarding blood and sweep flow settings, unloading of the left ventricle, diagnostics whilst on ECMO, temperature targets, neuromonitoring as well as suggested weaning and decannulation strategies.
Objectives
The objective of this study was to determine the association of the use of extracorporeal cardiopulmonary resuscitation (ECPR) with survival to hospital discharge in pediatric patients with a noncardiac illness category. A secondary objective was to report on trends in ECPR usage in this population for 20 years.
Design
Retrospective multicenter cohort study.
Setting
Hospitals contributing data to the American Heart Association’s Get With The Guidelines-Resuscitation registry between 2000 and 2021.
Patients
Children (<18 yr) with noncardiac illness category who received greater than or equal to 30 minutes of cardiopulmonary resuscitation (CPR) for in-hospital cardiac arrest.
Interventions
None.
Measurements and Main Results
Propensity score weighting balanced ECPR and conventional CPR (CCPR) groups on hospital and patient characteristics. Multivariable logistic regression incorporating these scores tested the association of ECPR with survival to discharge. A Bayesian logistic regression model estimated the probability of a positive effect from ECPR. A secondary analysis explored temporal trends in ECPR utilization. Of 875 patients, 159 received ECPR and 716 received CCPR. The median age was 1.0 [interquartile range: 0.2–7.0] year. Most patients (597/875; 68%) had a primary diagnosis of respiratory insufficiency. Median CPR duration was 45 [35–63] minutes. ECPR use increased over time ( p < 0.001). We did not identify differences in survival to discharge between the ECPR group (21.4%) and the CCPR group (16.2%) in univariable analysis ( p = 0.13) or propensity-weighted multivariable logistic regression (adjusted odds ratio 1.42 [95% CI, 0.84–2.40; p = 0.19]). The Bayesian model estimated an 85.1% posterior probability of a positive effect of ECPR on survival to discharge.
Conclusions
ECPR usage increased substantially for the last 20 years. We failed to identify a significant association between ECPR and survival to hospital discharge, although a post hoc Bayesian analysis suggested a survival benefit (85% posterior probability).
The International Liaison Committee on Resuscitation engages in a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation and first aid science. Draft Consensus on Science With Treatment Recommendations are posted online throughout the year, and this annual summary provides more concise versions of the final Consensus on Science With Treatment Recommendations from all task forces for the year. Topics addressed by systematic reviews this year include resuscitation of cardiac arrest from drowning, extracorporeal cardiopulmonary resuscitation for adults and children, calcium during cardiac arrest, double sequential defibrillation, neuroprognostication after cardiac arrest for adults and children, maintaining normal temperature after preterm birth, heart rate monitoring methods for diagnostics in neonates, detection of exhaled carbon dioxide in neonates, family presence during resuscitation of adults, and a stepwise approach to resuscitation skills training. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the quality of the evidence, using Grading of Recommendations Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence-to-Decision Framework Highlights sections. In addition, the task forces list priority knowledge gaps for further research. Additional topics are addressed with scoping reviews and evidence updates.
Background:
Mechanical circulatory support (MCS) is a common treatment modality for circulatory failure caused by pediatric myocarditis. Despite improvements in treatment strategy, the mortality rate of pediatric patients with myocarditis treated with MCS is still high. Identifying the factors associated with mortality among pediatric patients with myocarditis treated with MCS may help reduce the mortality rate.
Methods:
This retrospective cohort study examined the data of patients aged <16 years who were admitted to a hospital between July 2010 and March 2018 for myocarditis; the data were collected from the Diagnosis Procedure Combination database, which is a national inpatient database in Japan.
Results:
During the study period, 105 of the 598 patients with myocarditis were treated with MCS. We excluded seven patients who died within 24 h of admission, resulting in 98 eligible patients. The overall in-hospital mortality was 22 %. In-hospital mortality was higher among patients aged <2 years and those who received cardiopulmonary resuscitation (CPR). Multivariable logistic regression analysis showed significantly higher in-hospital mortality among patients aged <2 years old [odds ratio (OR), 6.57; 95 % confidence interval (CI), 1.89-22.87] and those who received CPR (OR, 4.70; 95 % CI, 1.51-14.63; p < 0.01).
Conclusion:
The in-hospital mortality of pediatric patients with myocarditis treated with MCS was high, particularly of children younger than 2 years and those who received CPR.
