scholarly journals Outcomes of Cardiopulmonary Resuscitation in the Pediatric Intensive Care of a Tertiary Center

2021 ◽  
Author(s):  
Ayman Al-Eyadhy ◽  
Mohammed Almazyad ◽  
Gamal Hasan ◽  
Nawaf AlKhudhayri ◽  
Abdullah F. AlSaeed ◽  
...  
Keyword(s):  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Discharge ◽  
Pediatric Intensive Care ◽  
Spontaneous Circulation ◽  
Careful Consideration ◽  
Factors Affecting ◽  
Lower Survival Rate ◽  
Tertiary Center ◽  
Minute Duration

AbstractUnderstanding 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.

Weaning From Noninvasive Ventilatory Support in Infants With Severe Bronchiolitis: An Observational Study

2021 ◽  
Author(s):  
Julie Cassibba ◽  
Claire Freycon ◽  
Julia Doutau ◽  
Isabelle Pin ◽  
Alexandre Bellier ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Pediatric Intensive Care Unit ◽  
Positive Airway Pressure ◽  
Ventilatory Support ◽  
Winter Season ◽  
Pediatric Intensive Care ◽  
High Flow Nasal Cannula ◽  
Tertiary Center

Abstract Background: The aim of the study was to analyze the weaning success, the type of weaning procedures, and weaning duration in consecutive infants hospitalized over a winter season in a Pediatric Intensive Care Unit.Methods: A retrospective observational study in a pediatric intensive care unit in a tertiary center. Infants hospitalized for a severe bronchiolitis were included and the weaning procedure from continuous positive airway pressure (CPAP), noninvasive ventilation (NIV) or high flow nasal cannula (HFNC) was analyzed.Results: Data from 95 infants (median age 47 days) were analyzed. On admission, 26 (27%), 46 (49%) and 23 (24%) infants were supported by CPAP, NIV and HFNC, respectively. One (4%), nine (20%) and one (4%) infants failed weaning while supported by CPAP, NIV or HFNC, respectively (p=0.1). In infants supported by CPAP, CPAP was stopped directly in 5 patients (19%) while HFNC was used as an intermediate ventilatory support in 21 (81%). The duration of weaning was shorter for HFNC (17 hours, [IQR 0-26]) than for CPAP (24 hours, [14-40]) and NIV (28 hours, [19-49]) (p<0.01).Conclusions: The weaning phase represent a large proportion of noninvasive ventilatory support duration in infants with bronchiolitis. The weaning procedure following a “step down” strategy may lead to an increase in duration of weaning.

Abstract 14868: Incidence and Outcomes of Cardiopulmonary Resuscitation in Pediatric Intensive Care Units

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Robert Berg ◽  
Amy Clark ◽  
Vinay M Nadkarni ◽  
Frank Moler ◽  
Robert M Sutton ◽  
...  
Keyword(s):  
Intensive Care ◽  
Observational Study ◽  
Hospital Discharge ◽  
Administrative Data ◽  
Neurological Outcome ◽  
Prospective Observational Study ◽  
Pediatric Intensive Care ◽  
Cardiac Patients ◽  
Neurologic Outcomes ◽  
Favorable Neurological Outcome

Introduction: Although registry and administrative data suggest that >6000 children have in-hospital cardiac arrests each year, most occur in pediatric intensive care units (PICUs), and 39% survive to hospital discharge, prospective research quality data on the incidence and outcomes of PICU CPR are not currently available. Objectives: To determine the incidence and outcomes CPR provided in PICUs. Methods: Multi-center prospective observational study of children <18 years old randomly selected and intensively followed from PICU admission to hospital discharge in the NICHD-funded Collaborative Pediatric Critical Care Research Network from December 2011 to April 2013. Results: Among 10,078 children enrolled, 139 (1.4%) received CPR for ≥1 minute and/or defibrillation. Of these children, 78% attained return of circulation, 45% survived to hospital discharge, and 89% of survivors had favorable neurological outcomes. The relative incidence of CPR events was higher for cardiac patients compared with non-cardiac patients (3.4% versus 0.8%, p<0.001), but survival rate to hospital discharge with favorable neurological outcome was not statistically different (41% versus 39%, respectively). Shorter duration of CPR was associated with higher survival rates: 66% [29/44] survived to hospital discharge after 1-3 minutes of CPR versus 28% [9/32] after >30 minutes, p<0.001. Among survivors, 26/29 (90%) had a favorable neurological outcome after 1-3 minutes versus 8/9 (89%) after >30 minutes of CPR. Conclusions: These data establish that contemporary PICU CPR, including long durations of CPR, 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 non-cardiac patients. The rigorous prospective, observational study design avoided the limitations of missing data and potential selection biases inherent in registry and administrative data.

scholarly journals Comparison of Pediatric Risk of Mortality III, Pediatric Index of Mortality 2, and Pediatric Index of Mortality 3 in Predicting Mortality in a Pediatric Intensive Care Unit

2018 ◽  
Vol 07 (04) ◽  
pp. 201-206 ◽  
Author(s):  
Priyamvada Tyagi ◽  
Mukesh Agrawal ◽  
Milind Tullu
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Roc Curve ◽  
Goodness Of Fit ◽  
Pediatric Intensive Care ◽  
Goodness Of Fit Test ◽  
Risk Of Mortality ◽  
Pediatric Index Of Mortality ◽  
Good Calibration

Aims To compare and validate the Pediatric Risk of Mortality (PRISM) III, Pediatric Index of Mortality (PIM) 2, and PIM 3 scores in a tertiary care pediatric intensive care unit (PICU) (Indian setting). Materials and Methods All consecutively admitted patients in the PICU of a public hospital (excluding those with unstable vital signs or cardiopulmonary resuscitation within 2 hours of admission, cardiopulmonary resuscitation before admission, and discharge or death in less than 24 hours after admission) were included. PRISM III, PIM 2, and PIM 3 scores were calculated. Mortality discrimination for the three scores was calculated using the receiver operating characteristic (ROC) curve, and calibration was performed using the Hosmer–Lemeshow goodness-of-fit test. Results A total of 350 patients were included (male:female = 1.3:1) over the study duration of 18 months (median age: 12 months [interquartile range: 4–60 months]). Nearly half were infants (47.4%). Patients with central nervous system disease were the highest (22.8%) followed by cardiovascular system (20.6%). Mortality rate was 39.4% (138 deaths). The area under the ROC curve for the PRISM III score was 0.667, and goodness-of-fit test showed no significant difference between the observed and expected mortalities in any of these categories (p > 0.5), showing good calibration. Areas under the ROC curve for the PIM 2 and PIM 3 scores were 0.728 and 0.726, respectively. For both the scores, the goodness-of-fit test showed good calibration. Conclusions Although all the three scores demonstrate good calibration, the PIM 2 and PIM 3 scores have an advantage regarding the better discrimination ability, ease of data collection, simplicity of computation, and inherent capacity of not being affected by treatment in PICU.

scholarly journals (A152) Comparison of Load Distributing Band and Standard Cardiopulmonary Resuscitation in Patients Presenting with Cardiac Arrest to Emergency Department

2011 ◽  
Vol 26 (S1) ◽  
pp. s43-s43
Author(s):  
M.E. Ong ◽  
P. Sultana ◽  
S. Fook-Chong ◽  
A. Annitha ◽  
S.H. Ang ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Hospital Admission ◽  
Hospital Discharge ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Secondary Outcome ◽  
Number Needed To Treat ◽  
Performance Category ◽  
Traumatic Cardiac Arrest

ObjectiveTo compare resuscitation outcomes before and after switching from manual cardiopulmonary resuscitation (CPR) to load-distributing band (LDB) CPR in a multi-center Emergency Departments (ED) trial.MethodsThis is a phased, prospective cohort evaluation with intention-to-treat analysis of adults with non-traumatic cardiac arrest. The intervention is change in the system from manual CPR to LDB-CPR at two Urban EDs. The main outcome measure is survival to hospital discharge, with secondary outcome measures of return of spontaneous circulation (ROSC), survival to hospital admission and neurological outcome at discharge.ResultsA total of 1,011 patients were included in the study, with 459 in the manual CPR phase (January 01, 2004, to August 24, 2007) and 552 patients in the LDB-CPR phase (August 16, 2007, to December 31, 2009). In the LDB phase, the LDB device was applied in 454 patients (82.3%). Patients in the manual CPR and LDB-CPR phases were comparable for mean age, gender and ethnicity. Rates for ROSC were comparable with LDB-CPR (manual 22.4% vs. LDB 35.3%; adjusted odds ratio [OR], 1.07; 95% confidence interval [CI], 0.63-1.83). Survival to hospital admission was increased, Manual 14.2% vs. LDB 19.7%; adjusted OR, 2.50; 95% CI, 1.05-6.00. Survival to hospital discharge was increased Manual 1.3% vs. LDB 3.3%; adjusted OR, 3.99; 95% CI, 1.06-15.02. The number of survivors with Cerebral Performance Category 1 (good) (Manual 1 vs. LDB 12, p < 0.01) and Overall Performance Category 1 (good) (Manual 1 vs. LDB 10, p < 0.01) was also increased. The Number Needed to Treat (NNT) for 1 survivor was 52 (95% CI, 26-1000).ConclusionA resuscitation strategy using LDB-CPR in an ED environment was associated with improved survival to admission and discharge in adults with non-traumatic cardiac arrest.

The Characteristics and Outcomes of Cardiopulmonary Resuscitation within the Neonatal Intensive Care Unit Based on Gestational Age and Unit Level of Care

2019 ◽  
Vol 37 (14) ◽  
pp. 1455-1461
Author(s):  
Kaashif A. Ahmad ◽  
Steven G. Velasquez ◽  
Katy L. Kohlleppel ◽  
Cody L. Henderson ◽  
Christina N. Stine ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Neonatal Intensive Care Unit ◽  
Gestational Age ◽  
Neonatal Intensive Care ◽  
Adverse Outcome ◽  
San Antonio ◽  
Spontaneous Circulation ◽  
Term Infants

Objectives This study aimed to describe the variation of in-neonatal intensive care unit (NICU) cardiopulmonary resuscitation (CPR) characteristics and outcomes across different gestational ages and levels of NICU care. Study Design This is a retrospective cohort study of in-NICU CPR events across 10 NICUs in San Antonio, TX from 2012 through 2017. Results We identified 140 patients experiencing a total of 210 in-NICU CPR events. CPR was performed in 0.23% of Level III and 0.85% of Level IV NICU admissions. Gestational age was inversely related to CPR incidence. The median age at in-NICU CPR was lower for preterm versus term infants (6 vs. 28 days, p = 0.002). With regression modeling, each added minute of chest compression decreased the odds of return to spontaneous circulation by 11%. Conclusion In-NICU CPR incidence rises with decreasing gestational age and increasing level of NICU care. The rate of return of spontaneous circulation decreases significantly with increasing duration of chest compressions. Further study is needed to identify patient factors associated with adverse outcome.

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