scholarly journals NEUROlogical Prognosis After Cardiac Arrest in Kids (NEUROPACK) study: protocol for a prospective multicentre clinical prediction model derivation and validation study in children after cardiac arrest

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e037517
Author(s):  
Barnaby Robert Scholefield ◽  
James Martin ◽  
Kate Penny-Thomas ◽  
Sarah Evans ◽  
Mirjam Kool ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Prediction Model ◽  
Neurodevelopmental Outcome ◽  
Paediatric Intensive Care ◽  
Ethical Review ◽  
Clinical Prediction ◽  
Clinical Prediction Model ◽  
Paediatric Cardiac Arrest

IntroductionCurrently, we are unable to accurately predict mortality or neurological morbidity following resuscitation after paediatric out of hospital (OHCA) or in-hospital (IHCA) cardiac arrest. A clinical prediction model may improve communication with parents and families and risk stratification of patients for appropriate postcardiac arrest care. This study aims to the derive and validate a clinical prediction model to predict, within 1 hour of admission to the paediatric intensive care unit (PICU), neurodevelopmental outcome at 3 months after paediatric cardiac arrest.Methods and analysisA prospective study of children (age: >24 hours and <16 years), admitted to 1 of the 24 participating PICUs in the UK and Ireland, following an OHCA or IHCA. Patients are included if requiring more than 1 min of cardiopulmonary resuscitation and mechanical ventilation at PICU admission Children who had cardiac arrests in PICU or neonatal intensive care unit will be excluded. Candidate variables will be identified from data submitted to the Paediatric Intensive Care Audit Network registry. Primary outcome is neurodevelopmental status, assessed at 3 months by telephone interview using the Vineland Adaptive Behavioural Score II questionnaire. A clinical prediction model will be derived using logistic regression with model performance and accuracy assessment. External validation will be performed using the Therapeutic Hypothermia After Paediatric Cardiac Arrest trial dataset. We aim to identify 370 patients, with successful consent and follow-up of 150 patients. Patient inclusion started 1 January 2018 and inclusion will continue over 18 months.Ethics and disseminationEthical review of this protocol was completed by 27 September 2017 at the Wales Research Ethics Committee 5, 17/WA/0306. The results of this study will be published in peer-reviewed journals and presented in conferences.Trial registration numberNCT03574025.

scholarly journals Validation of a Clinical Prediction Model for Early Admission to the Intensive Care Unit of Patients With Pneumonia

2012 ◽  
Vol 19 (9) ◽  
pp. 993-1003 ◽  
Author(s):  
José Labarère ◽  
Philipp Schuetz ◽  
Bertrand Renaud ◽  
Yann-Erick Claessens ◽  
Werner Albrich ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Prediction Model ◽  
Clinical Prediction ◽  
Clinical Prediction Model ◽  
Early Admission

Cardiopulmonary resuscitation: special considerations for infants and children with cardiac disease

2007 ◽  
Vol 17 (S4) ◽  
pp. 116-126 ◽  
Author(s):  
Stacie B. Peddy ◽  
Mary Fran Hazinski ◽  
Peter C. Laussen ◽  
Ravi R. Thiagarajan ◽  
George M. Hoffman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Intensive Care Units ◽  
Cardiac Disease ◽  
Paediatric Intensive Care ◽  
Cardiac Intensive Care Unit ◽  
Cardiac Intensive Care ◽  
Paediatric Intensive Care Units

AbstractPulseless cardiac arrest, defined as the cessation of cardiac mechanical activity, determined by unresponsiveness, apneoa, and the absence of a palpable central pulse, accounts for around one-twentieth of admissions to paediatric intensive care units, be they medical or exclusively cardiac. Such cardiac arrest is higher in children admitted to a cardiac as opposed to a paediatric intensive care unit, but the outcome of these patients is better, with just over two-fifths surviving when treated in the cardiac intensive care unit, versus between one-sixth and one-quarter of those admitted to paediatric intensive care units. Children who receive chest compressions for bradycardia with pulses have a significantly higher rate of survival to discharge, at 60%, than do those presenting with pulseless cardiac arrest, with only 27% surviving to discharge. This suggests that early resuscitation before the patient becomes pulseless, along with early recognition and intervention, are likely to improve outcomes. Recently published reports of in-hospital cardiac arrests in children can be derived from the multi-centric National Registry of Cardiopulmonary Resuscitation provided by the American Heart Association. The population is heterogeneous, but most arrests occurred in children with progressive respiratory insufficiency, and/or progressive circulatory shock. During the past 4 years at the Children’s Hospital of Philadelphia, 3.1% of the average 1000 annual admissions to the cardiac intensive care unit have received cardiopulmonary resuscitation. Overall survival of those receiving cardiopulmonary resuscitation was 46%. Survival was better for those receiving cardiopulmonary resuscitation after cardiac surgery, at 53%, compared with survival of 33% for pre-operative or non-surgical patients undergoing resuscitation. Clearly there is room for improvement in outcomes from cardiac resuscitation in children with cardiac disease. In this review, therefore, we summarize the newest developments in paediatric resuscitation, with an expanded focus upon the unique challenges and importance of anticipatory care in infants and children with cardiac disease.

scholarly journals Cardiac arrest in the paediatric intensive care unit: defining the problem and developing solutions

2020 ◽  
Vol 9 (4) ◽  
pp. e000930
Author(s):  
Candice M Ray ◽  
Matthew Pizzuto ◽  
Edith Reyes-Alvarado ◽  
Kimberly Jackson ◽  
David A Turner ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Paediatric Intensive Care Unit ◽  
Early Recognition ◽  
Heart Association ◽  
Paediatric Intensive Care ◽  
High Quality ◽  
Modifiable Factors ◽  
Risk Patients

Thousands of children experience a cardiac arrest event in the hospital each year, with more than half of these patients not surviving to hospital discharge. Cardiopulmonary resuscitation (CPR) depth, rate, velocity and percentage of high-quality chest compressions are modifiable factors associated with improved survival. Therefore, we created a novel and standardised process to track and analyse cardiac arrests in the Duke paediatric intensive care unit (PICU). Our aim was to identify areas for improved American Heart Association (AHA) compliance and implement education and communication-based initiatives to enhance early recognition of at-risk patients leading to improved outcomes. From January 2017 to December 2018, all cardiac arrests in our PICU were tracked, reviewed and presented at monthly morbidity and mortality conference. We used the data to track compliance with AHA guidelines and identify opportunities for improvement. Through these efforts, we established a multidisciplinary cardiac arrest education and review programme. Over the 2-year period, we tracked 45 cardiac arrests, which comprised 2% of all PICU admissions. In 2017, during the first year of development, 16 of 22 arrests (73%) were not reported to code committee members in time for complete review. Of the six cardiac arrests with complete reviews, only 17% followed AHA guidelines. In 2018, all 23 arrest events were communicated and 76% of resuscitations were found to be compliant with AHA guidelines. Survival of patients to discharge was 47% in 2017 and increased to 63% in 2018 with similar percentage of PICU admissions having a cardiac arrest between the 2 years. The primary aim of this project was to establish a multidisciplinary comprehensive cardiac arrest review process. This programme allowed for comprehensive analysis of individual events, promoted quality improvement initiatives and improved consistent delivery of high-quality CPR.

scholarly journals Failure to Validate a Multivariable Clinical Prediction Model to Identify Pediatric Intensive Care Unit Patients at High Risk for Candidemia

2015 ◽  
Vol 5 (4) ◽  
pp. 458-461 ◽  
Author(s):  
Brian T. Fisher ◽  
Rachael K. Ross ◽  
Emmanuel Roilides ◽  
Debra L. Palazzi ◽  
Mark J. Abzug ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Case Control Study ◽  
Prediction Rule ◽  
Pediatric Intensive Care ◽  
Clinical Prediction Rule ◽  
Clinical Prediction ◽  
Clinical Prediction Model ◽  
Control Study

Abstract We attempted to validate a previously derived clinical prediction rule for candidemia in the pediatric intensive care unit. This multicenter case control study did not identify significant association of candidemia with most of the previously identified predictors. Additional study in larger cohorts with other predictor variables is needed.

scholarly journals Influence of comorbidities and clinical prediction model on neurological prognostication post out-of-hospital cardiac arrest

Heart Asia ◽  
2018 ◽  
Vol 10 (2) ◽  
pp. e011016 ◽  
Author(s):  
Weiting Huang ◽  
Gary Kuan Wee Teo ◽  
Jack Wei-Chieh Tan ◽  
Nur Shahidah Ahmad ◽  
Hwee Hong Koh ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Prediction Model ◽  
Clinical Prediction ◽  
Clinical Prediction Model ◽  
Hospital Cardiac Arrest
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