Abstract 109: Pediatric CPR in the Emergency Department: Initial Findings From the Videography in Pediatric Emergency Research Collaborative

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Karen J O’Connell ◽  
Benjamin T Kerrey ◽  
Sage R Myers ◽  
Alexis B Sandler ◽  
Richard Hanna ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Pediatric Emergency ◽  
Ventilation Rate ◽  
Older Children ◽  
High Quality ◽  
Video Review ◽  
Cpr Quality ◽  
The Impact ◽  
Monitor Device

Introduction: Cardiopulmonary resuscitation (CPR) is frequently performed in a manner inconsistent with American Heart Association (AHA) guidelines. Published studies on CPR quality during pediatric cardiac arrest using chest compression (CC) monitor devices have reported data in aggregate form from entire CPR events. The addition of video review allows precise measurement of CPR quality at the level of individual providers. Hypothesis: To measure individual healthcare providers’ (HCP) CPR quality during pediatric cardiac arrest events in actual patients in the emergency department (PED) and describe adherence to AHA guidelines. Methods: A report from the Videography in Pediatric Emergency Resuscitation (VIPER) Collaborative, a prospective observational database from three tertiary PEDs. All study sites videorecord and review resuscitations and use a pressure sensor/monitor device during CPR. All events where chest compressions (CC) were performed under videorecorded conditions with the monitor device in use were eligible for inclusion. Data on CPR performance was collected by a combination of video review and monitor device; CC rate and depth and ventilation rate were extracted in time periods corresponding to individual CPR providers. CPR segments were defined as ‘high-quality’ if all AHA guidelines were achieved (CC rate 100-120 cpm; CC depth >= 1.5 inches for infants or >= 2 inches for children; ventilation rate 8-12 bpm, no pauses > 10 seconds). Results: Between August 2016 and April 2018, complete data was available for 31 events (infants: n=5; older children: n=6). 279 compression segments were analyzed. Median CC rate was 119 cpm (IQR 110 – 129); median depth was 1.0 inches in infants (IQR 0.85 – 1.2) and 2.1 inches in older children (IQR 1.4 – 2.4). Median ventilation rate was 15 bpm (IQR 10 - 30). 22/279 (8%) compression segments met all criteria for high-quality CPR. Conclusions: PED HCPs infrequently met AHA guidelines for CPR quality. Future studies using video review and CC monitor data collection should examine the impact of specific training strategies on provider-level CPR performance during pediatric cardiac arrest.

Abstract 274: Verbal Prompts During Pediatric Cardiopulmonary Resuscitation in Emergency Department: A Report From the Videography in Pediatric Emergency Resuscitation (VIPER) Collaborative

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Ichiro Watanabe ◽  
Richard S Hanna ◽  
Sage R Myers ◽  
Benjamin Kerrey ◽  
Mary Frey ◽  
...  
Keyword(s):  
Age Groups ◽  
Pediatric Emergency ◽  
Ventilation Rate ◽  
Chest Compressions ◽  
Video Review ◽  
Study Sites ◽  
Verbal Prompts ◽  
Monitor Device ◽  
Monitoring Devices

Introduction: The quality of chest compressions (CC) is crucial for good outcomes for pediatric cardiac arrest. Verbal prompts from resuscitation leader or CPR coach may help to optimize it. The objective of this study is to describe the frequency of appropriate verbal prompts during pediatric CPR. We hypothesized that verbal prompts for CC would be given less frequently to infants compared to children. Methods: A report from the Videography In Pediatric Emergency Resuscitation (VIPER) Collaborative, a prospective observational database from three tertiary PEDs from December 2016 to April 2018. All study sites videorecord and review resuscitations and use a pressure sensor/monitor device during CPR. All events where chest compressions (CC) were performed under videorecorded conditions with the monitor device in use were eligible for inclusion. Events where real-time feedback from monitoring devices for CC was available were excluded (ages > 8). Data on CPR performance was collected by a combination of video review and monitor device; CC rate and depth and ventilation rate were extracted in time periods corresponding to individual CPR providers. Data on verbal prompts (time, who gave prompts, what prompt consisted of) were identified during video review. Results: There were 21 cases with total 182 providers included in database during study periods (infants: n=15, children: n=6). Verbal prompts for compression rate and depth were given in 14/21 (67%) of cases. 19/80 (24%) came from the resuscitation leader; 32/80 (40%) and from a CPR coach. 7 (3.9%) providers doing CC watched ZOLL monitor for feedback. Appropriate verbal prompts for CC rate were given to 4.2 % of providers in infants and 8.8 % in children (p=0.024). And 9.2% in infants and 10.5 % in children (p=0.064) were given to providers for CC depth. After adjusting by confounders, there weren’t any significant differences between age groups for both CC rate: OR1.22 (95%CI 0.49-3.05, P=0.670) and depth: OR 2.82 (95%CI 0.73-10.9, P=0.134). Conclusions: Verbal prompts frequency for CC rate and depth during pediatric CPR was described. There weren’t any significant differences between infants and children under 8 years old.

scholarly journals LO67: The impact of CPR quality during entire resuscitation episode on survival from cardiac arrest

CJEM ◽  
2017 ◽  
Vol 19 (S1) ◽  
pp. S51
Author(s):  
I. Drennan ◽  
A.K. Taher ◽  
S. Cheskes ◽  
C. Zhan ◽  
A. Byers ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Chest Compression ◽  
Patient Survival ◽  
P Value ◽  
High Quality ◽  
Compression Depth ◽  
Entire Duration ◽  
Cpr Quality ◽  
The Impact

Introduction: High-quality cardiopulmonary resuscitation (CPR) is essential for patient survival. Typically, CPR quality is only measured during the first 10 minutes of resuscitation. There is limited research examining the quality of CPR over the entire duration of resuscitation.Objective: To examine the quality of CPR over the entire duration of resuscitation and correlate the quality of CPR to patient survival. Methods: This was a retrospective observational study using data from the Toronto RescuNET Epistry-Cardiac Arrest database. We included consecutive, adult (>18) OHCA treated by EMS between January 1, 2014 and September 30, 2015. High-quality CPR was defined, in accordance with 2015 AHA Guidelines, as a chest compression rate of 100-120/min, depth of 5.0-6.0 cm and chest compression fraction (ccf) of >0.80. We further categorized high-quality resuscitation as meeting benchmarks >80% of the time, moderate-quality between 50-80% and low-quality meeting benchmarks <50% of the resuscitation. We used multivariable logistic regression to determine association between variables of interest, including CPR quality metrics, and survival to hospital discharge. Results: A total of 5,208 OHCA met our inclusion criteria with a survival rate of 8%. The median (IQR) duration of resuscitation was 23.0 min (15.0,32.7). Overall CPR quality was considered high-quality for ccf in 81% of resuscitation episodes, 41% for rate, and 7% for depth. The percentage of resuscitations meeting the quality benchmarks differed between survivors and non-survivors for both depth (15% vs 6%) and ccf (61% vs 83%) (P value <0.001). After controlling for Utstein variables maintaining a chest compression depth within recommendations for >80% showed a trend towards improved survival (OR 1.68, 95% CI 0.96, 2.92). Other variables associated with survival were public location, initial CPR by EMS providers or bystanders, witnessed cardiac arrest (EMS or bystander), and initial shockable rhythm. Increasing age and longer duration of resuscitation were associated with decreased survival. Conclusion: Overall, EMS providers were not able to maintain rate or depth within guideline recommendations for the majority of the duration of resuscitation. Maintaining chest compression depth for greater than 80% of the resuscitation showed a trend towards increased survival from OHCA.

scholarly journals Short‐term outcomes in children following emergency department visits for minor injuries sustained at home

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Matthew J Molloy ◽  
Wendy Shields ◽  
Molly W Stevens ◽  
Andrea C Gielen
Keyword(s):  
Emergency Department ◽  
Pediatric Population ◽  
Pediatric Emergency ◽  
Emergency Department Visits ◽  
Short Term ◽  
Minor Injury ◽  
Minor Injuries ◽  
A Minor ◽  
The Impact ◽  
At Home

Abstract Background Minor injuries are very common in the pediatric population and often occur in the home environment. Despite its prevalence, little is known about outcomes in children following minor injury at home. Understanding the impact of these injuries on children and their families is important for treatment, prevention, and policy. The objectives of our study were (1) To describe the distribution of short-term outcomes following pediatric minor injuries sustained at home and (2) To explore the relationship of injury type and patient and household demographics with these outcomes. Methods Children (n = 102) aged 0–7 years with a minor injury sustained at home were recruited in an urban pediatric emergency department as part of the Child Housing Assessment for a Safer Environment (CHASE) observational study. Each patient had a home visit following the emergency department visit, where five parent-reported outcomes were assessed. Relationships were explored with logistic regression. Results The most common type of injury was soft tissue (57.8 %). 13.2 % of children experienced ≥ 7 days of pain, 21.6 % experienced ≥ 7 days of abnormal activity, 8.9 % missed ≥ 5 days of school, 17.8 % of families experienced ≥ 7 days of disruption, and 9.1 % of parents missed ≥ 5 days of work. Families reported a total of 120 missed school days and 120 missed work days. Children who sustained a burn had higher odds of experiencing pain (OR 6.97), abnormal activity (OR 8.01), and missing school (OR 8.71). The parents of children who sustained a burn had higher odds of missing work (OR 14.97). Conclusions Families of children suffering a minor injury at home reported prolonged pain and changes in activity as well as significant school and work loss. In this cohort, burns were more likely than other minor injuries to have these negative short-term outcomes reported and represent an important target for interventions. The impact of these injuries on missed school and disruption of parental work warrants further consideration.

scholarly journals MP027: Automated cardiopulmonary resuscitation quality data abstraction for complete episodes of out-of-hospital cardiac arrest resuscitation

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S75-S75
Author(s):  
A.K. Taher ◽  
S. Lin ◽  
A. Turgulov ◽  
J.E. Buick ◽  
A. Byers ◽  
...  
Keyword(s):  
Quality Assurance ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Error Rates ◽  
Quality Data ◽  
Data Abstraction ◽  
Internal Validation ◽  
Software Program ◽  
Cpr Quality ◽  
The Impact

Introduction: Cardiopulmonary resuscitation (CPR) quality assurance and research has traditionally been limited to the first five minutes of resuscitation due to significant costs in time, resources and personnel from manual data abstraction. Moreover, CPR quality can be affected during prolonged resuscitations, which represents significant knowledge gaps. The objective of this study was to develop a software program to help automate the abstraction of CPR quality data from electronic defibrillators. Methods: We developed a software program to facilitate and help automate data abstraction from electronic defibrillator files for entire resuscitation episodes. Internal validation of the software program was performed on 50 randomly selected cardiac arrest cases with resuscitation durations of up to 60 minutes. CPR quality data variables such as number of ventilations, number of compressions, minute compression rate, minute compression depth, minute compression fraction, minute end-tidal CO2, were manually abstracted independently by two trained data abstractors and by the automated software program. Error rates and the time needed for data abstraction were measured. Results: A total of 9826 data points were abstracted. Manual data abstraction resulted in a total of six errors (0.06%) compared to zero errors by the software program. The mean time ± SD needed for manual data abstraction was 20.3 ± 2.7 minutes compared to 5.3 ± 1.4 minutes using the software program (p=0.003). Conclusion: Our CPR quality data abstraction software was 100% accurate in abstracting CPR quality data for complete resuscitation episodes and showed a significant reduction in data abstraction duration. This software will enable quality assurance programs and future cardiac arrest studies to evaluate the impact of CPR quality during prolonged resuscitations.

The Impact of Mental Health Services in a Pediatric Emergency Department

2017 ◽  
Vol 33 (5) ◽  
pp. 311-314 ◽  
Author(s):  
Sharon M. Holder ◽  
Kenneth Rogers ◽  
Eunice Peterson ◽  
Robbie Shoenleben ◽  
Dawn Blackhurst
Keyword(s):  
Mental Health ◽  
Emergency Department ◽  
Mental Health Services ◽  
Health Services ◽  
Pediatric Emergency ◽  
Pediatric Emergency Department ◽  
The Impact

scholarly journals Study of clinical and etiological profile of hypertensive emergencies in children admitted in pediatric emergency department

2021 ◽  
Vol 8 (5) ◽  
pp. 797
Author(s):  
Sumathi Kotapuri ◽  
Mahendranath Putta ◽  
Sudharshanraj Chitgupikar
Keyword(s):  
Emergency Department ◽  
Target Organ Damage ◽  
Age Groups ◽  
Organ Damage ◽  
Pediatric Emergency ◽  
Primary Objective ◽  
Primary Hypertension ◽  
Older Children ◽  
Medical College ◽  
Hypertensive Emergencies

Background: Hypertension (HTN) in children, all though an uncommon entity is associated with end-organ damage. With increasing prevalence of hypertension and obesity in children; hypertensive emergencies are also increasing over recent years and screening is must. The primary objective of this study was to determine the incidence of hypertensive emergencies, the clinical presentation and etiological diagnosis at different age groups and to access the real burden of primary hypertension in causing hypertensive emergencies in children.Methods: This study was a prospective, descriptive, analytical cohort study done on children attending the emergency department of pediatrics, government general hospital, a tertiary referral pediatric center attached to Kurnool medical college, Kurnool, over a period of 18 months i.e., from january2016 to June 2017. Data was collected in a pre-determined proforma after institutional ethical committee clearance and appropriate informed concerned.Results: Among 98 children with hypertension; 30 had hypertensive emergency.  Incidence was 0.3%. Intrinsic renal and renal vascular causes were the commonest. Headache, dizziness and vomiting were the comment presentation. Half of them had encephalopathy. Younger children had more of secondary HTN and in children (older than 7 years) primary hypertension increased as did family history of hypertension.Conclusions: With increasing primary hypertension among older children, hypertensive emergencies are increasing. As most of the children with HTN are asymptomatic; detection of target organ damage is vital.

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