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1. The study examined survival outcomes for pediatric patients receiving extracorporeal cardiopulmonary resuscitation (ECPR) for in-hospital cardiac arrest. 2. Of 199 pediatric patients who received ECPR, 87 (43.7%) survived to hospital discharge. 3. Patients with preexisting cardiac conditions had higher survival rates at 48% compared to other conditions like pneumonia or renal insufficiency which were associated with higher mortality.
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![Top Ten Things To Know
Survival Outcomes Among Neonates, Infants and Children
Following Extracorporeal Cardiopulmonary Resuscitation
for Refractory In-Hospital Pediatric Cardiac Arrest
1. Pediatric in-hospital cardiac arrest (IHCA) has about 27% (25-33%) survival to
discharge. Survival rates are usually lower with prolonged CPR.
2. Survival for pediatric IHCA may be improved with use of ECPR for the cardiac arrest
patient who does not respond to conventional CPR.
3. The primary outcome for this *NRCPR study population was survival to discharge
(SDC) for the pediatric IHCA victim.
4. There were two secondary outcomes for this study:
• the patient who never becomes pulseless would have an improved chance for
survival;
• the pediatric victim would have a favorable neurologic outcome (pediatric cerebral
performance category [PCPC] of 1, 2 or 3) at hospital discharge.
5. Of the 199 pediatric CPR events that met criteria for ECPR, 87(43.7%) had SDC.
6. The two secondary outcomes showed:
• the patient who maintained a pulse showed no better survival than those who
became pulseless;
• favorable neurologic outcomes occurred in 56 (94.9%) of 59 survivors with
recorded PCPC.
7. Patients categorized with a cardiac condition prior to ECPR are more likely to
survive, 48% of the pediatric cardiac IHCA victim reached SDC.
8. Compared to those with pulseless electrical activity or asystole, survival was
increased for patients when the first documented pulseless rhythm was a shockable
(ventricular fibrillation/pulseless ventricular tachycardia) rhythm (P=0.04).
9. Certain preexisting conditions were associated with increased mortality, including
pneumonia, renal insufficiency, and septicemia.
10. Further studies could focus on ECPR patients with preexisting cardiac conditions to
validate variables pre- and post- ECPR care that have a positive impact on survival
(ie, pre-quality of CPR, mode of ECPR, cannulation and complications, and post
ECPR care with glucose and temperature monitoring).
*NRCPR is a performance improvement tool that can be used to identify and monitor key process variables and patient
outcomes for in-hospital cardiac arrest. NRCPR.org
Survival Outcomes Among Neonates, Infants and Children Following Extracorporeal Cardiopulmonary Resuscitation (ECPR) for Refractory
In-Hospital Pediatric Cardiac Arrest: Data from the National Registry of Cardiopulmonary Resuscitation. Pediatric Critical Care Medicine:
PAP, 17 November 2009doi: 10.1097/PCC.0b013e3181c0141b. Tia Tortoriello Raymond, Christopher Cunnyngham, Marita Thompson,
Vinay M. Nadkarni, James Thomas for the American Heart Association National Registry of Cardiopulmonary Resuscitation Investigators.
© 2010, American Heart Association. All rights reserved.](https://image.slidesharecdn.com/126452593301420100125toptennrcprpediatric-100516194003-phpapp02/85/126452593301420100125-top-tennrcpr_pediatric-1-320.jpg)
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2. High-flow nasal cannula oxygen is an alternative to NIV and has been shown to reduce intubation compared to conventional oxygen in patients with acute hypoxemic respiratory failure.
3. Invasive mechanical ventilation should be reserved for patients with significant hypercapnia, acidosis or respiratory distress that cannot be managed with NIV.
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3) The results showed that despite the patients' high risk profile, they experienced a substantial reduction in all-cause emergency department visits and hospitalization rates in the 6 months following EECP therapy compared to the 6 months prior to treatment.
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Global Hospitals’ Advanced Heart, Lung & Vascular Institute provides all kinds of endovascular procedures including coronary intervention and peripheral intervention, heart surgery, heart bypass surgery as well as heart transplantation surgery in Hyderabad, Chennai, and BangaloreWhat's hot (20)
Lifting the lid on decompressive craniectomy by Associate Professor Lindy Jef...
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Decompressive hemicraniectomy for Large Hemispheric infarction
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The patient with AHF on the ICU : Respiratory Support
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EMGuideWire's Radiology Reading Room: Pericardial Effusion
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Best Cardiologists Hyderabad, Chennai, and Bangalore
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focused-echocardiographic-evaluation-in-resuscitation-management425.ppt
The document discusses the use of focused echocardiography evaluation in resuscitation (FEER). It describes FEER as a 10-step examination that can be performed within brief pauses in chest compressions to identify potentially treatable causes of cardiac arrest like pericardial tamponade. Observational trials found FEER differentiated pseudo-PEA states from true cardiac standstill and identified issues like pericardial effusions without prolonging no-flow intervals. The document concludes that FEER can help emergency physicians identify reversible causes of cardiac arrest and improve resuscitation outcomes when integrated into advanced life support protocols with proper training.
focused-echocardiographic-evaluation-in-resuscitation-management425.ppt
Focused echocardiography during resuscitation (FEER) can help identify potentially treatable causes of cardiac arrest like pericardial tamponade and help differentiate pseudo-pulseless electrical activity (PEA) from true PEA. An observational trial found FEER capable of differentiating PEA states and identifying pseudo-PEA, allowing for continued CPR and treatment of underlying disorders. A training program on FEER saw improvements in trainee skills and knowledge. The review argues FEER should be standardized in resuscitation guidelines to provide direct cardiac information during cardiopulmonary resuscitation and improve outcomes.
2022 Head and thorax elevation during cardiopulmonary PIIS030095722200630X.pdf
This clinical paper compares outcomes of patients receiving ACE-CPR (which includes controlled elevation of the head and thorax during CPR using various adjunct devices) versus conventional C-CPR. Data was collected from 227 ACE-CPR patients in 6 EMS systems and compared to 5196 C-CPR patients from previous trials. Propensity score matching was used. Results found that rapid initiation of ACE-CPR (within 11 or 18 minutes) was associated with higher odds of survival to hospital discharge compared to C-CPR, as well as higher rates of ROSC and favorable neurological outcomes. The study concludes ACE-CPR may improve survival after out-of-hospital cardiac arrest when initiated
CPR with ECLS vs conventional CPR in IHCA
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1. Atrioventricular septal defect (AVSD) is a congenital heart defect where there is a common atrioventricular valve, defects in the atrial and ventricular septum, and it can be complete or partial. It accounts for around 5% of congenital heart defects.
2. Perioperative management of complete AVSD aims to address issues like pulmonary hypertension, low cardiac output, and arrhythmias. Optimal timing of repair is between 3-6 months of age when weight is over 4kg.
3. Expected early postoperative outcomes include a median hospital stay of 9 days, potential need for reoperation for valve issues or outflow tract obstruction, and low mortality rates in the
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Dr. Anand Gangadharan discusses the management of neonatal hypoxic ischemic encephalopathy (HIE). Initial management focuses on oxygenation, ventilation, circulation, and correcting metabolic derangements. Hypothermia therapy is the only proven neuroprotective treatment for HIE. Applying whole-body hypothermia at 33.5°C for 72 hours in infants with moderate to severe HIE improves outcomes. Several adjunctive neuroprotective treatments are being studied along with hypothermia but require further clinical trials to establish efficacy and safety.
TP Salazar arch
This study evaluated the impact of antegrade cerebral perfusion (ACP) at 25°C on cerebral oxygenation and serum creatinine in 61 newborns and children undergoing aortic arch reconstruction. Cerebral and somatic oxygenation as measured by near-infrared spectroscopy was well-preserved during and after surgery for all patients. Peak postoperative serum creatinine levels were normal and complications such as seizures, neurological deficits, or need for dialysis were low. The results suggest ACP at 25°C provides adequate cerebral and somatic protection for newborns and children undergoing arch reconstruction.
-advances-in-neonatal-care-respiratory.pptx
This document reviews several topics in neonatology, including:
1) Delayed cord clamping which provides benefits like increased hemoglobin but risks like polycythemia. Guidelines recommend 30-60 seconds for vigorous infants.
2) Therapeutic hypothermia for hypoxic ischemic encephalopathy, which improves mortality and neurodevelopment when started in the first 6 hours of life.
3) Exogenous surfactant for respiratory distress syndrome, which is most effective with early administration and antenatal steroids. Less invasive methods like INSURE/MIST provide benefits over intubation.
4) Non-invasive ventilation strategies to reduce intubation including CPAP developed in the 1970s.
Post cardiac arrest syndrome
This document discusses post-cardiac arrest syndrome among cardiac arrest survivors. It defines the four key components of post-cardiac arrest syndrome: post-cardiac arrest brain injury, post-cardiac arrest myocardial dysfunction, systemic ischemia/perfusion response, and persistent precipitating pathology. It then provides details on the pathophysiology of post-cardiac arrest brain injury, focusing on cellular mechanisms, cerebral perfusion, and other issues like pyrexia, hyperglycemia, and seizures that can impact outcomes.
Interventional management of out hospital cardiac arrest
1) Out-of-hospital cardiac arrest remains a major cause of death, though improvements in pre-hospital care have increased ROSC rates to 50%.
2) Significant coronary artery disease is present in 70% of cases. Coronary angiography finds acute culprit lesions in up to 90% of STEMI patients and 58% of non-STEMI patients.
3) Observational studies show the feasibility and safety of immediate invasive coronary strategies after cardiac arrest, with overall survival rates of 76% and neurological recovery in 52% of "comatose" survivors. However, randomized trials are still needed to confirm benefits.
TAEM10:Emergency Medicine update
The document summarizes evidence from studies on resuscitation. It finds that survival from cardiac arrest in Thai hospitals is poor, associated with shorter CPR duration and effective BLS. Key issues include improving data collection and pre-hospital care. Evidence shows biphasic defibrillation and amiodarone improve outcomes for ventricular fibrillation. Induced hypothermia is recommended for unconscious adults with ROSC after out-of-hospital cardiac arrest due to VF. Resuscitation efforts may continue beyond 60 minutes if the patient's core temperature is below 29 degrees C.
We have ROSC. What next? by Professor Rinaldo Bellomo
1) The documents discuss several ongoing and planned clinical trials investigating optimal post-resuscitation care and targets for oxygen, carbon dioxide, temperature management, and other factors after return of spontaneous circulation (ROSC) following cardiac arrest.
2) The TAME Cardiac Arrest Trial will investigate whether targeted therapeutic mild hypercapnia improves outcomes compared to standard normocapnia care.
3) The TTM-2 Trial will compare outcomes between post-cardiac arrest patients treated with targeted temperature management at 33°C versus 37.5°C.
4) Together these trials and others aim to establish best practices for multisystem organ support after cardiac arrest to optimize survival and neurological outcomes.
Rn com ccc eco fetal
This study examined the impact of prenatal diagnosis via fetal echocardiography on outcomes for neonates with critical congenital heart defects (CHD) requiring intervention within the first month of life. The study compared outcomes between neonates who were diagnosed prenatally (n=29) versus postnatally (n=71). Key findings included that neonates diagnosed prenatally presented at birth in better condition, with a mean age of presentation of 0 days compared to 10 days for those diagnosed postnatally. Prenatal diagnosis also facilitated delivery at a tertiary care center for 34.5% of cases and improved preoperative stabilization. However, there were no significant differences found in postoperative outcomes between the two groups.
Ann pediatrcard eco fetal no diag precoce
This study examined the impact of prenatal diagnosis via fetal echocardiography on neonatal outcomes for critical congenital heart defects. The study compared outcomes for 29 neonates diagnosed prenatally via fetal echocardiography to 71 diagnosed postnatally. Prenatal diagnosis resulted in planned deliveries at tertiary care centers for 10/29 babies and allowed for prompt postnatal stabilization. Prenatal diagnosis was associated with shorter time to presentation, better preoperative stabilization including use of prostaglandin, and improved pH and mortality rates compared to postnatal diagnosis. Fetal echocardiography facilitated improved counseling and management planning, leading to reduced morbidity and mortality.
The Top 10 Resuscitation Headlines and Controversies: And How To Read Past Th...
We’ve all heard controversies about cardiac resuscitation. “Use the right medications.”, “Medications don’t matter.”, “Airway first!”, “Don’t worry about the airway!” It is confusing for EMS professionals to sort out exactly what they’re supposed to do. Taking a look at the Top Ten Headlines for cardiac resuscitation, this program evaluates the strength of the science behind each recommendation as well as how they might be implemented in different EMS systems. Getting past the “Headlines,” attendees will return home well-equipped to open up discussions about optimizing EMS cardiac arrest resuscitation in their systems beyond “I read this study once” or “This is what the algorithms say now.”
ECLS – where are we now? Young ones by Dr Adrian Mattke
Extracorporeal membrane oxygenation assisted cardiopulmonary resuscitation (ECPR) is an effective therapy to improve outcomes for children who experience cardiopulmonary arrest. Survival after ECLS varies between 60% and 75%. For ECPR survival is lower, with 40% to 50% of children surviving ECPR. After ECPR good neurological outcomes are seen in 40% to 60% of children. This contrasts with adult patients where neurological outcomes after ECPR are poor. Given these findings the American Heart Association has included ECPR in their 2015 guidelines for children who experience an in hospital cardiac arrest (IHCA).
Bernard - Refractory Cardiac Arrest
Professor Stephen Bernard is an Intensive Care Physician at The Alfred Hospital and Medical Advisor to Ambulance Victoria. His research interests include the use of therapeutic hypothermia for the treatment of neurological injury after resuscitation from out-of hospital cardiac arrest. Here he provides a presentation on recent advances in the management of refractory cardiac arrest in the out of hospital setting.
CPR -Whats New
1. A Cochrane review found that for untrained bystanders, continuous chest compressions without rescue breathing improved survival to hospital discharge compared to interrupted CPR. For trained professionals, interrupted CPR had slightly better outcomes.
2. The AHA recommends that untrained lay rescuers provide continuous chest compressions with or without dispatcher assistance for adults in cardiac arrest. For trained lay rescuers, compression-only CPR is recommended.
3. A study found no difference in outcomes between continuous compressions with asynchronous ventilations and 30:2 CPR. 30:2 CPR was associated with better outcomes than 15:2 CPR. It may be reasonable for EMS to use 10 breaths per
Hemodynamic-monitoring-in-ICU_sachin_2008.pdf
This document summarizes a seminar on invasive and non-invasive hemodynamic monitoring in the intensive care unit (ICU). It discusses various monitoring techniques including clinical parameters, blood pressure, echocardiography, esophageal Doppler monitoring, gastric tonometry, central venous pressure, and pulmonary artery catheters. For each method, it covers principles of measurement, indications, limitations, evidence, and clinical applications in critically ill patients. The document emphasizes that hemodynamic monitoring should improve outcomes when coupled with effective treatments, and intensive care physicians should be trained in goal-directed echocardiography.
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The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
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126452593301420100125 top tennrcpr_pediatric
- 1. Top Ten Things To Know Survival Outcomes Among Neonates, Infants and Children Following Extracorporeal Cardiopulmonary Resuscitation for Refractory In-Hospital Pediatric Cardiac Arrest 1. Pediatric in-hospital cardiac arrest (IHCA) has about 27% (25-33%) survival to discharge. Survival rates are usually lower with prolonged CPR. 2. Survival for pediatric IHCA may be improved with use of ECPR for the cardiac arrest patient who does not respond to conventional CPR. 3. The primary outcome for this *NRCPR study population was survival to discharge (SDC) for the pediatric IHCA victim. 4. There were two secondary outcomes for this study: • the patient who never becomes pulseless would have an improved chance for survival; • the pediatric victim would have a favorable neurologic outcome (pediatric cerebral performance category [PCPC] of 1, 2 or 3) at hospital discharge. 5. Of the 199 pediatric CPR events that met criteria for ECPR, 87(43.7%) had SDC. 6. The two secondary outcomes showed: • the patient who maintained a pulse showed no better survival than those who became pulseless; • favorable neurologic outcomes occurred in 56 (94.9%) of 59 survivors with recorded PCPC. 7. Patients categorized with a cardiac condition prior to ECPR are more likely to survive, 48% of the pediatric cardiac IHCA victim reached SDC. 8. Compared to those with pulseless electrical activity or asystole, survival was increased for patients when the first documented pulseless rhythm was a shockable (ventricular fibrillation/pulseless ventricular tachycardia) rhythm (P=0.04). 9. Certain preexisting conditions were associated with increased mortality, including pneumonia, renal insufficiency, and septicemia. 10. Further studies could focus on ECPR patients with preexisting cardiac conditions to validate variables pre- and post- ECPR care that have a positive impact on survival (ie, pre-quality of CPR, mode of ECPR, cannulation and complications, and post ECPR care with glucose and temperature monitoring). *NRCPR is a performance improvement tool that can be used to identify and monitor key process variables and patient outcomes for in-hospital cardiac arrest. NRCPR.org Survival Outcomes Among Neonates, Infants and Children Following Extracorporeal Cardiopulmonary Resuscitation (ECPR) for Refractory In-Hospital Pediatric Cardiac Arrest: Data from the National Registry of Cardiopulmonary Resuscitation. Pediatric Critical Care Medicine: PAP, 17 November 2009doi: 10.1097/PCC.0b013e3181c0141b. Tia Tortoriello Raymond, Christopher Cunnyngham, Marita Thompson, Vinay M. Nadkarni, James Thomas for the American Heart Association National Registry of Cardiopulmonary Resuscitation Investigators. © 2010, American Heart Association. All rights reserved.