Background: During cardiac arrest, a child may be in one of five clinical states (“rhythms”): 1) ... more Background: During cardiac arrest, a child may be in one of five clinical states (“rhythms”): 1) Bradycardia with poor perfusion; 2) Pulseless Electrical Activity (PEA); 3) Ventricular Fibrillation or Pulseless Ventricular Tachycardia (VF/VT); 4) Asystole; or 5) Spontaneous Circulation (ROSC). The aim of study was to investigate and quantify the dynamic characteristics of this process. Methods: We prospectively acquired data on rhythm and clinical states using recording defibrillators during active CPR. Recordings were analyzed as a multi-state statistical model, focusing on transitions between PEA (including bradycardia with poor perfusion), VF/VT, Asystole, and ROSC (defined as an organized electrical rhythm without chest compressions >= 1 minute). Instantaneous transition rates were obtained by smoothing the Nelson-Aalen estimator of cumulative intensities. Results: In 74 Cardiac Arrest events with evaluable data, median patient age was 15 years [range 1.75 to 22.9; IQR 11 to ...
Introduction: American Heart Association (AHA) targets of high quality CPR are associated with im... more Introduction: American Heart Association (AHA) targets of high quality CPR are associated with improved survival. We previously identified deficiencies in CPR quality in our ICU, despite CPR refres...
Background: Most newborns manage the transition from intra- to extrauterine life without interven... more Background: Most newborns manage the transition from intra- to extrauterine life without interventions. Still, approximately 5 % need positive pressure ventilation (PPV) for successful transition. Guidelines urge providers to ensure good quality PPV for at least 30 seconds before considering chest compressions and intravenous therapy. Pauses in PPV during this first minute may delay recovery of spontaneous respiration and heart rate. Objective: To find the proportion of no-blow time during the first minute of PPV in non-breathing babies. Methods: Prospective observational study at Oslo University Hospital, Norway. All newborns (gestational age > 32 weeks) receiving PPV immediately after delivery were included. Six cameras with motion detectors were installed at every resuscitation bay capturing both expected and unexpected compromised newborns. We determined no-blow time as the cumulative number of seconds without PPV efforts and without spontaneous breathing and report fraction ...
Background: American Heart Association (AHA) recommends high quality CPR to promote optimal patie... more Background: American Heart Association (AHA) recommends high quality CPR to promote optimal patient outcomes. Few reports compare team members’ perceptions of CPR quality with quantitative CPR data during actual pediatric CPR. Hypothesis: Self-reported team perception of CPR performance will not meet quantitative CPR metrics using AHA BLS guideline criteria. Methods: Prospective data from an international pediatric (pediRES-Q) resuscitation collaborative from February 2016 to August 2017. A modified Team Emergency Assessment Measure framework for qualitative content analysis was used to assess data from “hot” debriefings (held soon after arrest) by language processing experts blinded to CPR data. Events without reported perception of CPR and quantitative CPR data were excluded. Comments regarding CPR perception were grouped as either Plus perceptions of performance (PPP) or Delta perceptions of performance (DPP). Grouped events were matched and compared to quantitative CPR data of c...
Introduction: Compliance with CPR performance metrics during pediatric in-hospital cardiac arrest... more Introduction: Compliance with CPR performance metrics during pediatric in-hospital cardiac arrest (IHCA) is associated with outcome. The evolution of CPR performance over time (early vs. late) has ...
Introduction/Hypothesis: Hypoand hyperoxia after cardiac arrest (CA) are associated with worse ou... more Introduction/Hypothesis: Hypoand hyperoxia after cardiac arrest (CA) are associated with worse outcome. We aimed to determine the association between hyperoxia and survival to hospital discharge (SHD) in children after CA, using both the conventional cut-off analysis and cumulative analysis. Methods: Prospective observational cohort study of children (<18 years) that survived index inhospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) across 14 sites within an international pediatric resuscitation collaborative (pediRES-Q). Children with single ventricle were excluded. We explored 3 cut-off values (PaO2 >200 mmHg, >250 mmHg and >300 mmHg), whereas the cumulative PaO2 was determined with the area under the curve (AUC). Logistic regression analysis was applied to explore the influence of hyperoxia on SHD with the highest PaO2 over the first 24 hours. In the multivariable analysis, we calculated an adjusted odds ratio (OR, 95%-CI, p-value) for prospecti...
www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives... more www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives: Bag mask ventilation (BMV) is an essential skill for pediatric ICU providers. We hypothesize that providing realtime feedback system on a tablet screen with respiratory rate (RR), expiratory tidal volume (eTV), peak inspiratory pressure (PIP), and % leak around mask (inspiratory tidal volume: iTVeTV/ iTV) is associated with achieving targeted ventilation for infants with normal and low lung compliance. Methods: PICU providers and students rotating ICU were recruited. Each subjected provided BMV in 4 conditions for 30 sec in a random order: Infant with normal compliant lungs with/ without realtime feedback, and infant with low compliant lungs with/without realtime feedback. A tablet screen next to an infant simulator provided realtime feedback in RR, eTV, PIP and %leak around the mask. Subjects were blinded for lung compliance. Each subject was instructed to provide BMV to target RR at ...
Source code for our CPR manikin that simulates blood pressure and end tidal CO2 waveforms for the... more Source code for our CPR manikin that simulates blood pressure and end tidal CO2 waveforms for the purpose of training the titration of CPR mechanics to physiology, as recommended by the American Heart Association.
Introduction/Hypothesis: Extracorporeal cardiopulmonary resuscitation (E-CPR) during inhospital c... more Introduction/Hypothesis: Extracorporeal cardiopulmonary resuscitation (E-CPR) during inhospital cardiac arrest (IHCA) refractory to standard advanced life support can be lifesaving. ECPR cannulation strategies often require interruptions to chest compressions (CC), potentially impacting survival and neurologic outcome. This study characterized CC pauses during pediatric ECPR and the association of pause duration with survival and neurologic outcomes. We hypothesized that increased CC pause number and duration would be associated with lower survival rate and worse neurological outcome. Methods: Cohort study from 13 sites in the Pediatric Resuscitation Quality (PediRES-Q) Network from July 2015 to February 2019. All E-CPR events ≥10 min with CC pause data captured by monitor/defibrillators (Zoll R-Series, Chelmsford, MA) were included. We calculated the association between CC pause duration and survival to hospital discharge and survival with good neurological outcome (defined as pedi...
Objective: To determine whether use of a backboard (BB) during CPR can reduce mattress displaceme... more Objective: To determine whether use of a backboard (BB) during CPR can reduce mattress displacement, thereby allowing more of the sternal force to directly compress the chest. Methods: Epochs of 50...
Background: During cardiac arrest, a child may be in one of five clinical states (“rhythms”): 1) ... more Background: During cardiac arrest, a child may be in one of five clinical states (“rhythms”): 1) Bradycardia with poor perfusion; 2) Pulseless Electrical Activity (PEA); 3) Ventricular Fibrillation or Pulseless Ventricular Tachycardia (VF/VT); 4) Asystole; or 5) Spontaneous Circulation (ROSC). The aim of study was to investigate and quantify the dynamic characteristics of this process. Methods: We prospectively acquired data on rhythm and clinical states using recording defibrillators during active CPR. Recordings were analyzed as a multi-state statistical model, focusing on transitions between PEA (including bradycardia with poor perfusion), VF/VT, Asystole, and ROSC (defined as an organized electrical rhythm without chest compressions >= 1 minute). Instantaneous transition rates were obtained by smoothing the Nelson-Aalen estimator of cumulative intensities. Results: In 74 Cardiac Arrest events with evaluable data, median patient age was 15 years [range 1.75 to 22.9; IQR 11 to ...
Introduction: American Heart Association (AHA) targets of high quality CPR are associated with im... more Introduction: American Heart Association (AHA) targets of high quality CPR are associated with improved survival. We previously identified deficiencies in CPR quality in our ICU, despite CPR refres...
Background: Most newborns manage the transition from intra- to extrauterine life without interven... more Background: Most newborns manage the transition from intra- to extrauterine life without interventions. Still, approximately 5 % need positive pressure ventilation (PPV) for successful transition. Guidelines urge providers to ensure good quality PPV for at least 30 seconds before considering chest compressions and intravenous therapy. Pauses in PPV during this first minute may delay recovery of spontaneous respiration and heart rate. Objective: To find the proportion of no-blow time during the first minute of PPV in non-breathing babies. Methods: Prospective observational study at Oslo University Hospital, Norway. All newborns (gestational age > 32 weeks) receiving PPV immediately after delivery were included. Six cameras with motion detectors were installed at every resuscitation bay capturing both expected and unexpected compromised newborns. We determined no-blow time as the cumulative number of seconds without PPV efforts and without spontaneous breathing and report fraction ...
Background: American Heart Association (AHA) recommends high quality CPR to promote optimal patie... more Background: American Heart Association (AHA) recommends high quality CPR to promote optimal patient outcomes. Few reports compare team members’ perceptions of CPR quality with quantitative CPR data during actual pediatric CPR. Hypothesis: Self-reported team perception of CPR performance will not meet quantitative CPR metrics using AHA BLS guideline criteria. Methods: Prospective data from an international pediatric (pediRES-Q) resuscitation collaborative from February 2016 to August 2017. A modified Team Emergency Assessment Measure framework for qualitative content analysis was used to assess data from “hot” debriefings (held soon after arrest) by language processing experts blinded to CPR data. Events without reported perception of CPR and quantitative CPR data were excluded. Comments regarding CPR perception were grouped as either Plus perceptions of performance (PPP) or Delta perceptions of performance (DPP). Grouped events were matched and compared to quantitative CPR data of c...
Introduction: Compliance with CPR performance metrics during pediatric in-hospital cardiac arrest... more Introduction: Compliance with CPR performance metrics during pediatric in-hospital cardiac arrest (IHCA) is associated with outcome. The evolution of CPR performance over time (early vs. late) has ...
Introduction/Hypothesis: Hypoand hyperoxia after cardiac arrest (CA) are associated with worse ou... more Introduction/Hypothesis: Hypoand hyperoxia after cardiac arrest (CA) are associated with worse outcome. We aimed to determine the association between hyperoxia and survival to hospital discharge (SHD) in children after CA, using both the conventional cut-off analysis and cumulative analysis. Methods: Prospective observational cohort study of children (<18 years) that survived index inhospital cardiac arrest (IHCA) and out-of-hospital cardiac arrest (OHCA) across 14 sites within an international pediatric resuscitation collaborative (pediRES-Q). Children with single ventricle were excluded. We explored 3 cut-off values (PaO2 >200 mmHg, >250 mmHg and >300 mmHg), whereas the cumulative PaO2 was determined with the area under the curve (AUC). Logistic regression analysis was applied to explore the influence of hyperoxia on SHD with the highest PaO2 over the first 24 hours. In the multivariable analysis, we calculated an adjusted odds ratio (OR, 95%-CI, p-value) for prospecti...
www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives... more www.ccmjournal.org Critical Care Medicine • Volume 46 • Number 1 (Supplement) Learning Objectives: Bag mask ventilation (BMV) is an essential skill for pediatric ICU providers. We hypothesize that providing realtime feedback system on a tablet screen with respiratory rate (RR), expiratory tidal volume (eTV), peak inspiratory pressure (PIP), and % leak around mask (inspiratory tidal volume: iTVeTV/ iTV) is associated with achieving targeted ventilation for infants with normal and low lung compliance. Methods: PICU providers and students rotating ICU were recruited. Each subjected provided BMV in 4 conditions for 30 sec in a random order: Infant with normal compliant lungs with/ without realtime feedback, and infant with low compliant lungs with/without realtime feedback. A tablet screen next to an infant simulator provided realtime feedback in RR, eTV, PIP and %leak around the mask. Subjects were blinded for lung compliance. Each subject was instructed to provide BMV to target RR at ...
Source code for our CPR manikin that simulates blood pressure and end tidal CO2 waveforms for the... more Source code for our CPR manikin that simulates blood pressure and end tidal CO2 waveforms for the purpose of training the titration of CPR mechanics to physiology, as recommended by the American Heart Association.
Introduction/Hypothesis: Extracorporeal cardiopulmonary resuscitation (E-CPR) during inhospital c... more Introduction/Hypothesis: Extracorporeal cardiopulmonary resuscitation (E-CPR) during inhospital cardiac arrest (IHCA) refractory to standard advanced life support can be lifesaving. ECPR cannulation strategies often require interruptions to chest compressions (CC), potentially impacting survival and neurologic outcome. This study characterized CC pauses during pediatric ECPR and the association of pause duration with survival and neurologic outcomes. We hypothesized that increased CC pause number and duration would be associated with lower survival rate and worse neurological outcome. Methods: Cohort study from 13 sites in the Pediatric Resuscitation Quality (PediRES-Q) Network from July 2015 to February 2019. All E-CPR events ≥10 min with CC pause data captured by monitor/defibrillators (Zoll R-Series, Chelmsford, MA) were included. We calculated the association between CC pause duration and survival to hospital discharge and survival with good neurological outcome (defined as pedi...
Objective: To determine whether use of a backboard (BB) during CPR can reduce mattress displaceme... more Objective: To determine whether use of a backboard (BB) during CPR can reduce mattress displacement, thereby allowing more of the sternal force to directly compress the chest. Methods: Epochs of 50...
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