7 results
Paediatric In-hospital cardiopulmonary resuscitation quality and outcomes in children with CHD during nights and weekends
- Priscilla Yu, Ivie Esangbedo, Xuemei Zhang, Richard Hanna, Dana E. Niles, Vinay Nadkarni, Tia Raymond
-
- Journal:
- Cardiology in the Young / Volume 33 / Issue 1 / January 2023
- Published online by Cambridge University Press:
- 21 January 2022, pp. 42-51
-
- Article
-
- You have access Access
- Open access
- HTML
- Export citation
-
Background:
Survival after paediatric in-hospital cardiac arrest is worse on nights and weekends without demonstration of disparity in cardiopulmonary resuscitation quality. It is unknown whether these findings differ in children with CHD. This study aimed to determine whether cardiopulmonary resuscitation quality might explain the hypothesised worse outcomes of children with CHD during nights and weekends.
Methods:In-hospital cardiac arrest data collected by the Pediatric Resuscitation Quality Collaborative for children with CHD. Chest compression quality metrics and survival outcomes were compared between events that occurred during day versus night, and during weekday versus weekend using multivariable logistic regression.
Results:We evaluated 3614 sixty-second epochs of chest compression data from 132 subjects between 2015 and 2020. There was no difference in chest compression quality metrics during day versus night or weekday versus weekend. Weekday versus weekend was associated with improved survival to hospital discharge (adjusted odds ratio 4.56 [1.29,16.11]; p = 0.02] and survival to hospital discharge with favourable neurological outcomes (adjusted odds ratio 6.35 [1.36,29.6]; p = 0.02), but no difference with rate of return of spontaneous circulation or return of circulation. There was no difference in outcomes for day versus night.
Conclusion:For children with CHD and in-hospital cardiac arrest, there was no difference in chest compression quality metrics by time of day or day of week. Although there was no difference in outcomes for events during days versus nights, there was improved survival to hospital discharge and survival to hospital discharge with favourable neurological outcome for events occurring on weekdays compared to weekends.
Bedside clinical neurologic assessment utilisation in paediatric cardiac intensive care units
- Matthew P Kirschen, Josh Blinder, Aaron Dewitt, Megan Snyder, Rebecca Ichord, Robert A Berg, Vinay Nadkarni, Alexis Topjian
-
- Journal:
- Cardiology in the Young / Volume 28 / Issue 12 / December 2018
- Published online by Cambridge University Press:
- 16 October 2018, pp. 1457-1462
-
- Article
- Export citation
-
Introduction
Neurodevelopmental disabilities in children with CHD can result from neurologic injury sustained in the cardiac ICU when children are at high risk of acute neurologic injury. Physicians typically order and specify frequency for serial bedside nursing clinical neurologic assessments to evaluate patients’ neurologic status.
Materials and methodsWe surveyed cardiac ICU physicians to understand how these assessments are performed, and the attitudes of physicians on the utility of these assessments. The survey contained questions regarding assessment elements, assessment frequency, communication of neurologic status changes, and optimisation of assessments.
ResultsSurveys were received from 50 institutions, with a response rate of 86%. Routine clinical neurologic assessments were reported to be performed in 94% of institutions and standardised in 56%. Pupillary reflex was the most commonly reported assessment. In all, 77% of institutions used a coma scale, with Glasgow Coma Scale being most common. For patients with acute brain injury, 82% of institutions reported performing assessments hourly, whereas assessment frequency was more variable for low-risk and high-risk patients without overt brain injury. In all, 84% of respondents thought their current practice for assessing and monitoring neurologic status was suboptimal. Only 41% felt that the Glasgow Coma Scale was a valuable tool for assessing neurologic function in the cardiac ICU, and 91% felt that a standardised approach to assessing pre-illness neurologic function would be valuable.
ConclusionsRoutine nursing neurologic assessments are conducted in most surveyed paediatric cardiac ICUs, although assessment characteristics vary greatly between institutions. Most clinicians rated current neurologic assessment practices as suboptimal.
Safety of tracheal intubation in the presence of cardiac disease in paediatric ICUs
- Eleanor A. Gradidge, Adnan Bakar, David Tellez, Michael Ruppe, Sarah Tallent, Geoffrey Bird, Natasha Lavin, Anthony Lee, Vinay Nadkarni, Michelle Adu-Darko, Jesse Bain, Katherine Biagas, Aline Branca, Ryan K. Breuer, Calvin Brown III, Kris Bysani, Guillaume Emeriaud, Sandeep Gangadharan, John S. Giuliano, Jr, Joy D. Howell, Conrad Krawiec, Jan Hau Lee, Simon Li, Keith Meyer, Michael Miksa, Natalie Napolitano, Sholeen Nett, Gabrielle Nuthall, Alberto Orioles, Erin B. Owen, Margaret M. Parker, Simon Parsons, Lee A. Polikoff, Kyle Rehder, Osamu Saito, Ron C. Sanders, Jr, Asha Shenoi, Dennis W. Simon, Peter W. Skippen, Keiko Tarquinio, Anne Thompson, Iris Toedt-Pingel, Karen Walson, Akira Nishisaki, For National Emergency Airway Registry for Children (NEARKIDS) Investigators and Pediatric Acute Lung Injury and Sepsis Investigators (PALISI)
-
- Journal:
- Cardiology in the Young / Volume 28 / Issue 7 / July 2018
- Published online by Cambridge University Press:
- 25 April 2018, pp. 928-937
-
- Article
- Export citation
-
Introduction
Children with CHD and acquired heart disease have unique, high-risk physiology. They may have a higher risk of adverse tracheal-intubation-associated events, as compared with children with non-cardiac disease.
Materials and methodsWe sought to evaluate the occurrence of adverse tracheal-intubation-associated events in children with cardiac disease compared to children with non-cardiac disease. A retrospective analysis of tracheal intubations from 38 international paediatric ICUs was performed using the National Emergency Airway Registry for Children (NEAR4KIDS) quality improvement registry. The primary outcome was the occurrence of any tracheal-intubation-associated event. Secondary outcomes included the occurrence of severe tracheal-intubation-associated events, multiple intubation attempts, and oxygen desaturation.
ResultsA total of 8851 intubations were reported between July, 2012 and March, 2016. Cardiac patients were younger, more likely to have haemodynamic instability, and less likely to have respiratory failure as an indication. The overall frequency of tracheal-intubation-associated events was not different (cardiac: 17% versus non-cardiac: 16%, p=0.13), nor was the rate of severe tracheal-intubation-associated events (cardiac: 7% versus non-cardiac: 6%, p=0.11). Tracheal-intubation-associated cardiac arrest occurred more often in cardiac patients (2.80 versus 1.28%; p<0.001), even after adjusting for patient and provider differences (adjusted odds ratio 1.79; p=0.03). Multiple intubation attempts occurred less often in cardiac patients (p=0.04), and oxygen desaturations occurred more often, even after excluding patients with cyanotic heart disease.
ConclusionsThe overall incidence of adverse tracheal-intubation-associated events in cardiac patients was not different from that in non-cardiac patients. However, the presence of a cardiac diagnosis was associated with a higher occurrence of both tracheal-intubation-associated cardiac arrest and oxygen desaturation.
The effect of step stool use and provider height on CPR quality during pediatric cardiac arrest: A simulation-based multicentre study
- Adam Cheng, Yiqun Lin, Vinay Nadkarni, Brandi Wan, Jonathan Duff, Linda Brown, Farhan Bhanji, David Kessler, Nancy Tofil, Kent Hecker, Elizabeth A. Hunt
-
- Journal:
- Canadian Journal of Emergency Medicine / Volume 20 / Issue 1 / January 2018
- Published online by Cambridge University Press:
- 03 April 2017, pp. 80-88
- Print publication:
- January 2018
-
- Article
-
- You have access Access
- HTML
- Export citation
-
Objectives
We aimed to explore whether a) step stool use is associated with improved cardiopulmonary resuscitation (CPR) quality; b) provider adjusted height is associated with improved CPR quality; and if associations exist, c) determine whether just-in-time (JIT) CPR training and/or CPR visual feedback attenuates the effect of height and/or step stool use on CPR quality.
MethodsWe analysed data from a trial of simulated cardiac arrests with three study arms: No intervention; CPR visual feedback; and JIT CPR training. Step stool use was voluntary. We explored the association between 1) step stool use and CPR quality, and 2) provider adjusted height and CPR quality. Adjusted height was defined as provider height + 23 cm (if step stool was used). Below-average height participants were ≤ gender-specific average height; the remainder were above average height. We assessed for interaction between study arm and both adjusted height and step stool use.
ResultsOne hundred twenty-four subjects participated; 1,230 30-second epochs of CPR were analysed. Step stool use was associated with improved compression depth in below-average (female, p=0.007; male, p<0.001) and above-average (female, p=0.001; male, p<0.001) height providers. There is an association between adjusted height and compression depth (p<0.001). Visual feedback attenuated the effect of height (p=0.025) on compression depth; JIT training did not (p=0.918). Visual feedback and JIT training attenuated the effect of step stool use (p<0.001) on compression depth.
ConclusionsStep stool use is associated with improved compression depth regardless of height. Increased provider height is associated with improved compression depth, with visual feedback attenuating the effects of height and step stool use.
Cardiopulmonary resuscitation: special considerations for infants and children with cardiac disease
- Stacie B. Peddy, Mary Fran Hazinski, Peter C. Laussen, Ravi R. Thiagarajan, George M. Hoffman, Vinay Nadkarni, Sarah Tabbutt
-
- Journal:
- Cardiology in the Young / Volume 17 / Issue S4 / September 2007
- Published online by Cambridge University Press:
- 26 November 2007, pp. 116-126
-
- Article
- Export citation
-
Pulseless 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.
53 - Pediatric cardiopulmonary resuscitation
- from Part VI - Special resuscitation circumstances
-
- By Robert A. Berg, Department of Pediatrics, The University of Arizona College of Medicine, Departments of Anesthesia and Pediatrics, University of Pennsylvania School of Medicine, Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, PA, USA, Vinay M. Nadkarni, Department of Pediatrics, The University of Arizona College of Medicine, Departments of Anesthesia and Pediatrics, University of Pennsylvania School of Medicine, Department of Anesthesia and Critical Care Medicine, The Children's Hospital of Philadelphia, PA, USA
- Edited by Norman A. Paradis, University of Colorado, Denver, Henry R. Halperin, The Johns Hopkins University School of Medicine, Karl B. Kern, University of Arizona, Volker Wenzel, Douglas A. Chamberlain, Cardiff University
-
- Book:
- Cardiac Arrest
- Published online:
- 06 January 2010
- Print publication:
- 18 October 2007, pp 937-959
-
- Chapter
- Export citation
-
Summary
Appropriate pediatric CPR differs from that in adults, because children are anatomically and physiologically different from adults. In addition, the pathogenesis of the cardiac arrests and the most common rhythm disturbances are different in children. In contrast to adults, children rarely suffer sudden ventricular fibrillation (VF) cardiac arrest from coronary artery disease. The causes of pediatric arrests are more diverse and are usually secondary to profound hypoxia or asphyxia due to respiratory failure or circulatory shock. Prolonged hypoxia and acidosis impair cardiac function and ultimately lead to cardiac arrest. By the time the arrest occurs, all organs of the body have generally suffered significant hypoxic-ischemic insults.
Importantly, children of various ages exhibit developmental changes that affect cardiac and respiratory physiology before, during, and after cardiac arrest. For example, newborns undergoing transitional physiological changes during emergence from an environment of amniotic fluid to a gaseous environment certainly differ from adolescents. Similarly, newborns and infants have much less cardiac and respiratory reserve, and higher pulmonary vascular resistance than do older children. Moreover, many children who experience in-hospital cardiac arrest have pre-existing developmental challenges and other organ dysfunction. Finally, pediatrics is developmental medicine, and pediatric neurological tools that are appropriate at one age may not be accurate or valid at another age.
Perhaps the most profound difference between child and adult cardiac arrest is the devastating effect of the death of a child on a family. Coping with a sudden unexpected death is always difficult. When the victim is a child, the loss tends to be even more oppressive. We do not expect children to die before their parents and thus are not prepared for it.
71 - Consensus development in resuscitation: the growing movement towards international emergency cardiovascular care guidelines
- from Part VII - Special issues in resuscitation
-
- By Jerry P. Nolan, Department of Anaesthesia and Intensive Care Medicine, Royal United Hospital, Bath BA1 3NG, UK, Douglas Chamberlain, Department of Resuscitation Medicine, School of Medicine, Cardiff University, Wales, UK, William H. Montgomery, Department of Anesthesiology, Straub Clinic and Hospital, University of Hawaii School of Medicine, Honolulu, Hawaii, USA, Vinay M. Nadkarni, Departments of Anesthesia, Critical Care and Pediatrics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA
- Edited by Norman A. Paradis, University of Colorado, Denver, Henry R. Halperin, The Johns Hopkins University School of Medicine, Karl B. Kern, University of Arizona, Volker Wenzel, Douglas A. Chamberlain, Cardiff University
-
- Book:
- Cardiac Arrest
- Published online:
- 06 January 2010
- Print publication:
- 18 October 2007, pp 1278-1288
-
- Chapter
- Export citation
-
Summary
Introduction
Clinical guidelines aredefinedby the Institute ofMedicine in the United States as“systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances.” The main objective of guidelines is to improve the quality of care received by patients by closing the gap between what clinicians do and what scientific evidence supports. Guidelines provide a point of referencefor auditing performanceof clinicians or hospitals and may improve effectiveness and efficiency. The development of guidelines requires appropriate resources: expert clinicians, group process leaders, and financial support. All these statements refer to guideline development in general, but they are particularly relevant to the development of resuscitation guidelines that have existed for at least 40 years. The steps involved in the process for developing evidence-based guidelines have been outlined by the Grades of Recommendation Assessment, Development and Evaluation (GRADE) Working Group (Table 71.1).
This chapter will review the history of consensus development in resuscitation, the role of the International Liaison Committee on Resuscitation (ILCOR), the process involved in undertaking a systematic review of resuscitation science, and the writing of clinical guidelines based on a consensus of the science.
The history of international CPR consensus and guideline development
The modern approach to cardiopulmonary resuscitation (CPR) was described in the late 1950s and early 1960s. Although this was undoubtedly the birth of CPR, it was immediately realized that the challenge was to spread the word and educate healthcare workers and laypeople throughout the world. This same challenge faces us today whenever CPR guidelines are modified and updated.