Objective In-hospital cardiac arrest is an important public health problem. High-quality resuscitation improves survival but is difficult to achieve. Our objective is to evaluate the effectiveness of a novel, interdisciplinary, postevent quantitative debriefing program to improve survival outcomes after in-hospital pediatric chest compression events. Design, Setting, and Patients Single-center prospective interventional study of children who received chest compressions between December 2008 and June 2012 in the ICU. Interventions Structured, quantitative, audiovisual, interdisciplinary debriefing of chest compression events with front-line providers. Measurements and Main Results Primary outcome was survival to hospital discharge. Secondary outcomes included survival of event (return of spontaneous circulation for ≥ 20 min) and favorable neurologic outcome. Primary resuscitation quality outcome was a composite variable, termed “excellent cardiopulmonary resuscitation,” prospectively defined as a chest compression depth ≥ 38 mm, rate ≥ 100/min, ≤ 10% of chest compressions with leaning, and a chest compression fraction > 90% during a given 30-second epoch. Quantitative data were available only for patients who are 8 years old or older. There were 119 chest compression events (60 control and 59 interventional). The intervention was associated with a trend toward improved survival to hospital discharge on both univariate analysis (52% vs 33%, p = 0.054) and after controlling for confounders (adjusted odds ratio, 2.5; 95% CI, 0.91–6.8; p = 0.075), and it significantly increased survival with favorable neurologic outcome on both univariate (50% vs 29%, p = 0.036) and multivariable analyses (adjusted odds ratio, 2.75; 95% CI, 1.01–7.5; p = 0.047). Cardiopulmonary resuscitation epochs for patients who are 8 years old or older during the debriefing period were 5.6 times more likely to meet targets of excellent cardiopulmonary resuscitation (95% CI, 2.9–10.6; p < 0.01). Conclusion Implementation of an interdisciplinary, postevent quantitative debriefing program was significantly associated with improved cardiopulmonary resuscitation quality and survival with favorable neurologic outcome. (Crit Care Med 2014; XX:00–00)
Background: To improve pediatric airway management outside of the operating room, a Hospital-wide Emergency Airway Response Team (HEART) program composed of anesthesiology, otorhinolaryngology, and respiratory therapy clinicians was developed.Aims: To report processes and outcomes of HEART activations in a quaternary academic children's hospital. Methods:A retrospective observational cohort study between January 2017 and December 2019. Local airway emergency database was reviewed for HEART activations. Additional safety data was obtained from patients' electronic health records.Primary outcome: Adverse airway outcomes, either adverse tracheal intubationassociated events or oxygen desaturation (SpO 2 <80%). We compared airway management by primary teams before HEART arrival and by HEART after arrival.
Introduction: Management of airway secretion clearance and atelectasis during acute respiratory infections presents unique challenges for children with congenital myopathies. We describe a child with myotubular myopathy and pneumonitis in which non-invasive High Frequency Percussive Ventilation (HFPV) was used for lung recruitment and secretion mobilization, alleviating need for reintubation. Case Report: An 11 month-old male with congenital myotubular myopathy, and chronic non-invasive positive pressure ventilation (NIPPV) support was admitted to our pediatric ICU with respiratory failure secondary to rhinovirus pneumonitis. He was intubated on admission and supported with conventional ventilation for three weeks. His OI peaked at 8 on hospital day 1 with a P/F ratio of 192. Radiographs revealed clearing airspace disease. He was extubated to BiPAP: IPAP 24, EPAP 12, rate of 25. Two days after extubation, he developed complete opacification of his left hemithorax and associated hypoxemia from mucus plugging and atelectasis. He was managed with aggressive Chest physiotherapy, alternating intermittent percussive ventilation (IPV) treatments and cough-assist treatments with bronchodilators and hypertonic saline every 2 hours However, his respiratory distress and complete left lung atelectasis did not improve. He was then managed with non-invasive HFPV via a NIPPV interface and the VDR to improve secretion mobilization and airway clearance. Initial VDR settings were: Pulsatile Flowrate 20cmH20, Demand Peep 2cmH2O, Oscillatory Peep 10H2O, Convective rate 30bpm, Percussive rate 600, I:E 1:1, FiO2 0.4. Within 12 hours of HFPV initiation, chest radiography revealed fully expanded left lung (Figures 1-2). He had resolution of his hypoxemia and respiratory distress and was transitioned to conventional BiPAP, and weaned towards his home BiPAP regimen without further requirement for invasive mechanical ventilation. Discussion: HFPV is an advanced mode of ventilation that
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